In an article that "is apparently the first by a sitting president to be published by the [Journal of the American Medical Association (JAMA)]" according to NPR, Barack Obama, JD, reviews the effects the Affordable Care Act (ACA) has had since it was passed in 2010. He notes, "Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms." The article goes on to describe remaining "major opportunities to improve the health care system," including offering a government-run insurance plan, the so-called public option, as part of the ACA. While Obama advocates for Congress to revisit the idea of "a public plan to compete alongside private insurers in areas of the country where competition is limited," the public option has been controversial thus far and was dropped from the health law prior to its passage because of fears it represented a step toward fully government-run system.