The Unfinished Work of Obamacare

Remember what matters.

Photographer: Andrew Harrer/Bloomberg

Unless Congress finds a way to repeal the Affordable Care Act over the next 10 months -- after more than 60 failed attempts -- President Barack Obama will leave office with his signature legislation intact, and running pretty smoothly.

QuickTake Obamacare, Assessed

Obamacare, which turns six today, has reduced the share of Americans without health insurance by half, provided people without job-based coverage access to affordable high-quality options, and prevented people from being denied insurance because of preexisting health conditions. Meanwhile, health-care costs have grown more slowly than they did before the law was passed.

Yet the ACA should by no means be the end of health-care reform -- not least because it leaves 11.5 percent of adults under 65 uninsured. Greater efforts are needed to make sure everyone who qualifies for government subsidies to buy insurance knows that they do. And the 19 states that still refuse to expand Medicaid to more residents need to get with the program.

Efforts are needed to lower the increasingly crippling costs of copayments, deductibles and other expenses. In the past decade, the average deductible has more than doubled, to $1,318. Among Americans who now have insurance, one in five say they struggle to pay medical bills, often by emptying their savings or taking an extra job.

One good suggestion is Hillary Clinton's proposal to allow patients three annual visits to a doctor before deductibles kick in. Clinton's refundable tax credit for out-of-pocket costs could help, too.

Another fundamental problem with the U.S. health-care system is the trajectory of total spending. From 2014 to 2024, it's expected to grow 1.1 percent faster than the economy as a whole, reaching 19.6 percent of gross domestic product.

The Obama administration is trying to counteract this trend by moving away from fee-for-service reimbursement to doctors and hospitals and basing their payments instead on measures of success. This effort will not be finished before Obama leaves office, and it's important that it continue into the next administration.

In years to come, policy makers, voters and the next president will need to expand the goals of health-care reform. It's essential, for example, to shrink persistent health disparities by income and geography; to stem rising death rates among middle-aged whites; and to reduce suicide, opioid addiction and infant mortality. Ultimately, the U.S. health-care system should go beyond making sure Americans have insurance cards, and see that they live in the best possible health. 

To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net.