One Year Left: How Can Obama Secure His Health Care Legacy?

President Obama and his administration have spent countless time and resources ensuring the implementation of the Affordable Care Act — all while defending it from attacks on almost every side. As his second term comes to an end, experts say the president will have to continue to secure the law if he wants it to be his legacy.

“Obamacare is still in its infancy, but the president wants it to be for him what Social Security was for Franklin D. Roosevelt and what Medicare was for Lyndon B. Johnson: a part of the American fabric, a thriving system that will be his legacy,” Sreedhar Potarazu — an ophthalmologist, founder of a health care delivery software company and author of a book on health care costs — writes for CNN. To achieve that, “Obama must refocus on the program that bears his name in order to ensure that his successor, whether Republican or Democrat, doesn’t alter it dramatically or simply dismantle it,” Potarazu writes.

As the ACA’s third open enrollment period winds down, Potarazu notes that the law “is standing on very wobbly legs,” adding that it “could collapse if the President fails to address its shortcomings.”

So where should Obama focus?

Reducing Health Care Costs

Most experts agree that cost controls should be a key focus for the president as this year progresses.

Under the Obama administration, “health care cost growth has slowed dramatically, resulting in lower spending on Medicare and Medicaid,” according to the Campaign to Fix the Debt, a nonpartisan group. However, the group notes that certain legislation — such as the permanent “doc fix” passed earlier this year and the postponement until 2020 of the ACA’s Cadillac Tax — “threaten this slowdown.”

As Potarazu points out: “It’s called the Affordable Care Act for a reason.” During his last year in office, many experts say Obama should double down on efforts to control health care costs — which has proven to be a difficult task.

A poll released earlier this month by the New York Times and the Kaiser Family Foundation found that about one in five U.S. residents under age 65 faced obstacles to paying their medical bills in 2015.

“From a consumer perspective, monthly premiums and deductibles are skyrocketing, largely because insurers have been forced to enroll customers who are sicker than average,” Potarazu writes, adding, “Insurers also received only a fraction of the money they expected from the risk corridors the government set up to help them cover their shortfalls” and “the cost of medication is rising dramatically, affecting the ability of consumers to pay for their prescription drugs.”

Boosting Enrollment

Flat-lining enrollment is another area of concern.

While the Congressional Budget Office had projected enrollment growth of about eight million in 2016, numbers released in October 2015 by the Obama administration projected growth of just 1.3 million this year.

In addition, a Gallup report earlier this month showed that the U.S. uninsured rate in the fourth quarter of 2015 was 11.9%, up slightly from 11.6% in Q3 2015. The numbers may seem like a relatively small jump, but they mark the first time the uninsured rate has gone up since the ACA went into effect. (Still, Gallup noted that the uninsured rate in Q4 2015 was 5.2 percentage points lower than in Q4 2013, when key provisions of the law went into effect.)

Potarazu calls the “leveling-off” of the uninsured rate “a cause for concern, because those who remain uninsured may be harder to reach or generally less inclined to buy into the program.” The participation of such individuals is important for the continued success of the law because they are needed “to defray the costs of insuring older, sicker Americans in the system,” he notes.

Ensuring Quality Care

While this “pillar” of the ACA is “not as shaky” as health care costs or insurance coverage, Potarazu writes that “there is still considerable room for improvement” in care quality. For instance, “The health care industry is still struggling to adopt technology that will provide greater transparency and data sharing, which are needed to keep costs down,” he notes.

“Also worrisome are the massive administrative and overhead costs associated with maintaining not only the insurance marketplaces, but also the infrastructure required by hospitals, physicians, insurance companies and others to align themselves with these new programs,” Potarazu adds, citing CMS data that projected nearly $2.7 trillion in overhead and administrative costs for private insurers and federal health programs between 2014 and 2022.

“If the quality of care is to be maintained or improved, then these costs will have to be kept within budget,” he writes.

No Term Limits for Defending the ACA

The president “cannot afford to take his eye off the most important legislation in his presidency,” Potarazu argues.

And even after Obama leaves office, his time defending the ACA may not be over.

Georges Benjamin, executive director the American Public Health Association, told Modern Healthcare, “People will continue to try to take the ACA away, but he’ll still be a force out there supporting it,” adding, “I think he will be more empowered. You are always more revered after you leave.”

Around the Nation

Presidential push. Obama is pushing the Affordable Care Act ahead of the Jan. 31 deadline to enroll in coverage during the law’s third open enrollment period.

Oregon under fire. Oracle has filed a lawsuit in the Marion County Circuit Court against Oregon over a settlement agreement regarding the company’s contract to develop the state’s exchange website.

Premiums on an upswing. An HHS report finds that the average monthly premium for health plans selected by U.S. residents who re-enrolled in coverage through the Affordable Care Act’s federal exchange is $408, up about 9% from the same time last year.

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