The Obama administration is readily conceding that its signature achievement is not perfect.

The Affordable Care Act could use a few fixes, and the administration is scrambling to lay out a plan that the next president will be able to implement in the coming years.

To be clear, the plan will be most relevant if Hillary Clinton, Obama’s preferred successor, is the next White House occupant. All bets are off if Donald Trump wins the election. While Trump’s own health care agenda remains vague, he has at the very least pledged to scrap the ACA, suggesting he might not take a policy document written by the law’s architect very seriously.

The proposed reforms of the law focus largely on the stability and solvency of the ACA private insurance exchanges. Insurers have complained that the risk profile of exchange customers has been worse than anticipated and led to higher than expected costs. Major insurers have exited state marketplaces as a result, saying they can’t turn a profit.

The 2.1 million people in the marketplace who will have to find new plans as a result of the disruption has created administrative problems as well as political headaches for Democrats that the Obama administration is trying to alleviate.

The document proposes strengthening the marketplace is by reining in abuse of “special enrollment periods” — the exemptions that allow customers to enroll outside of the typical open enrollment period for a number of reasons, including loss of employment or a move.

The administration also outlines ways to bolster the marketplace through the various premium stabilization programs that are part of the law. Some of those programs deliver tax credits to customers in advance, to make sure they stay enrolled. Others help the insurers absorb the losses they incurred by being forced to take on customers, regardless of pre-existing conditions.

Such financial measures that the next president might want to undertake to boost the marketplace may not be easily obtained, however. Republicans in Congress have not only balked at continuing the “risk corridor” programs to help insurers, but they have sued the Obama administration over its disbursement of cost-sharing funds to insurers to provide steep discounts on plans to the poorest marketplace customers.

Despite all the attention given to the problems in the ACA marketplace, it’s important to remember that Obamacare was much more than the creation of an individual insurance exchange. Drew Altman, of the Kaiser Family Foundation, stressed that point in a column Monday in the Wall Street Journal, pointing out that more people have gained coverage through Medicaid than the marketplace since the ACA took effect.

“(R)ecent talk of “Obamacare failing” seems to conflate the marketplaces with the ACA overall. It’s hard to call the entire law, which covered 20 million more people and reformed insurance rules, a failure,” he writes.

Instant Insights /

Obama administration outlines ACA improvements for next president

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