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View: There's more to health reform than expanding coverage

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(Bloomberg View) — The numbers are in: The Patient Protection and Affordable Care Act (PPACA) — Obamacare — reduced the share of Americans without health insurance last year to 10.4 percent, down from 13.3 percent the year before. That represents 8.8 million fewer people who risked financial ruin if they needed significant medical care. Most of the improvement came from people getting coverage through Medicaid or the state insurance exchanges.

See also: Uninsured rate drops sharply in some swing states

The figures put to rest the notion that Obamacare would cause more people to lose coverage than gain it. But U.S. health care is by no means fixed. Three substantial improvements are still needed.

First, the uninsured rate needs to be pushed even lower. The people who’ve signed up for Medicaid or exchange coverage are those who have most wanted insurance; the challenge remains to persuade those who are less motivated or don’t understand their options. That includes the parents of the 4.8 million children who were uninsured last year, as well as the 30.6 percent of high-school dropouts and the 19.9 percent of Hispanics who went without. At the same time, all 50 states need to be persuaded to expand Medicaid.

The administration and Congress also have to make sure that people can afford to use their insurance. Copayments and deductibles continue to rise, with almost one in four people saying such costs have led them to put off treatment for a serious condition. Solutions include lower caps on cost-sharing, extending subsidies and even reforming the “Cadillac plan tax” on high-quality employer-sponsored insurance policies, a tax that encourages companies to shift costs to patients.

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Perhaps most important is the need to find ways to deliver care more efficiently — higher quality for lower cost. Obamacare includes pilot projects to experiment with coordinating treatments, and although the results have been mixed so far, that’s only reason to try harder. There’s also room to bring down drug costs by letting Medicare negotiate prices.

These are hard problems that require clever solutions from both political parties. Successful health care reform begins with shrinking the share of Americans without insurance, but that doesn’t finish the job.