In a speech that arrives amid heightened criticism of his signature healthcare reform law, President Barack Obama challenged the general public and politicians to “put aside all the political rhetoric, all the partisanship, and just be honest about what’s working, what needs fixing and how we fix it.”
In less than two weeks, the Obama administration will preside over its final Affordable Care Act open enrollment period, a critical time for the marketplaces that are facing steep challenges. ACA plan premiums are rising significantly in some parts of the country, and insurer dropouts are sparking concerns about competition.
Obama, speaking at Miami-Dade College on Thursday, was frank about the ACA’s challenges, likening the law to a “starter home” that is better than not having a house, but could use improvements.
While the vast majority of Americans get coverage from an employer, Medicare or Medicaid, and most marketplace consumers have access to plans that cost less than $75 a month thanks to tax credits, for the remaining Americans, “these premium increases do make insurance less affordable,” Obama said.
An extreme example is in Arizona, he noted, where benchmark premiums are expected to more than double thanks to low initial plan pricing and scarce competition.
And though the national uninsured rate is at its lowest ever, “there are still too many hardworking people who are not being reached by the law,” he said.
To address the ACA’s remaining challenges, Obama called upon Republicans in Congress, state governors and state legislatures to work with his and future administrations on solutions--other than a repeal of the law.
“When governors and state legislatures expand Medicaid for their citizens, and they hold insurance companies accountable, and they’re honest with uninsured people about their options, and they’re working with us on outreach, then the marketplace works the way it’s supposed to,” Obama said. “And when they don’t, the marketplaces tend to have more problems.”
Echoing arguments he made in a recent paper published by the Journal of the American Medical Association, Obama advocated four main steps to bolster the ACA:
- Encourage every state to expand Medicaid. If the remaining 19 states opt to accept federal funds to do so, an additional 4 million individuals could gain coverage, he said. He also noted that Medicaid eligibility expansion can boost state budgets.
- Provide more tax credits for more middle-income families and young adults to help them buy insurance on the marketplaces. The administration has also pointed out that more than 2.5 million people who buy off-exchange plans could be eligible for subsidies.
- Add a “public plan fallback” option on the marketplaces to give people more options in places where there are not enough insurers to foster competition--especially in rural communities. Obama noted that the public-option concept is actually modeled on a Republican idea, saying: “It was fine when it was their idea. The fact that they’re now opposed to it, as some socialist scheme, is not being consistent, it’s being partisan.”
- Continue to encourage innovation by the states. He challenged states to “show us ideas we haven’t thought of,” likely referring to the ACA provisions known as state innovation waivers, which allow states to design initiatives that achieve similar goals of the ACA.
Some, however, remain convinced about the merits of the public option.
“Government meddling exacerbated the problems with our healthcare system, and more government would just add fuel to the fire,” Freedom Partners Senior Policy Adviser Nathan Nascimento wrote in an email to FierceHealthPayer.
And industry consultant Rita Numerof worried a government plan "would dominate the market in every location it is introduced and quickly sweep aside any commercial competition," causing private insurers to exit, she said in an email.
Major industry trade groups including America’s Health Insurance Plans and the American Hospital Association also oppose the public option.