'Obamacare’s Kindest Critic'

Obamacare has been assailed from the political right and left, but its namesake took an unusual step in publishing a critique that suggested ways his legacy achievement could be perfected and expanded.

Obamacare has been assailed from the political right and left, but its namesake took an unusual step in publishing a critique that suggested ways his legacy achievement could be perfected and expanded.

Republicans are convening in Cleveland this week and can be expected to bash Obamacare nonstop, but constructive criticism of the Affordable Care Act came last week from an unanticipated quarter – Barack Obama.

Signing his critique as Barack Obama, J.D., the President described how his legacy achievement could be perfected by adding a public health insurance option and allowing Medicare to negotiate prescription drug rates, which is currently prohibited.

The New York Times called Obama “Obamacare’s kindest critic” and said his suggestions have the appearance of a memo to his hoped-for Democratic presidential successor, Hillary Clinton.

“Presidents usually wait until their memoirs to review their work,” the Times editorialized, but in this case Obama used the sixth anniversary of the act to make observations about his handiwork in the Journal of the American Medical Association. "Health care costs are still too high, he wrote, and 29 million people still lack coverage.”

One of Obamacare’s “failings” is an incomplete expansion of Medicaid in 19 states that chose not to accept federal financial assistance to pay for expanded coverage.

But Obama points to the actual failure of providing coverage for 9.1 percent of the U.S. population. Obamacare reduced that total from 16 percent, but there are still people who can’t afford health care, often because they lack the money for co-pays and deductibles in addition to health insurance premiums.

Unsuccessful Democratic presidential candidate Bernie Sanders campaigned hard on a Medicare-for-all health insurance plan that captured a lot of attention and rekindled interest in a single-payer system. Obama’s recommendation to add a public option to the health insurance exchange is a more targeted version of the idea, which possibly could win bipartisan support if aimed at rural areas with few private-sector health insurance choices, the Times said.

Clinton has expressed support for a public option. The Times notes Clinton has also voiced interest in allowing Americans between the ages of 55 and 64 to enroll in Medicare.

The Obama view on Obamacare is that it isn’t going away any time soon, but it should be improved and perfected as part of a continuing drive to put a blanket of health insurance coverage over all Americans.

Not everyone agrees. Leading Republicans continue to call for repeal of Obamacare and replacing it with something else, which has largely been ill-defined. The Obamacare health care exchanges are under pressure as costs continue to rise and some insurers lose money. Efforts in Oregon and elsewhere to promote coordinated care and integration of physical and mental health care have registered some positive results, but are still in an extended trial stage. Employers have largely retained private health insurance coverage for employees, but have blunted cost increases by opting for plans with higher deductibles and co-pays and trimmer provider networks.

“What Mr. Obama has done is unusual – asking someone else to burnish a legacy of which he is personally proud,” the Times said. “If the candidates (and Congress) pay attention, his request may also do a world of good for millions of Americans for whom decent health care remains out of reach."