As it enters its seventh year, the Affordable Care Act is facing challenges, leading some to speculate that the law will have to change in order to survive.
From insurers leaving federal exchanges to problems getting young, healthy consumers enrolled, the Affordable Care Act has had a bumpy ride of late.
Health and Human Services Secretary Sylvia Burwell acknowledged that changes are needed to improve competition, affordability and access.
"In some rural markets and smaller markets there isn't as much competition and we need to take steps to improve that," Burwell said. “And for some people while the subsidies are very generous and create affordability we think there are places for more assistance and help for working families.”
In August, Aetna announced that it was pulling out of the public exchanges in Florida. The insurer's exit leaves 44 of Florida's 67 counties with just one provider on the exchange.
Burwell says the Obama administration is working to improve competition and considering a public option that would see the government enter the marketplace.
Thirty-two U.S. senators recently signed a resolution calling for a public option.
“The public option is a way that we can, in places where there is not competition, make sure that people have choice and options and I think we think that's an approach,” Burwell said. “We welcome the opportunity to have the conversation about what are the best ways to create additional competition.”
Burwell says gains in enrollment can be made by offering better subsidies for working families and explaining the benefits of health insurance to young people.
"Many of them think about it in terms of just the premiums but people need to think through the issues of the benefits they get in terms of preventative care that's free and also the kinds of things that people want to do in terms of health and nutrition and taking care of themselves and getting access to those services," she said.
Open enrollment begins Nov. 1.