President Obama is urging Congress to revisit a public option for Obamacare in parts of the country where coverage is limited in an article published in the Journal of the American Medical Association.
Obama noted that while 88 percent of enrollees live in counties with at least three insurers, a large number of Americans live in areas with only one or two insurers.
"Some parts of the country have struggled with limited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan," Obama wrote. "Now based on experience with the [Affordable Care Act], I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited."
"Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government," he added.
While Obama touted the progress his signature health care law has made and referred to it as "the most important health care legislation enacted" since the creation of Medicare and Medicaid, he noted some of the law’s shortcomings while suggesting ways to remedy them.
"I am proud of the policy changes in the ACA and the progress that has been made toward a more affordable, high-quality, and accessible health care system," Obama said. "Despite this progress, too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured."
Obama highlighted one critique of the health care law often repeated by Republicans: many individuals still cannot afford health insurance.
"While the ACA has greatly improved the affordability of health insurance coverage, surveys indicate that many of the remaining uninsured individuals want coverage but still report being unable to afford it," Obama said. "Although the ACA included policies to help address prescription drug costs, like more substantial Medicaid rebates and the creation of a pathway for approval of biosimilar drugs, those costs remain a concern for Americans, employers, and taxpayers alike."
To solve these problems, Obama proposed increasing financial assistance, introducing a public option for care, and giving the federal government authority to negotiate prices for prescription drugs.
"Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs," Obama wrote. "Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges."
In response to Obama’s article, Speaker Paul Ryan (R., Wis.) said Republicans are offering health reform that increases choice and lowers costs.
"Obamacare has failed the American people and Democrats doubling down on more of the same would only worsen the pain," Ryan said. "House Republicans have offered a better way to achieve true health care reform that actually decreases costs and increases choice for Americans."
Republican legislators said expanding the role of government in health care would exacerbate the problems Obama identified.
"If we have learned one thing from Obamacare, it's that government-run health care leads to higher costs, lower quality, and fewer choices for Americans – the President himself admitted this," said Rep. Kevin Brady (R., Texas), who worked with Ryan on a proposal to replace Obamacare. "But we need less bureaucracy in our healthcare system, not more. That's why House Republicans are fighting to deliver a patient-centered alternative, one that promotes competition and innovation to lower costs and expand access to high-quality options."