Tuesday, July 12, 2016

The ACA and Health Care Reform: President Obama does JAMA

This week, the Journal of the American Medical Association (JAMA) published a report entitled Health Care Reform: Progress to Date and Next Steps authored by none other than Barack Obama, JD, the first sitting president to do so in the prestigious medical journal. While he surely had a little help with the piece (68 references!), the single-author, swan-song brings some unique gravity to its contents. Since passage of his legacy the Affordable Care Act (ACA), our health care system has experienced unprecedented change (mostly for better...but some for worse). Cutting through the fluff, here are the some of the major highlights of the paper, with achievements including:

  • Guaranteed preventive care for all, including contraceptive coverage and domestic violence screening and counseling for 55 million women
  • Defined caps on annual out of pocket spending to over 95% of workers in employer-based health insurance plans
  • Tools and research bodies to test new payment models that will reduce waste and improve the value of our health care dollars
  • 20 million more Americans with health insurance, dropping the national uninsured rate to single digits for the first time in history from 16% to 9%:

The President admits that there are plenty of areas where the ACA fell short. While the graph above proves success, insurance coverage does not directly equate to access to care, as many newly insured continue to face barriers in obtaining much needed primary and specialty care. Worse, 19 red states still have not expanded their Medicaid programs, leaving 4 million low-income Americans without affordable coverage options.

He also offers significant policy changes for future consideration to improve the law and help curb the unsustainable growth in national health spending, including:

  • A public insurance option (!) in markets that are dominated by one or two insurers who have stifled competition
  • Improving prescription drug price transparency and granting federal authority to negotiate pricing for high-cost drugs in Medicare and Medicaid

The law survived multiple bouts with the Supreme Court and countless attempts at repeal in the legislature, yet is certainly here to stay. Looking forward in this hyperpartisan era, he urges pragmatism and finding common ground, resisting the many well-funded special interests in our American health care system that put profit over patients. And in a well-placed nod to bipartisanship, he concludes with a quote from former GOP primary candidate Governor John Kasich explaining his decision to expand Medicaid in Ohio:

 “For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them.”