President Obama is enlisting the help of some health insurance companies to try to fix the Affordable Care Act, better known as Obamacare.

Obama dropped by a meeting between the Secretary of Health and Human Services Sylvia Burwell and 13 health insurance CEOs, including the CEOs of giants Humana and Cigna, to emphasise the need to work together on the ACA’s public marketplaces.

Recently, a number of high-profile insurers have rolled back their offerings on the Obamacare exchanges. This has led to questions about the long-term sustainability of the ACA.

In addition to the meeting, Obama sent a letter to every health insurance CEO that is participating in the exchanges, asking for their help with improving the exchanges.

Obama acknowledged there have been struggles during the first few years of the exchanges.

“We know that this progress has not been without challenges,” said the letter. “Most new enterprises have growing pains and opportunities for improvement. The marketplace, while strong, is no exception. Time and experience will help drive that improvement, as will constructive policy changes.”

Obama said that Secretary Burwell was working on making needed changes, as was his administration, but that the government needed their support to make it work.

“To that end, I want to enlist your help as we head into this fourth annual open enrollment period,” said the letter from Obama. “We know that signing up more uninsured Americans for coverage generates benefits all around.”

It continued by saying that the administration is attempting to address some challenges, including the fact that fewer than expected young people are signing up through Obamacare, making it costlier than projected for insurers. Here’s Obama (emphasis added):

And since the remaining uninsured are disproportionately younger and healthier, signing them up improves the risk pool and consequently the affordability of coverage for all enrollees. Secretary Burwell has developed a data-driven plan to find and enroll those who still lack coverage, including by stepping up the outreach activities that worked best over the last 3 years; working with the Department of the Treasury to reach out to uninsured people who paid the individual responsibility fee for 2015; and increasing our focus on enrolling young adults. We are also hosting a Millennial Outreach and Engagement Summit at the White House on September 27focused exclusively on how to enroll more youth in the Marketplace during open enrollment. We welcome efforts to increase your outreach during this open enrollment period.”

Obam concluded that the “work is not over” in implementing the ACA.

Of note, the CEOs of Aetna and UnitedHealthcare were not in attendance. Both companies are part of the “big five” nationwide insurers and have announced plans to roll back their Obamacare coverage substantially.

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