President Barack Obama on Monday called for the creation of a "public option" for Obamacare, an idea that had previously been considered but then abandoned during the creation of the Affordable Care Act in Congress.
Obama, in an article published in a leading medical journal, said that Obamacare customers in some areas of the country that have limited competition among insurance plans should be offered the option to buy coverage from a government-sponsored health plan.
Obama argued for a public option that would be sold on government-run ACA marketplaces by noting that in 12 percent of the country, Obamacare enrollees only have one or two insurance issuers to chose from.
"Based on the experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited," Obama wrote in the Journal of the American Medical Association, which for the first time was publishing an article by a sitting president. He said such an option would give consumers "more affordable options while also creating savings for the federal government."
He wrote that "public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers."
Obama's JAMA article credited the Affordable Care Act with making "substantial progress" in controlling health-care costs and increasing insurance coverage to millions of Americans, but called for several more actions beyond a public option to bolster the effects of Obamacare.
Obama suggested that Congress increase federal financial assistance to people who enroll in private plans sold on Obamacare marketplaces, such as HealthCare.gov. He noted that the ACA's coverage provisions are projected to cost 28 percent less than original projections, creating an opportunity to invest those savings into making coverage less expensive.
The president also called on 19 states to follow the example of 31 others and expand their Medicaid programs to provide health coverage to nearly all poor adults.
And Obama also took aim at rising prescription drug costs, which have become an increasingly larger share of national health care spending.
The president asked that Congress should act on proposals for the upcoming 2017 budget that would "increase transparency" around the actual manufacturing costs of prescription drugs, "to increase the rebates manufacturers are required to pay for drugs prescribed to certain Medicare and Medicaid beneficiaries," and also asked for the federal government to be given "the authority to negotiate prices for certain high-priced drugs."
"There is another important role for Congress: it should avoid moving backward on health reform," Obama wrote. "While I have always been interested in improving the law — and signed 19 bills that do just that — my administration has spent considerable time in the last several years opposing more than 60 attempts to repeal parts or all of the ACA."
A White House official said that Obama's JAMA article "is the culmination of a review of the ACA's performance that started more than six months ago at the president's request, examining areas in which the law has been successful and in which it could be further strengthened to ensure all Americans have access to quality, affordable health care."
"Despite this significant progress, the president recognizes that more work is necessary to ensure every American can afford health care and navigate a complex health system," the official said.
Obama noted that since the ACA became law, in 2010, "the uninsured rate has declined by 43 percent, from 16.0 percent in 2010 to 9.1 percent in 2015, with most of that decline occurring after the law's main coverage provisions took effect in 2014."
"The number of uninsured individuals in the United States has declined from 49 million in 2010 to 29 million in 2015," Obama wrote. "This is by far the largest decline in the uninsured rate since the creation of Medicare and Medicaid 5 decades ago."
With Republicans in control of Congress, and overwhelmingly opposed to Obamacare, the president is unlikely to see increases in financial assistance to ACA customers, or the creation of a public option for the Obamacare marketplaces before he leaves offices next January.