President-Obama-obamacareLooking back at the Affordable Care Act (ACA or Obamacare) and its “quality and accountability” impacts, President Obama recently took the unusual step of publishing an article suggesting (but not proposing) that Congress add a public option to the ACA and increase federal funding for coverage. A public option is a tax-based government-run health care system, similar in principle to the public schools or Medicare. When Obama proposed a public option in 2009, he was ignored by the Senate Finance Committee and its chair, Max Baucus (D-MT), as they went about deciding on the components of the ACA.

Now, on his way out, “Barack Obama, JD” appears as author of “United States Health Care Reform: Progress To Date and Next Steps,” in the Journal of the American Medical Association for August 2, Vol. 316, No. 5 (published online July 11). He reflects on the state of the U. S. health care “system” in 2008, which, he writes, “left more than 1 in 7 Americans without health insurance coverage.”

Working with the only Democratic-majority session of Congress that he would have in his eight years, Obama signed the ACA on March 23, 2010. Since that time, the uninsured rate has declined from 16% of the populace to 9.1% by the end of 2015. The law has also seen Medicaid extensions adopted in 31 states, with payments flowing through new models in the health insurance marketplace, although relying primarily on existing private health insurance plans and Medicare/Medicaid programs.

While incorporating some new approaches, the Affordable Care Act lacked the one ingredient that has transformed healthcare systems in other nations, including Canada: a public option. On this issue, Baucus silenced Obama, who admits that “too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills, struggle to navigate a complex, sometimes bewildering system, and remain uninsured.”

Thinking it over, President Obama writes, “Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited. Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.”

As has been reported here previously, many rural markets have been abandoned by private healthcare insurers whose executives can’t find a way to operate profitably there. These are the areas, with many millions of citizens, in which the President evidently thinks that a public option ought to be introduced.

President Obama has not offered Congress any new legislation based on his suggestions for healthcare reform, nor has he spoken out publicly. The issue of health care is, of course, politicized in a presidential election year. Hillary Clinton, standing on the Democratic Party platform, identifies healthcare as a basic human right and promises to “defend and expand” the ACA with many features, including a public option and a Medicare buy-in for people 55+. Donald Trump and the Republican Party, silent about a public option, call for the abolition of the ACA.

Photo credit. Piece by Robert Booth.

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