Is the Affordable Care Act (ACA) working? Is it doing what President Obama and other supporters promised?
Depends on who you ask.
Recently released figures seem to be tipping the balance in favor of Obamacare. Backers of the program are touting those numbers, saying they prove the ACA has succeeded on virtually every level.
Opponents say Obamacare itself has not significantly increased the number of people with health insurance. Nor, they say, has it been the catalyst to higher quality care and less expensive coverage that supporters claim.
The program has been in the public spotlight since the ACA was passed in 2010.
The law is back on the front pages this week, too.
On Wednesday, the U.S. Supreme Court will hear arguments on whether the subsidies issued by the federal government to help people pay for health insurance are legal. The ruling only addresses the federal exchange website healthcare.gov, not state-run insurance sites.
The court is expected to issue a ruling in June. Up to 10 million people could lose their coverage if the subsidies are outlawed. Because of the law’s hot-button status, people in the medical field on both sides of the issue are reluctant to be interviewed on the subject.
Healthline reached out to the American Medical Association, the Physicians Foundation, the Kaiser Family Foundation, the federal department of Health and Human Services (HHS), Consumer Reports, and America’s Health Insurance Plans.
None provided an expert to comment on the status of Obamacare.
The closest is a statement released on Feb. 18 by HHS Secretary Sylvia Burwell.
“The Affordable Care Act is now an important part of the everyday lives of millions of Americans,” Burwell stated. “They finally have the financial and health security that comes with affordable health coverage.”
Politicians, on the other hand, aren’t hesitant to provide their opinions on the law. Neither are columnists and bloggers.
“Now statistics for the second year are largely in hand and the verdict is indisputable,” wrote Steven Rattner in a Feb. 21 editorial in the New York Times. “Its disastrous 2013 rollout notwithstanding, the Affordable Care Act has achieved nearly all of its ambitious goals.”
Critics don’t see it that way.
“No matter how badly you want something to be true, simply wishing will not make it so,” wrote Michael Tanner last month in the conservative National Review. “This is a lesson that Obamacare supporters need to learn, as they tell us yet again that the Affordable Care Act ‘is working.’”
Enrollment Numbers Tell the Story … Sort Of
There’s no shortage of figures on enrollment, uninsured Americans, doctor participation, premium rates, healthcare costs, and other issues.
During the latest sign-up period from Nov. 15 to Feb. 15, almost 11.4 million Americans either signed up for health insurance plans or were re-enrolled in their current plans.
That’s 3 million more than in 2014.
However, it’s estimated that about 12 percent of the new enrollees will become ineligible because they won’t make their first insurance premium payment.
The White House has trumpeted the numbers, but opponents say they’re misleading.
In his National Review column, Tanner wrote the number of enrollees is primarily due to the federal subsidies offered to offset costs for those buying plans.
“If you subsidize something, you should expect to get more of it. And Obamacare heavily subsidizes health insurance,” he wrote.
Tanner adds that 60 percent of people newly insured through the ACA are actually being enrolled in Medicaid, the federal healthcare program for low-income households. He notes an analysis by Health Affairs shows only 69 percent of physicians accept Medicaid patients.
A Feb. 18 column on Investors.com also downplays the enrollment numbers.
It states that, before Obamacare, 16 million people bought insurance on the individual market without government encouragement or subsidies. The authors say many of those people shifted their coverage to ACA plans.
“Creating a class of people dependent on government for things they used to be able to afford on their own is not a sign of progress,” the column states.
Supporters, however, say the numbers speak for themselves. They say there are millions of people who don’t have insurance through a company and don’t qualify for Medicaid who can now get care.
“For the over 10 million adults between the ages of 18-64 who are now insured, the numbers are not mere statistics,” Keith Brekhus wrote in a Dec. 4 column on PoliticusUSA.
“They are opportunities for better health, obtaining necessary medications, and enjoying a longer life. Despite all the criticisms heaped upon ‘Obamacare’ by the charlatans and naysayers on the far right, the program is working as intended. For most Americans that is a good thing.”
Uninsured Down, Choices Up
Supporters also point to figures showing the number of Americans who are uninsured has declined by about 30 percent.
Before the Affordable Care Act, there were 42 million Americans who didn’t have health insurance. That number has dwindled to between 28 and 30 million.
Of those, about half are eligible for ACA coverage, according to a December 2014 study by the Kaiser Family Foundation.
“Every serious method of measuring has shown the law effecting significant reductions in the uninsured rate,” wrote Jonathan Chait in the Daily Intelligencer.
Supporters also say Americans now have more choices in healthcare coverage.
This year, there’s a 25 percent increase in the number of “issuers” of health insurance on the ACA site. HHS officials say 91 percent of consumers using the site can choose from among at least three providers, compared to 74 percent in 2014.
There are also 40 plans to choose from now, compared to 30 plans last year.
Are Healthcare Costs Getting Under Control?
Supporters say Obamacare is finally reeling in the skyrocketing cost of healthcare. The United States spends more per person on healthcare than any other high-income country, at nearly $9,000 a year.
The Kaiser Family Foundation reported that as of January premiums had risen only an average of 2 percent for current coverage.
“A surge in health insurer competition appears to be helping restrain premium increases in hundreds of counties next year, with prices dropping in many places where newcomers are offering the least expensive plans,” reported Kaiser Health News.
Federal officials add that 65 percent of ACA enrollees can get coverage for $100 or less per month after tax credits if they shop around.
In addition, the Kaiser Foundation reported 46 percent of people who switched coverage had lower premiums, while 39 percent had higher premiums and 15 percent had the same.
A survey by the Commonwealth Fund reported the number of Americans who had trouble paying their medical bills has dropped from 75 million in 2012 to 64 million last year.
Federal officials say healthcare spending in 2014 grew at the slowest rate since recordkeeping started in 1960.
They add that consumers have saved $9 billion since 2011 because the ACA requires insurance companies to spend 80 cents of every dollar on customer healthcare.
Opponents again point out that subsidies that have cost taxpayers billions of dollars have helped prop up the system.
Supporters Acknowledge Some Things Need to Change
Even Obamacare supporters acknowledge there are things that need improvement.
For one, the number of Hispanic and African-American enrollees is still low.
Federal officials reported in late January that 10 percent of ACA website sign-ups were from people who identified as Latino. California officials said 50 percent of people eligible for Covered California were Latino. However, only about 28 percent of sign-ups were from people in that ethnic group.
Moreover, more young adults who don’t need a lot of health-related services must be added to prop up the older enrollees who do need to visit the doctor a lot.
At the end of January, federal officials reported that about 26 percent of people who enrolled through the ACA website were between 18 and 34 years old.
There’s also the controversial tax penalty.
About 6 million Americans are facing a penalty on their income taxes this year for failing to sign up for health coverage last year, according to a story in the New York Times.
The fine this year is $95 per person or 1 percent of income, whichever is higher. Next year, the fine rises to $325 per person or 2 percent of income.
In addition, federal officials acknowledged last week that they had sent incorrect tax information to 800,000 people who purchased healthcare coverage in 2014 through the ACA website.
The issue has caused enough concern that federal officials are offering people facing tax penalties an extra chance to sign up for healthcare coverage between March 15 and April 30. Several states, including Washington and Vermont, are offering similar extensions.
Despite these hurdles, HHS Secretary Burwell and other supporters of Obamacare still shout its praises.
“While we have more work to do, the numbers tell the story, and the story is clear,” said Burwell. “The Affordable Care Act is working, and families, businesses, and taxpayers are all better off as a result.”