Obama on Obamacare: If GOP Replacement Is Better, I'll Support It

President Barack Obama said Friday he would support a Republican plan to replace the Affordable Care Act (ACA), if it can be shown to be superior to the current law.

But, he said, repealing the ACA without a replacement plan is a “disservice to the American people,” who do not support repealing the law without knowing what will come next.

“If, in fact, there’s going to be a massive undoing of what’s one-sixth of our economy, the Republicans need to put forward very specific ideas on how they’re going to do it,” Obama said during an interview with Ezra Klein and Sarah Kliff of Vox.

“If they’re so convinced they can do better, they shouldn’t be afraid to make that presentation,” the president said. “It’s really interesting to figure out why they are trying to rush the repeal so quickly.”

Obama asked, “What is it that they’re afraid of?”

The president said he would have no problem supporting a replacement plan that solves problems with the current law, and he would encourage other Democrats to do the same. But he would want to see certain elements: such as retaining the ban on denying coverage for preexisting conditions, ensuring the Medicaid and Medicare work properly, and making sure rural Americans have good access to care. And he would want an independent third-party to verify that the GOP replacement is superior.

The ACA, he said, has brought coverage to 20 million people and extended the life of Medicare by 11 years, but the more important victories are in the letters Obama receives from Americans who got a mammogram in time to catch treatable breast cancer, or whose child was able to get drug treatment.

“If you can put a plan together that is demonstrably better than what Obamacare is doing, I will support your plan, but I want to see it first,” he said.

Obama’s wide-ranging interview on his signature law came the same day that the Kaiser Health Tracking Poll showed that three-quarters of Americans do not support repealing the law without a replacement in hand, including 47% who don’t want a repeal, period. Despite this, the Senate voted Wednesday 51-48 to start debate on a budget resolution that could set an ACA repeal in motion.

Kliff started off the session by asking Obama why the ACA had not become more popular, even though there are many accounts of how it has helped individuals who were previously uninsured. The president recounted the law’s history—he would have preferred a single-payer system, but instead adopted a model passed in Massachusetts by then-Governor Mitt Romney, a Republican. The president thought since the idea of the individual mandate had originated with the GOP—in fact, it originates with the conservative Heritage Foundation—he would have a better chance a bipartisan support.

Needless to say, Obama recounted, things did not turn out that way. He pointed out that the term “Obamacare” did not start with him—it emerged as an epithet to “personalize” GOP opposition to the law. Instead, the president embraced the term. But he said he has “no pride of authorship” if a future president and Congress can do better.

Polls have shown that while the public remains deeply divided about “Obamacare” nearly 7 years after its passage, opinion shifts when people are asked about individual provisions within the law. Most popular is the fact that parents can leave adult children on their family health plan through age 26. Another popular provision—already embraced by President-elect Donald J. Trump—bars insurers from denying coverage based on preexisting conditions.

Obama explained that keeping these in place without the individual mandate would require huge subsidies for insurers to cover the people who are sick.

The interview also covered parts of the ACA are less well-known by consumers but are key to improving quality and bringing down costs. Obama said:

· System reform is driving down hospital readmissions and proving the benefit of doing what he called “smart follow-up.”

· Support for payment reform, and moving away from fee-for-service, is bipartisan.

· As he stated in an article published in JAMA, Obama believes a public option may be needed for certain markets, especially rural areas, where there’s not enough competition.

· The current system of pharmaceutical research and development produces important breakthroughs, but it allows other countries to be “free riders” who cap drug costs, while manufacturers look to maximize profits in the US market.

· System reform and new payment models are driving down healthcare costs for everyone, but most Americans don’t realize it. Obamacare simultaneously gets blamed for problems in healthcare that have nothing to do with the law, but it doesn’t get credit for the fact that most families have saved at least $3000 because health costs are being contained.

· Use of electronic medical records has not progressed as much as he would have liked, in part because the system is so decentralized but also because some firms make money by controlling patient data. “It’s been a lot slower than I would have expected … in some cases, you have economic incentives against making the system work better.”

Obama said that failing to replace the ACA with something that ensures most Americans keep coverage would work against the 21^st Century Cures Act, which he noted had strong bipartisan support. If the nation funds research to bring new therapies to the market, but it doesn’t ensure that patients can access them, he said, “We’re not helping anybody.”

When asked what his role in the healthcare debate might look like after leaving office, Obama said the most important role of any American is “citizen,” and that local efforts to support the ACA will be needed to counter the loudness of the opposition.

When he is no longer president, Obama said, “I will still be a citizen who remembers what it was like when his mom died of cancer younger than I am now, and who didn’t have all the insurance and disability insurance and wasn’t using the healthcare system enough to have early detection that might have prevented her from passing away.”

(For a transcript of the interview, click here.)