Barack Obama: Bring back the public insurance option

President Barack Obama giving a speech

President Barack Obama says the nation must do more to further the goals of healthcare reform--such as revisiting the idea of a public insurance option to boost competition in the ACA marketplaces.

In a special-edition article published by the Journal of the American Medical Association, Obama writes that while 88 percent of marketplace enrollees live in counties with at least three issuers, other areas of the country have long struggled with limited competition. The situation may worsen in 2017, FierceHealthPayer has reported, as major insurers including UnitedHealth and Humana plan to pull back from some marketplaces.

While the provision never made it into the final draft of the ACA, Obama says that Congress should revisit a “Medicare-like public plan” to compete alongside private insurers in parts of the country where competition is limited. Such an option, the president writes, would not only boost choice but also create savings for the federal government, as public programs are more adept at cutting administrative overhead and securing better prices from providers.

Obama’s support of the public option coincides with Hillary Clinton’s endorsement of the idea--as well as other progressive healthcare policies--in a bid to win over Bernie Sanders supporters who backed the candidate’s idea to create a single-payer healthcare system.

In his JAMA article, Obama outlines the following other ideas to strengthen the ACA:

  • Push to get the remaining 19 states to expand their Medicaid program
  • Continue driving delivery system reform through the Center for Medicare & Medicaid Innovation and accountable care organizations
  • Maintain bipartisan support for the Precision Medicine and BRAIN initiatives and the Cancer Moonshot
  • Encourage congressional action to increase financial assistance for consumers to purchase coverage through the ACA marketplaces
  • Test new ways to pay for drugs, as well as take legislative action to require more pricing transparency from manufacturers, increase rebates for drugs prescribed to certain Medicare and Medicaid beneficiaries, and give the federal government the power to negotiate prices for certain high-cost drugs

Obama concludes his piece with lessons for future policymakers gleaned from his experiences with the ACA, noting that change is difficult “in the face of hyperpartisanship” and special interests, and emphasizing the importance of pragmatism and compromise. Even amid the challenges, though, “I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere,” he writes.

- read the JAMA article