No one would claim that the Affordable Care Act rollout has all gone according to plan. The troubles started in the summer of 2012, when the Supreme Court took an ax to one of the main pillars of Obamacare: expanding Medicaid to cover any American earning less than $16,000. The federal government, the court ruled, couldn't force the states to take funding to cover the working poor, leading nearly half of them to boycott the program out of partisan spite. Then, powerful GOP-governed states like Texas, Florida and Pennsylvania refused to set up their own insurance exchanges, foisting the responsibility onto the underfunded healthcare.gov – which failed catastrophically at launch. The Congressional Budget Office downsized its first-year private enrollment projection from 7 million to 6 million people – a bar even administration allies feared could be impossible to clear, leading House Speaker John Boehner to brand the president's signature legislation "a train wreck."
But then something extraordinary happened. That "wrecked" train pulled right into the station. Early. On March 27th, the administration announced that the federal and state exchanges had signed up more than 6 million Americans for insurance plans. Four days later, on the last night of open enrollment, that number jumped past the original goal of 7 million. And that didn't include as many as 9 million people who bypassed exchanges and bought policies directly from insurance companies. "It's been a winding road," says Larry Levitt, a senior vice president at the nonpartisan Kaiser Family Foundation, "but Obamacare is actually working as expected." With support for the ACA growing – in the latest NPR poll, 54 percent either approve of the law or want it to go further – the reality is dawning on the GOP that the law could still prove a wedge issue this fall, against its own electoral interests. "The Republican focus on Obamacare is backfiring," says Stanley Greenberg, a top Democratic pollster, who conducted the survey with a GOP counterpart. "They're on the wrong side of the issue."
For many Americans, Obamacare is synonymous with a buggy website. But consider that the president's health-care law has insured far more people outside the private insurance exchanges – upward of 10 million, beginning with 1 million children with pre-existing conditions who were covered with the law's 2010 passage, and 3 million young adults who have secured coverage on their parents' health plans. Obamacare never did get a public option, but a huge portion of its new enrollees are now on a publicly funded health plan: Medicaid. In the 26 states participating in its expansion, Medicaid now offers comprehensive coverage for anyone earning less than 138 percent of poverty income – $16,105 for individuals or $27,310 for a family of three. More than 4.5 million poor Americans have already gained coverage, and with no enrollment deadline that figure will only grow. Meanwhile, outreach efforts have also brought nearly 2 million very poor Americans out of the woodwork to sign up for Medicaid benefits for which they would already have been eligible.
The law's impact is greater even than these enrollment metrics might suggest: Where insurers previously rejected nearly one in five applicants, today an estimated 120 million Americans with a pre-existing condition cannot be denied coverage. Obamacare also guarantees zero-co-pay preventive care for policies bought on its exchanges. For some young women with modest incomes who take the Pill, the value of these benefits (up to $1,200) is greater than the yearly premiums on a very basic plan (roughly $1,100). Addiction treatment, mental-health care and maternity coverage are all now guaranteed. Even seniors are coming out ahead, having already pocketed an average $1,265 in savings on prescription drugs bought under Medicare.
Far from driving a spike in prices, Obamacare implementation has coincided with a "bend in the curve" of health-care costs that everyone agrees is essential to solving the nation's long-term budget woes. Since the bill's passage in 2010, growth in health-care spending has dialed down to just 1.3 percent – less than one-third the average since 1965 – and the insurance industry's 2014 premiums weighed in at 15 percent less than CBO projections.
The disastrous launch of the $319 million healthcare.gov last October will remain a black eye for the Obama administration. "This has been really wounding," says a former administration official. "We've been engaged in a 50-year war on the role of government. Please do not help the other side!"
The administrative failures of ACA implementation left an untold number of Americans needlessly uninsured. How many? Had all states been as effective as California at signing up private insurance buyers – the state enrolled nearly 20 percent of the national total – more than 9 million would have found coverage. This diminished outcome is not just the fault of the federal exchange but also of states like Hawaii, where a hobbled exchange enrolled fewer than 8,000 people in private insurance, and Oregon, which paid Silicon Valley giant Oracle more than $130 million in federal funds to build an online marketplace. The tech firm botched the job so spectacularly that the state was forced to hire an army of temp workers to process applications – on paper.
Republican Party sabotage has also impeded enrollment. "Obamacare has become so politically divisive that elected officials not only find it to their advantage to oppose the program but to actively undermine it," says Levitt. At least 17 states passed laws to restrict ACA "navigators" – professionals paid to help uninsured Americans enroll in suitable coverage. The difference in the two states with the greatest number of uninsured residents is striking: Where California signed up close to a third of its eligible citizens, Texas limped into March having enrolled just one in 10.
Of course, the Republican Party is so invested in the idea of Obamacare as a failure that it won't allow the truth to get in the way of its messaging. It has deployed hordes of consultants, elected officials and Fox News anchors to recite a litany of talking points that are gross distortions, if not outright lies.
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