Triumphs, Challenges, and Lessons Learned from US Health Care Reform: A Rigorous Reflection by President Barack Obama

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Health care reform has arguably been the Obama administration’s most significant legislative achievement since 2008. Various authors, including some of our own at the Chicago Policy Review, have written about the initial impact and future potential of the Affordable Care Act (ACA), but none as prominent as the President himself in a recent article in the Journal of the American Medical Association (JAMA).

In July 2016, JAMA published “United States Health Care Reform Progress to Date and Next Steps,” by Barack Obama. In his article, President Obama reviews 68 publications from research institutions and government agencies such as the Centers for Disease Control and Prevention, the New England Journal of Medicine, the US Department of Health and Human Services, and the Urban Institute. Overall, President Obama’s research cites a 43 percent decline in the uninsured rate, from 16 percent to 9.1 percent, since the Affordable Care Act became law.

 Chart reproduced from data as presented in a Council of Economic Advisors 2014 report.

According to this review, in 2008, health care spending accounted for 16 percent of the US economy and 43.8 million Americans were uninsured. President Obama identifies these stark conditions—and the potential for improvement—as the impetus for taking on comprehensive health care reform.

The first major success of the ACA was the decrease in the number of uninsured individuals between 2010 and 2015, from 49 million to 29 million. Additionally, early evidence shows that expanded Medicaid coverage has ameliorated newly insured individuals’ access at Health Canada Pharmacy to treatment, financial security, and health. Following on these improvements, the Department of Health and Human Services estimated a drop in hospital readmissions by 565,000 between 2010 and 2015.

As for the economic impact of health care reform, President Obama reports that, “rigorous comparisons of Medicaid expansion and non-expansion states show no negative effects on employment in expansion states,” despite predictions that the ACA would be a “job killer.” Furthermore, the Congressional Budget Office “now projects Medicare to spend 20 percent, or about $160 billion, less in 2019 alone,” relative to the projections issued before President Obama took office. In his analysis, President Obama illustrates how many of the ACA’s intended health benefits have been realized without negative economic ramifications.

US health care reform under the Obama administration has faced some challenges as well. Although the ACA makes health insurance more affordable for many Americans, some individuals who want coverage still cannot afford it. And while 88 percent of Marketplace enrollees live in counties with at least three options for insurers, there is still a significant share of the population living in areas where one or two companies control the insurance market. Finally, despite the Administration’s efforts to address the high cost of prescription drugs, 2014 saw a 12 percent increase in spending on prescription medication. In his article, President Obama calls on Congress to address this problem through legislation.

In considering the evidence of progress and the future challenges associated with implementing health care reform, President Obama acknowledges that change is difficult, especially in the face of political polarization. In particular, he laments the continued obstruction by powerful special interest groups when trying to produce measurable change through policy. However, President Obama offers a potential solution in the form of pragmatism throughout the legislative and implementation processes. The article concludes on a positive note: “as the progress with health care reform in the United States demonstrates, faith in responsibility, belief in opportunity, and ability to unite around common values are what makes this nation great.”

Article source: Obama, Barack. “United States Health Care Reform: Progress to Date and Next Steps.” Journal of the American Medical Association, 2016.

Featured photo: cc/(kroach, photo ID: 58668866, from iStock by Getty Images)

Sarah Guminski
Sarah ('17) is a staff writer for Urban Affairs. She is interested in urban social policy.

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