Last week on Fox News Sunday, Independent Sen. Angus King from Maine made a smart observation that has escaped almost all other politically minded Americans: “There is no such thing as Obamacare.” King was pointing out the Affordable Care Act is a bundle of reforms, not one type of insurance plan. One of the reforms mandates that people have insurance or be subjected to a fine. That deadline passed on Monday. With the first open enrollment period now closed, it seems like an opportune time to evaluate the ACA thus far.
The best approach to policy evaluation is to first decide if the law is doing what it aimed to do: lower the rate of the uninsured. According to Gallup, the uninsured rate peaked in 2011 at 17.5 percent. Now, the uninsured rate is 15.9 percent. Opponents of the law point to uncertainty regarding whether the newly insured have benefitted directly from the ACA. It’s possible that some lost their plans after the rollout began and are not newly insured.
There’s a flipside to that argument conservatives ignore. The signup figures count applications—actual plans will in many cases cover more than one person. So, the actual number of people getting insured because of the ACA should be higher than the enrollment figures project. Plus, there’s the fact that some states have refused to expand Medicaid, an essential feature of the law. It’s unclear how many people who enrolled in the program would otherwise go uninsured, or how many are missing out on coverage because of noncompliance.
Others criticize the drop in the uninsured rate as a result of the slow, steady economic recovery. Since the recession peaked in 2010, those who are newly insured might be benefitting from better employment opportunities thanks to the recovery. If that’s true, the ACA must not be as costly as these critics suggest. It’s either due to the ACA or the improving economy—both pluses for the administration.
In his 2015 budget, unveiled yesterday, Rep. Paul Ryan (R-Wis.) cites a CBO report suggesting the ACA will reduce productivity, punishing higher incomes with lower insurance subsidies. This approach ignores the divorce between practicality and policy. CEOs don’t make decisions to hire based on the fact they might get some obscure tax credit if they do—and people don’t plan salaries around a few hundred dollars in a subsidy. At the margins, maybe there is some possibility they do. It is, however, highly unlikely people will make decisions based on that calculation.
Problems with the law do exist, and Democrats are under pressure to address concerns. For one, it’s unknown how many of the seven million or so enrollees have paid their first bill, activating coverage. Lowball figures put the number between four million and six million. This excludes the coattail factor described earlier, in which single plans cover multiple people. The most legitimate concern remains the demographics of enrollees, which could cause insurers to raise premiums in 2015. That would pose real threats to the economy and the law. At this point though, these claims are all speculative—the evidence is about as indisputable as what happened to MH flight 370.
The ACA has been a success, and not just because the uninsured rate is dropping. The real reason is because, no matter what, the United States isn’t going to go back to the way things were. Many parts of the ACA, such as staying on parents’ health plans until age 26, are extraordinarily popular, as are other provisions in the law. These things are here to stay, and any Republican alternative will have to respect that. Now, the messier details of the law could be subject to change—obviously the administration has seen fit to adjust the law 38 times on its own. Changing, though, isn’t the same as repealing. Healthcare reform is here to stay—and if the goal was reform, then in the words of another controversial U.S. president, “Mission accomplished.”