Drawing on a wide range of evidence, Obama states his major, unsurprising findings: 20 million people have gained insurance, bringing the uninsured rate to 9.1 percent in 2015. He notes an increase in the number of non-elderly people who have a physician and access to medicine. He cites a study that found people who gained coverage through expanded Medicaid have greater financial security, reducing the debts sent to collection by $600 to $1,000. His most controversial argument is probably this: He credits the law with helping to control health care spending, a point that has been much debated. It's unclear how much of the slowdown in the growth of health care spending is due to the Great Recession and how much should be attributed to the law or other factors.
Obama acknowledges that work remains to be done to make health care more affordable and to increase competition in the marketplaces where people purchase plans, including by offering a public option like Medicare where there are few insurance providers.
Hardly a month goes by without a handful of studies on how the Affordable Care Act is doing -- how many people signed up for insurance, how people feel about the law, whether it is affecting employment and where gaps remain. Obama's article might be seen as a simple partisan pat on the back, and it does have a point of view, but Jonathan Skinner, an economist at Dartmouth College who wrote an accompanying editorial, said he took it as a real work of scholarship and not just a stump speech.
Skinner said that Obama's point about the expansion of insurance is uncontested; there's no debate that the law succeeded in expanding coverage. Where he and his coauthor, Amitabh Chandra of Harvard University, differ with Obama is on whether the law is containing spending.
"We don't see evidence that it's doing it," Skinner said. The growth in health care spending slowed from 2010 to 2014, but costs have recently begun rising again.
In addition to the slowdown in health spending triggered by the Great Recession, Skinner pointed to the shift to high-deductible health plans, which has been shown in some studies to reduce use of medical care across the board. He also noted that in recent years there has been a marked "exnovation," in which trendy, expensive medical procedures have fallen out of favor for various reasons -- for example coronary artery bypass graft surgery or inpatient back surgery.
Another editorial critiquing Obama's essay points out that although coverage has expanded -- particularly for middle class families that do not qualify for subsidies, health care costs can still be considerable and hard to predict.
"For many households, the president's promise of affordable coverage rings hollow and has not been realized," Stuart Butler, a senior fellow of economic studies at Brookings wrote.
Jim Michalski, a spokesman for JAMA, said in an e-mail that the president did not get special treatment.
"The article by President Obama was treated in the same fashion as other Special Communication articles, including undergoing rigorous internal review, two revisions of the manuscript, and subsequent modifications during the editing process as the revised manuscript was reviewed again by the Editor-in-Chief and Executive Editor," Michalski wrote.
Obama provides recommendations for the future: he'd like to see more competition in the marketplaces, increased financial assistance for people struggling with premiums and expansion of Medicaid in the 19 states that have not done it.
But Obama ends on a note of hope, arguing that "a broken status quo is not the nation's destiny."
The signature law of his presidency, he writes, gives him hope "about this country's capacity to make meaningful progress on even the biggest public policy challenges."
Correction: A previous version of the story incorrectly stated the number of states that have not expanded Medicaid.