Mark Twain famously responded that a report of his death “was an exaggeration.” He had nothing on Obamacare.
At one time or another during his tenure, President Donald Trump declared the Patient Protection and Affordable Care Act dead, ended, terminated and obliterated. “What we really have left is the carcass of Obamacare,” Trump told Fox News a year ago. It was, in his words, a disaster and a joke.
“Has anybody heard of Obamacare?” Trump mocked at a campaign stop in September.
20 million insured Americans
Supporters of the Affordable Care Act rally outside the Supreme Court in 2015.Brendan Smialowski/AFP via Getty Images
Actually, that would be a most definitive yes — particularly for the 20 million Americans who have health insurance today thanks to the 11-year-old federal sponsored health insurance program that was a signature achievement of President Barack Obama. Either by expanding Medicaid enrollment or providing government discounts (tax credits) on health insurance plans, the law has been effective at reducing longstanding health coverage deficits among the poor and people of color.
It made health care more affordable to millions of Americans with ailments such as high blood pressure or lung disease who had previously been denied health coverage by insurance companies for their preexisting conditions. And the law specified that adult children until age 26 be covered under their parents’ plan. The law also did away with annual and lifetime dollar limits on insurance payouts.
Some very thorough studies have found that the ACA produced clear benefits in overall health and mortality reduction among Americans.
These are all the reasons Obamacare has remained popular among most Americans despite relentless attacks from opponents, particularly Trump, who made a campaign promise (thankfully unfulfilled) to kill it.
Health care during COVID-19
President Donald Trump signs an executive order to loosen restrictions on the Affordable Care Act in 2017.Alex Wong/Getty Images
Trump and a Republican-led Congress worked hard in 2017 to cripple the ACA by zeroing out a tax penalty aimed at compelling more people, particularly the healthiest, to buy health insurance.
The ACA goal was to generate broader participation in the government insurance exchanges so more than just sick people were being insured. Broad participation was meant to ultimately reduce overall insurance costs.
Whether the result of the so-called individual mandate’s demise, insurance carriers did flee the health insurance exchanges in the early years of Obamacare. But amazingly, that trend appears to have reversed, perhaps in part because of healthy new enrollees seeking coverage during the pandemic. To help those Americans, President Joe Biden did what Trump refused to do — reopening enrollment after taking office. Regular annual enrollment is during a 45-day period at the end of each calendar year. In more than a month of the reopened period, over 528,000 people signed up through HealthCare.gov.
Constitutional challenges to the ACA have twice failed and a third might also not succeed. A majority of justices indicated during oral arguments in November that however they rule on a portion of it, the basic law will survive. A decision is expected by June.
All the resilience in the world doesn’t mean Obamacare has been a total success.
At least 29 million Americans remain uninsured, in part because a dozen states still refuse to participate in that portion of Obamacare that provides federal funding to expand Medicaid coverage.
High health care costs
On 11th anniv., Biden extends Obamacare enrollment
In addition, the law failed to stem the nation’s rising health care costs, one of Obama’s goals.
And deductibles for some of the affordable plans sold on the exchanges have remained intolerably high, up to $8,150 for individuals and $16,300 for families. Surveyed enrollees say they appreciate the security of health insurance, but still avoid medical visits to reduce out-of-pocket costs.
To their credit, Biden and the Democratically controlled Congress created at least a temporary fix with passage of the COVID-19 relief bill, which increases tax subsidies for purchasing health insurance on the exchanges and expands the number of people eligible for those subsidies. The expanded tax credits effectively create free health insurance for at least 7 million Americans, according to Vox, and allow people to purchase premium health insurance plans with lower deductibles.
But it’s a temporary fix through 2022 unless Congress extends it.
The mantra through the Trump era was to repeal and replace Obamacare. Opponents failed on the first despite more than 60 votes to repeal and never came up with a better alternative.
There are more radical options that progressives are pushing such as a single-payer, government-run insurance program. And there’s a Biden proposal that would allow all Americans the option of enrolling in government health care.
Until something better comes, Obamacare, for all its flaws, is alive and well and working.
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5:05 am UTC Apr. 9, 2021
8:03 am UTC Apr. 9, 2021