Obama’s Legacy

Perhaps the single most important piece of legislation passed by President Barack Obama was the Affordable Care Act (ACA), otherwise known as “Obamacare.” The original goal of the ACA was to give more Americans access to affordable, quality health insurance and to reduce the growth in US healthcare spending. But has it worked?

It cannot be denied that the bill has increased the number of people with health insurance. From 2010, when the law was passed, to 2014, the number of uninsured people dropped by around 5 percent (1). The question of whether Obamacare has delivered more affordable health insurance, however, is another matter. Democrats point out that prior to the ACA, if a patient had a preexisting condition, their health insurance wouldn’t cover treatment for that condition – whereas now it is required to. Obamacare also stops insurers from setting yearly or lifetime dollar limits (the amount your insurance company will pay toward a treatment after you have reached your deductible) on essential benefits.

But Republicans argue that, although the number of people with health insurance has increased since the ACA was introduced, the rising cost of deductibles and copayments are also increasing the number of people who can’t afford to go to the doctor or buy the medicines they need when they get sick – rendering insurance useless. Moreover, plans that do offer coverage outside of the insurer’s network are becoming more expensive and harder to find. This tradeoff between coverage and affordability characterizes the Obamacare debate. Hillary Clinton argues that Obamacare is the first step down the road to full coverage, whereas Donald Trump wants to repeal the Act and replace it with “Donaldcare.”

But even after one of the biggest shakeups of the US healthcare system in decades, the pharmaceutical industry has been largely unaffected. When Obamacare was being negotiated, PhRMA – Pharmaceutical Research and Manufacturers of America – supported the bill on the condition that Medicare price negotiations and drug importation would be left out. And the bill almost did not get passed at all. Obama needed 60 votes in the Senate and 218 votes in the House to pass Obamacare; he received 60 and 219 votes respectively. If the President had included wholesale changes to drug pricing, the bill would almost certainly have been blocked by Congress – especially without the support of the pharma industry.

Back then, drug prices weren’t the hot topic that they are now. With both Clinton and Trump supporting, and even agreeing on, policies to curb the rising cost of medicines, the pharma industry may struggle to make it through another presidential cycle unscathed.