But as the president himself acknowledged, healthcare costs are still unaffordable for many Americans, the system is still mind-numbingly complicated, and tens of millions of people remain uninsured. “The work toward a high-quality, affordable, accessible health care system is not over,” he wrote in a recent JAMA article.
Major unfinished tasks include fixing the ACA's insurance exchanges to make them more financially viable for insurers and affordable for consumers; curbing the rapid growth of prescription drug costs; speeding delivery system reforms to boost quality and efficiency; and improving the quality and affordability of long-term care. The latter issue was one of the big disappointments of Obama's tenure, as his administration was forced to jettison the ACA's financially unsustainable long-term-care benefit program.
Republican experts argue the Obama administration failed to take effective action to control healthcare costs. “Obama didn't do anything to get Medicare on a stable financial footing,” said Gail Wilensky, who served as Medicare chief under President George H.W. Bush.
She also criticized his administration for investing nearly $37 billion, as part of the economic stimulus bill, to help healthcare providers install EHR systems before solutions were found to enable all those providers to share patient information. “That will make it more complicated to fix the interoperability problems,” Wilensky said.
Tommy Thompson, who served as HHS secretary under President George W. Bush, said he'd like to see the ACA changed to include more market-based mechanisms while keeping popular features such as the ban on insurers setting benefit caps. But he gives Obama props. “He got a partisan bill passed that changed healthcare,” Thompson said. “For that you have to give him credit.”
Dr. Don Berwick, who served as CMS administrator in 2010 and 2011, said, “The action needs to shift from focusing on coverage and payment to true delivery system reform” involving a transformation to community-based, primary-care-centered care.
Despite what Obama has left undone, Democrats and Republicans agree he will long be remembered for his healthcare accomplishments. The president himself recognized that would be a key part of his legacy in that 2009 healthcare speech to Congress, when he promised, “We will meet history's test.”
Obama's “leadership and courage to take on healthcare reform is a monumental achievement,” Berwick said. “He changed the conversation in America around healthcare.”