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Obama polishes health care law for victory lap

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Lauding the Patient Protection and Affordable Care Act, President Barack Obama is calling on Congress to make changes to improve the act, whose passage more than six years ago is considered one of his top domestic achievements.

In an article published Monday in the Journal of the American Medical Association, President Obama detailed what he said are the ACA's accomplishments, including the expansion of health insurance coverage.

“The number of uninsured individuals in the United States has declined from 49 million in 2010 to 29 million in 2015. This is by far the largest decline in the uninsured rate since the creation of Medicare and Medicaid five decades ago,” President Obama wrote.

President Obama credited the act's federal premium subsidies that help lower-income individuals afford coverage in public exchanges, as well as expanded federal subsidies for states that ease eligibility requirements for their Medicaid programs.

He also cited the elimination of annual and lifetime dollar coverage limits that many health plans imposed before the ACA, as providing “real protection against catastrophic costs.”

But, President Obama wrote, lawmakers can improve ACA by, among other things, expanding federal premium subsidies available to those with incomes between 100% and 400% of the federal poverty level. For example, subsidies are available in 2016 for a family of four collectively earning up to $97,200.

In addition, he said lawmakers should consider allowing the federal government to directly offer coverage in the exchanges, particularly in states where few insurers offer plans in the public exchanges.

Adding a public plan would strengthen the exchanges, “giving consumers more affordable options,” he said.

President Obama also backed the unpopular excise tax, better known as the Cadillac tax — on the portion of health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. The tax is set to take effect in 2020 though many in Congress want to repeal it.

“Although this provision can be improved … the tax creates strong incentives for the least-efficient private-sector health plans to engage in delivery system reform efforts, with major benefits for the economy and the budget. It should be preserved,” President Obama wrote.

Employers groups agree that the law has accomplished this key goal of reducing the number of uninsured, but they support other ways to control health care costs than the excise tax.

“Rather than taxing employer plans, we should focus on payment and delivery system reforms to control costs,” said Steve Wojcik, vice president of public policy with the National Business Group on Health in Washington.

In addition, they have concerns about the federal government offering coverage in the public exchanges.

“Would there be a level playing field if the government offered coverage in the exchanges?” asked James Gelfand, senior vice president of health policy at the ERISA Industry Committee in Washington. In addition, if the government insurer had higher-than-expected costs, taxpayers could be hit with new levies, he said.