Damn! Obama's JAMA paper is a full rebuke of ACA naysayers!

[joshcryer]

While historians will draw their own conclusions about the broader implications of the ACA, I have my own. These lessons learned are not just for posterity: I have put them into practice in both health care policy and other areas of public policy throughout my presidency.

The first lesson is that any change is difficult, but it is especially difficult in the face of hyperpartisanship. Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported. For example, they supported a fully funded risk-corridor program and a public plan fallback in the Medicare drug benefit in 2003 but opposed them in the ACA. They supported the individual mandate in Massachusetts in 2006 but opposed it in the ACA. They supported the employer mandate in California in 2007 but opposed it in the ACA—and then opposed the administration’s decision to delay it. Moreover, through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts. We could have covered more ground more quickly with cooperation rather than obstruction. It is not obvious that this strategy has paid political dividends for Republicans, but it has clearly come at a cost for the country, most notably for the estimated 4 million Americans left uninsured because they live in GOP-led states that have yet to expand Medicaid.65

The second lesson is that special interests pose a continued obstacle to change. We worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured. Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits.66 We need to continue to tackle special interest dollars in politics. But we also need to reinforce the sense of mission in health care that brought us an affordable polio vaccine and widely available penicillin.

The third lesson is the importance of pragmatism in both legislation and implementation. Simpler approaches to addressing our health care problems exist at both ends of the political spectrum: the single-payer model vs government vouchers for all. Yet the nation typically reaches its greatest heights when we find common ground between the public and private good and adjust along the way. That was my approach with the ACA. We engaged with Congress to identify the combination of proven health reform ideas that could pass and have continued to adapt them since. This includes abandoning parts that do not work, like the voluntary long-term care program included in the law. It also means shutting down and restarting a process when it fails. When HealthCare.gov did not work on day 1, we brought in reinforcements, were brutally honest in assessing problems, and worked relentlessly to get it operating. Both the process and the website were successful, and we created a playbook we are applying to technology projects across the government.

While the lessons enumerated above may seem daunting, the ACA experience nevertheless makes me optimistic about this country’s capacity to make meaningful progress on even the biggest public policy challenges. Many moments serve as reminders that a broken status quo is not the nation’s destiny. I often think of a letter I received from Brent Brown of Wisconsin. He did not vote for me and he opposed “ObamaCare,” but Brent changed his mind when he became ill, needed care, and got it thanks to the law.67 Or take Governor John Kasich’s explanation for expanding Medicaid: “For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them.”68 Or look at the actions of countless health care providers who have made our health system more coordinated, quality-oriented, and patient-centered. I will repeat what I said 4 years ago when the Supreme Court upheld the ACA: I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere. As this progress with health care reform in the United States demonstrates, faith in responsibility, belief in opportunity, and ability to unite around common values are what makes this nation great.

http://jama.jamanetwork.com/mobile/article.aspx?articleid=2533698

Man, what a great president.

[democrattotheend]

1. I'm going to miss him!

I hope it doesn't ruin the spirit of unity here to say that January 20, 2017 will be a sad day no matter who wins the election. Obviously, it will be a lot sadder if Trump wins, but I will be sad either way.

[HuckleB]

10. Indeed, it will be a sad day.

[misterhighwasted]

2. He's leaving nothing for the dirty hands of the Republicans to destroy his legacy,

by re-writing the story of ACA in their twisted words.

Good for the Presiident!

[mcar]

3. Best in my lifetime

[zipplewrath]

4. Unreference assertion

Yet the nation typically reaches its greatest heights when we find common ground between the public and private good and adjust along the way.

One will note that this assertion was given without reference to proof.

There has been scholarly work looking into the whole "public/private partnership" approach that suggests it does not necessarily produce superior results. Quite the opposite, their assertion is to pick one or the other, which ever will be most/more effective. I'm not actually sure either assertion is universally true, almost assuredly it is very sensitive to the specific issue being addressed. But this statement stands out in an otherwise extensively footnoted article.

[Hoyt]

5. Do you consider Medicare a good program? - Government, insurance companies and privately practicing

providers and suppliers. And that is the traditional Medicare program. In less than 10 years, over 30% of Medicare beneficiaries have voluntarily chosen to enroll in Medicare Advantage which offers protections traditional Medicare does not -- cap on out-of-pocket costs and drug coverage primarily.

I suspect a pure government program from -- government employed providers, government owned claims adjudication, etc. -- might be better. But, there is no way in anyone's foreseeable future that will happen anytime soon in this country.

[zipplewrath]

13. Student loans

It was a poor public/private partnership. The banks provided no real value added.

Insurance companies probably aren't providing alot of added value. Basically, they are merely "managing" the insurance polices. SS doesn't really need this kind of help. Not sure ultimately why medicare does.

[Hoyt]

14. Except the banks had the money to lend. Unfortunately, someone made crappy for profit schools

eligible for students' money, and some students and parents weren't very smart about things.

[zipplewrath]

16. So does the government

Which is why the banks aren't part of it anymore.

[Hoyt]

19. What do you mean "banks aren't part of it anymore."

[zipplewrath]

21. I believe they have been removed from issuing new loans

The now only "administer" them.

The Obama administration has taken steps toward reform. It has eliminated the financial middlemen who long collected a fee to issue federal loans. The government now loans directly to students, though private companies continue to administer the loans. New regulations limit student debtors’ federal loan payments to 10 percent of their income.

[wryter2000]

6. Holy Cow

I don't know if we've ever had a president published in a peer-reviewed medical journal before.

[Doctor_J]

7. I make $60k, and my healthcare is 10 TIMES as much as before gingrichcare passed. but my

insurance company has record profits, like all of the other death merchants. and since I have a company plan, there is nothing I can do about it. I do have it better than the new people at my place, whose premiums and deductibles and copays and coinsurance take up half of their net instead of a third.

consider me a naysayer who doesn't feel rebuked in the least. I wonder if there is ANY republican scam that some people won't go along with as obama likes it.

[joshcryer]

8. I'm not getting into the details of your plan.

But I know every single time I hear something like this there is a catch. Every single time.

[Hoyt]

15. I just kind of move on when someone says their health care is 10 times what it was before.

[Hekate]

23. Certainly every time someone posts that here. Several instances come immediately to mind...

....all the "fault" of the POSUCS.

[Maraya1969]

27. This is a lie! Insurance companies have to pay 80% toward actual care or give a rebate. It's in the

AHC law. From the government website: https://www.healthcare.gov/health-care-law-protections/rate-review/

80/20 Rule

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.

The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR. If an insurance company uses 80 cents out of every premium dollar to pay for your medical claims and activities that improve the quality of care, the company has a Medical Loss Ratio of 80%.

Insurance companies selling to large groups (usually more than 50 employees) must spend at least 85% of premiums on care and quality improvement.

If your insurance company doesn’t meet these requirements, you’ll get a rebate on part of the premium that you paid.

Will I get a rebate check from my insurance company?

If your insurance company doesn’t meet its 80/20 targets for the year, you’ll get back some of the premium that you paid.

You may see the rebate in a number of ways:

A rebate check in the mail
A lump-sum deposit into the same account that was used to pay the premium, if you paid by credit card or debit card
A direct reduction in your future premium
Your employer may also use one of the above rebate methods, or apply the rebate in a way that benefits employees
If you or your employer will get a rebate, your insurance company must notify you by August 1.

If you have an individual insurance policy, you’ll get the rebate directly from your insurance company.

For small group and large group plans, the rebate is usually paid to the employer. It may use one of the above rebate methods, or apply the rebate in a way that benefits employees.

FYI: The 80/20 rebate rules don’t apply when an insurance company has fewer than 1000 enrollees in a particular state or market.

[randome]

9. "...and then opposed the administration’s decision to delay it."

This is awesome stuff! There has never been a President like Barack Obama before.
[hr][font color="blue"][center]Precision and concision. That's the game.[/center][/font][hr]

[central scrutinizer]

11. Without ACA, we would be bankrupt

I had steady employment at the University and my family had continuous coverage through my plan. Mrs. Central Scrutinizer is an IBEW electrician and had good coverage when she was working but often there were long gaps between jobs. We never needed to do COBRA. Then I reached Medicare age and retired and when her job ended, we went to the marketplace to buy coverage for her until her next electrician gig.

She had been dealing with transitory, undiagnosed pains for a while and finally our GP called for a CT scan. They found pancreatic cancer, inoperable. Thanks to the no pre-existing exclusion through ACA, she was not denied coverage and kicked off the plan. We quickly ate up the deductible and stop loss limits ($6800 at least out of pocket) but her care to date has cost many tens of thousands of dollars. Otherwise we would have had to drain our retirement accounts.

[Hoyt]

17. Sorry your family is going through that. I know it's difficult. But good illustration

of how important ACA is and why it needs to be improved.

[seabeyond]

20. Trying to understand since you are giving numbers.

And I am sorry for your wife. Pancreatc cancer is tough and by the time they find it, not good.

What was your deductible and what do you mean stop loss limit?

I have 2K DEDUCTIBLE AND THEN THEY pay 80%. (Sorry for capitals). At a 500k medical bill that would be about 100k.

[central scrutinizer]

24. Stop loss is your maximum out of pocket

We had a 2500 deductible then had to do copayment (percentage varied depending on whether the doctor was on a preferred list or not) of $70 per office visit plus 20% on other services. Once those totaled $4300, the plan started paying 100%. I think we went over that the first week with the CT scan and ultrasound endoscopy. We still have to do the $70 per office visit when we actually meet with a doctor. But the lab work and chemo is paid at 100%. If she survives until the new year, then we will have to come up with another $6800. Most plans have a stop loss provision.

[seabeyond]

25. Thank you for the information.

I know this is tough. I appreciate it. Take care of you....

[leftstreet]

12. What crap. He promised a Public Option

Then dropped it like a hot potato

"pragmatism" my ass

[Hoyt]

18. No choice at time. Thought that we would have been better with nothing is crazy.

[Hekate]

22. Author : Barack Obama, JD. I am already missing him.

[still_one]

26. What he accomplished was simply amazing

[Surya Gayatri]

28. He is what people once called a "Renaissance Man"--a person of multiple talents and qualities.