In launching his campaign for the presidency, then-Sen. Barack Obama announced his vision to be part of “the generation that says right here, right now, that we will have universal healthcare in America.”
When he was elected president, that vision informed the design of the 2010 Patient Protection and Affordable Care Act. There were three primary goals. First, to improve access to affordable care through expanding Medicaid and creating marketplaces where consumers without access to affordable employer insurance could get tax credits to help to pay for private insurance with protections for pre-existing health conditions. Second, to provide better care for patients and improve population health. And finally, to lower costs through innovation and a focus on paying for good healthcare outcomes.
By the time President Obama left office, the goals of the ACA were being realized. At the end of 2016, 20 million previously uninsured Americans had gained access to affordable care—driving the number of uninsured citizens to an all-time low—and healthcare inflation had fallen to its lowest rate in at least half a century. Patient-safety efforts were beginning to show signs of success, with fewer hospital infections and preventable readmissions. And the CMS Innovation Center created by the ACA was aggressively pursuing new models for payment and service delivery that rewarded providers for choosing the right care for each patient every time and securing the best possible price for that care.
These advancements are in spite of efforts to undermine the ACA, which have been ongoing since the law was passed and have only escalated in the past three years. Some states have flatly refused to expand Medicaid, despite the federal government's offer to pay 100% of the costs for newly insured for four years and the vast majority of costs in the future. Critical subsidies that help offset low-income Americans’ health-coverage expenses have been threatened or defunded, destabilizing insurance markets. Programs to promote awareness of the ACA and to help people find and secure the coverage they need have been slashed—and the enrollment period has been abbreviated.
The current administration has relaxed regulations requiring health plans to offer comprehensive coverage and once again allowed companies to discriminate against Americans with pre-existing health conditions, by limiting essential benefits and selective pricing. Officials have put out advertisements critical of ACA programs to discourage eligible people from enrolling in the plans.
The current administration has allowed states to put eligibility barriers in place to limit Medicaid enrollment or cause beneficiaries to lose coverage. And for the first time in decades, thousands of children have lost insurance coverage, reversing a trend underway since well before the ACA.
Despite all that, the ACA is more popular than ever before, according to the Kaiser Family Foundation.
The ACA has been remarkably resilient, despite myriad efforts to undermine it. After a decade of seemingly endless calls to “repeal and replace” the law and an assault by the current administration, the legal framework nevertheless remains in place. That means that with a president who supports the goals of more access, better care and lower costs, and renewed focus by HHS, we can reverse the harmful regulations and CMS directives and work on improving the 2010 law.
The 14 states that have not yet expanded Medicaid—including my home state of Kansas—still have the opportunity to provide coverage for the millions of low-income workers who lack coverage, and who too often are deprived of care and essential medications. Policymakers can make it clear that they will follow the law to pay the cost share for consumers and encourage more competition from insurers by rolling back the rules undercutting market stability. Congress can return to the 2010 commitment by ensuring that all Americans have access to comprehensive care and that Americans with pre-existing conditions can afford coverage.
We know the law works, because the data proves it. And if Congress commits to improvements—adjusting the framework to make coverage more affordable for everyone and adding a public option, which was in the original draft of the ACA, we will continue to progress toward universal coverage. Continuing to push forward with payment models that reward quality outcomes rather than quantity of procedures and drive innovation in the delivery system will result in a healthier country. That’s the road to realizing President Obama’s vision. And it’s the right thing to do.