Paper in a Top Medical Journal Has Unexpected Author: Barack Obama

Congress should revisit creating a public healthcare plan, President Barack Obama wrote in the Journal of the American Medical Association. "Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits".

Obama offered his views in a valedictory message summarizing what he sees as his legacy on health care, together with his ideas to improve the Affordable Care Act.

Coverage under the landmark health care law also known as Obamacare took effect in January 2014. No prizes for guessing the topic: It's an assessment of the Affordable Care Act as well as policy recommendations for the next president to improve the USA health care system.

"Public programs like Medicare often deliver care more cost effectively by curtailing administrative overhead and securing better prices from providers", Obama writes.

Usually, about 80 percent to 85 percent of people who seek individual coverage pay, though those rates are much higher among people with employment-based coverage, he said.

The online exchanges will be a viable source of coverage "for decades to come", Obama said, but "further adjustments and recalibrations will likely be needed".

There are an estimated 155 million people under age 65 covered by such plans. But for some, said Kristie Canegallo, a deputy chief of staff at the White House, the "tax credits aren't big enough".

It's the most comprehensive health reform since Medicare became law in 1965.

White House officials said that Obama's goal in writing the article was to start a discussion and suggest a direction for elected officials and future policymakers, but that he would not be offering detailed new legislative proposals to carry out his ideas.

With the Democratic Party coalescing around the public option as the next step for health care reform, the Journal's editorial board claimed the introduction of a publicly run insurer into the individual health insurance exchanges would lead to a "market exodus" by private insurers and eventually to a "government-run single payer" universal health care system. "As a result, the majority of the country has benefited from competition in the Marketplaces, with 88 percent of enrollees living in counties with at least three issuers in 2016, which helps keep costs in these areas low", Obama continued.

On Saturday, as part of a deal with Sanders, Clinton announced she will also "pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan", which is broader than what Obama is endorsing. Critics say the premiums are too high, the out-of-pocket costs are out of control, and the requirements and red tape are too thick. Clinton also called for a "Medicare buy-in", which would allow people 55 years or older to opt-in to the program "while protecting the traditional Medicare program". He just published an analysis of his health care policy in one of the premier medical journals in the world.

Such criticisms have been traded between Mr. Obama and Republicans for the entire life of the Affordable Care Act, with GOP lawmakers countering that the law was pushed through by Democrats using secretive and aggressive tactics, and that Mr. Obama has since abused his executive authority to implement it.

Obama accuses Republicans of "hyperpartisanship" without saying what he might have done differently. Accordingly, while some will dispute the findings and extent of progress described by the president, ultimately the data are critical and speak extremely well of the early years of the ACA. Because of Republican opposition, he said, 19 states have not expanded Medicaid eligibility. Nationwide, about 11.1 million of the 12.7 million people who enrolled in the marketplaces still were paying their premiums as of March 31, for a payment rate of about 87 percent.

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