President Obama defends ACA while calling premium increases ‘growing pains’

Ahead of the final open enrollment period of his presidency, Barack Obama made the case that the Affordable Care Act is working, but could be improved with additions like new tax credits and reviving the controversial public option.

Speaking at Miami Dade College, Obama first ran through the accomplishments of the Affordable Care Act, like driving the uninsured rate down to a historic low of 8.6 percent, to back up his “its worked” argument. The focus on repealing the law altogether have taken away from efforts to improve it, he said, while muddling facts like how most Americans still get their coverage from other sources, like employer-sponsored plans or Medicare.

What shouldn’t change, he said, are the minimum requirements for insurance plans, like requiring coverage for preventive services.

“Because of the law, doctors are finding better ways to perform heart surgeries and delivering healthier babies, and treating chronic disease, and reducing the number of people that, once they're in the hospital, end up having to return to the hospital,” he said. “So you’re getting better quality even though you don’t know that Obamacare is doing it.”

He said much of the opposition among Republican lawmakers is based on the fact “a Democratic President named Barack Obama passed the law,” and on predictions, like rationing of care, which ended up not being true. To consumers and the healthcare industry, the continuing growth in costs has been the bigger issue, though he argued much of that blame has been mistakenly pinned on the ACA.  

 “Now, some people may say, well, I've seen my copays go up, or my networks have changed.  But these are decisions that are made by your employers.  It's not because of Obamacare.  They're not determined by the Affordable Care Act,” Obama said.

So what does he want to see changed?

For one, he wants states which haven’t expanded Medicaid to do so. Florida is one of those states and he said“more than 700,000 Floridians” would have coverage if the state expanded the program, which he argued would benefit the state’s entire healthcare system by reducing uncompensated care in hospitals.

Secondly, he said premiums for ACA exchange plans need to be stablized. He noted the double digit increases in states like Arizona, along with the reduced number of insurers participating in many states in 2017. It’s a problem which needs to be addressed, he said, but not by repealing the law.

“I guarantee you there are people who right now think they hate Obamacare,” Obama said. “And if somebody told them, all right, we're repealing it, but now your kid who is on your plan is no longer on your plan, or now you've got a preexisting condition and you can't buy health insurance -- they'd be shocked.”

His solution would be use savings from reduced Medicare costs to expand tax credits for buying coverage on the exchanges.

Lastly, he again proposed adding a public health insurance option, but as a “fallback” for when few private insurers offer coverage in a specific state or region.

“Basically, you would just wait and see -- if the private insurers are competing for business, then you don’t have to trigger a public option,” Obama said. “But if no private insurers are providing affordable insurance in an area, then the government would step in with a quality plan that people can afford.”

Obama had advocated for the public option to be revived in a JAMA article he authored earlier this year, while Democratic presidential candidate Hillary Clinton argued for the same in her NEJM piece. As he wound up his speech, Obama said the option he’s proposing shouldn’t be equated to instituting single-payer healthcare.

“In fact, Bernie Sanders is still mad at me because we didn’t get single-payer passed,” he said. “Now, we couldn’t get single-payer passed, and I wanted to make sure that we helped as many people as possible, given the political constraints.  And so we adopted a system that Republicans should like; it's based on a competitive, market-based system in which people have to a responsibility for themselves by buy insurance.”

He closed his speech by calling on Republicans in Congress to end their repeal efforts and focus on improvements for the law—and even jokingly offering them to chance to rebrand it.

“I don’t care whose idea it is, I just want it to work.  They can even change the name of the law to ReaganCare. Or they can call it Paul Ryan Care.  I don’t care about credit, I just want it to work because I care about the American people and making sure they’ve got health insurance,” Obama said.