The Affordable Care Act, better known as Obamacare or ACA, rolled out a year ago amid a firestorm of controversy: Democrats said the health care overhaul would be the most beneficial piece of domestic legislation in decades, while Republicans claimed that it would cause all manner of negative side effects. Now that a year of Obamacare data and experience are available, it's a good time to take stock of the law and assess its successes and failures.
There were many claims made about the Affordable Care Act -- both before and after its rollout. Below we'll break down some of the key statements made by both sides in the runup to the launch date and provide some insight into whether they have proved true so far. It’s a checkup for a landmark law that has defined a presidency.
Fewer Uninsured People
The ACA was touted as a way to get uninsured Americans signed up for some form of health care coverage. The U.S. has long had staggeringly high rates of uninsured people, and the Obama administration said that the health care overhaul would help reduce the ranks of Americans on that list. After a year in effect, Obamacare has done just that, as 8.7 million people have signed up for Medicaid under the law’s Medicaid expansion provision, according to federal officials.
“States that expanded Medicaid have seen a remarkable reduction in the number of uninsured, a drop of nearly 40 percent,” Stan Dorn, a health policy expert at the Urban Institute research nonprofit, told the New York Times.
The number of uninsured Americans has fallen by about 25 percent, or 8 million to 11 million people this year, federal data show, but the number of new people on Medicaid is far lower than it would have been if the U.S. Supreme Court had not ruled that states could opt out of the expansion of the program mandated by the ACA. Data show that about 4 million low-income Americans in the 23 states that chose not to take part in the Medicaid expansion remain uninsured, the New York Times reported. Had they been served by the expansion, most of them would have coverage today. Still, there are millions more Americans with health insurance today than there were in October 2013.
You Can Keep Your Insurance
During the three years preceding the rollout, President Barack Obama repeated variations of: "If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold.” Since Obamacare's implementation, the president has come under heavy fire for making such statements. The concept has become something of a meme in right-wing circles, as critics of the law have claimed that the concept was a bald-faced lie from the outset.
A year after Obamacare went into effect, it appears that Republicans’ prognostications of large numbers of people having their insurance plans canceled were correct. Insurers have canceled millions of Americans’ existing insurance plans since Oct. 1, 2013, analysts said, and Obama’s claim that "if you like your health care plan, you can keep it” was selected as the 2013 “Lie of the Year” by the Tampa Bay Times’ PolitiFact.
Lower Health Care Costs And Premiums
Two of the central arguments in favor of the Affordable Care Act were that it would help drive down skyrocketing health care costs and insurance premiums. Evidence suggests the Obama administration has made good on its promise. In fact, the cost savings have even outstripped initial projections. The U.S. will spend about $4 trillion on health in 2019, the Centers for Medicare and Medicaid Services predicted last month. That’s $500 billion lower than the agency estimated when the ACA was signed into law in 2010. The Congressional Budget Office, CBO, has also revised its health care spending projections downward since the law was passed.
"The plans being offered through the exchanges this year appear to have, in general, lower payment rates for providers, narrower networks of providers and tighter management of their subscribers’ use of health care than employment-based plans," the CBO wrote in April.
Lower costs have led to less expensive premiums, meaning the White House was right on both counts.
Many Republicans have claimed since long before Obamacare went into effect that the law would create a health care rationing system that would lead to long waiting times for patients, shortages and other problems. Many politicians still claim it will, but the truth is that rationing was never intended to be a part of the national health care system, and it hasn’t proved to be in practice.
Rationing implies that doctors will withhold care from patients in need based on some kind of shortage, with preferred patients getting better treatment than others who would receive limited care. That has plainly not taken place. The creation of an Independent Payment Advisory Board, IPAB, has been seen as the public face of the supposed rationing regime, but it is only aimed at controlling future Medicare costs and the ACA requires that it not “ration care.” The whole idea of rationing is simply a farce, and the law states that even the IPAB “shall not include any recommendation to ration health care.”
And you can forget about Sarah Palin's infamous "death panel" fearmongering: Granny isn't going to have her fate handed over to Obama administration bureaucrats.
Health Outcomes Will Improve
Many of the changes implemented under the Affordable Care Act have had real results already, but some of its greatest impacts will not be widely noticeable until it has been in effect for years. The White House said that Obamacare would improve Americans’ health, but so far it has been difficult to determine whether better health will be a part of the law’s legacy.
Most observers and experts say that the law has not been in place long enough to draw a conclusion about its impacts on health outcomes, but it has appeared to help young people by allowing them to stay covered under their insurance policies until they turn 26, according to the New York Times. The paper reported that economists have found that slightly more young adults have been getting checkups and seeing doctors. And the federal Behavioral Risk Factor Surveillance System shows that young college graduates are “far more likely to report excellent health (an important indicator of future sickness and mortality, experts say), to have a primary care doctor, and to go to the doctor regularly than before the law.”