President Barack Obama on Thursday offered suggestions for improving his signature healthcare reform law while saying it has had many successes and is slowed mostly by political gamesmanship.
The speech at Miami Dade College in Miami was rescheduled because of Hurricane Matthew. Obama was in the battleground state campaigning for Democratic presidential candidate Hillary Clinton.
With just a few weeks before the election and the final open-enrollment period of his administration, Obama acknowledged some problems with the Affordable Care Act, but said it has slowed the overall growth of healthcare costs, pushed the country's uninsured rate to record lows and “has done what it was designed to do.”
But the law faces major challenges. Premiums are rising by double digits in many parts of the country and some major insurers have abandoned the exchanges, leaving consumers with few choices next year and contributing to higher prices.
Even some who have supported the law are questioning its success. Minnesota's Democratic governor recently said the ACA “is no longer affordable for increasing numbers of people.” Former President Bill Clinton, while campaigning in support of Hillary Clinton's presidential bid, called the law "the craziest thing in the world."
Obama on Thursday said there should be more premium tax credits for middle income families who currently make too much money to qualify for a subsidy. He also said there should be a fallback public option for states where there is not enough competition among insurers. Clinton has campaigned on this idea, but it would probably only be possible at a state level, especially if Republicans retain control of the House.
Obama's other recommendations were for the 19 states that have refused to expand Medicaid eligibility to change their stances and to encourage healthcare innovation in all states.
Obama said ACA struggles like increasing premiums and unstable exchange markets can be blamed mostly on Republicans playing politics. He likened the ACA to a smartphone that has some bugs when it is first rolled out.
“You don't go back to using a rotary phone,” he said. “You don't say 'We're repealing smartphones.'”
Obama also suggested he might have supported a single-payer system if it were politically possible but said “we couldn't get single payer passed” so he focused on getting coverage for as many people as possible.
He lamented the difficulty of getting people focused on the facts of the ACA because of its complexity and the nuance to some of supporters' policy statements. Keeping only elements of the ACA that are publicly popular would not work, he said.
“The sum of those parts that are popular in Obamacare is Obamacare,” he said. “It's just people don't often know it.”
HHS this week estimated 13.8 million people will sign up for 2017 coverage, a modest increase over the 12.7 million consumers who picked health insurance plans during open enrollment for this year.
Obama said Republicans were envious that "a Democratic president named Barack Obama passed the law. That's just the truth."
