100 Most Influential People in Healthcare: Obama's historic achievements earn him fourth time as No. 1

The new president was facing America's biggest economic crisis since the Great Depression. Key advisers urged him to keep his focus on economic recovery. The opposition party signaled it would wage an all-out fight to block healthcare reform. And his own party was divided on how to proceed.

But President Barack Obama charged ahead. “Now is the time to deliver on healthcare,” he told Congress in September 2009.

First, he pushed through a huge expansion of electronic health records as part of his 2009 economic stimulus package. Then, with stalwart help from congressional Democratic leaders House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid, he won passage—barely, after a titanic political battle—of a comprehensive healthcare overhaul that moved the country toward universal coverage. It was a goal that had eluded presidents going back to Harry S. Truman. But it damaged his presidency by costing Democrats control of Congress in the next election.

Ever since, the Obama administration and congressional Democrats have fought off relentless legislative and legal maneuvers by Republicans to repeal or undermine the Affordable Care Act, including three legal battles that went all the way to the U.S. Supreme Court.

Obama's achievements once again have earned him the top spot on Modern Healthcare's ranking of the 100 Most Influential People in Healthcare, the third time he has taken the No. 1 position and the 10th time he has appeared on the list.

“I don't know that anyone since President Johnson has achieved as much as he has in terms of healthcare,” said former Senate Majority Leader Tom Daschle. “This has probably been the most health-focused administration in my lifetime and perhaps in all time.”

Because of his administration's efforts, an estimated 20 million more Americans have gained public or private coverage, chopping the uninsured rate from 16% in 2010 to 9.1% in 2015. People no longer can be denied insurance because of pre-existing medical conditions, and insurers no longer can cap annual or lifetime benefits.

Private insurers and Medicare now must cover recommended preventive services with no deductible or copayments. Hospital-acquired infection rates and preventable readmissions have declined. Payment and delivery reform experiments to improve care and reduce costs have proliferated. Community health centers around the country have received billions in additional funding to better serve low-income patients. And national healthcare spending growth has slowed.

“After a century of trying, we declared that healthcare in America is not a privilege for a few, it is a right for everybody,” Obama said at the Democratic National Convention last month.

Beyond the ACA, the Obama administration reached a deal with Congress last year to overhaul the Medicare Part B physician payment system — shifting it toward value-based reimbursement—and to extend the Children's Health Insurance Program. And over the past two years, the administration has launched the Precision Medicine Initiative to enable researchers, providers and patients to work together to develop more effective individualized care. This year, during his State of the Union address, Obama announced the so-called Cancer Moonshot to accelerate cancer research.

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.”