Has Obamacare been a success?

What’s happening

President Biden has always considered the Affordable Care Act (ACA), the major health care overhaul commonly known as Obamacare, to be a “big f***ing deal.”

Over the weekend, he marked the 14th anniversary of the bill’s signing, not with a celebration but with a warning that it could be at risk if Donald Trump regains the presidency.

In 2017, Trump came within a single vote in the Senate of fulfilling his campaign promise to repeal the “broken mess” of health care reforms passed by his predecessor. Though that effort failed, he was able to chip away at certain provisions of the law during his time in office. Still, the core of the ACA remains intact and has even been bolstered under Biden.

Trump has given mixed signals on whether getting rid of the ACA is still one of his goals. Late last year, he wrote that “Obamacare Sucks!!!” and said he is “seriously looking at alternatives” if he becomes president again in separateposts on Truth Social. On Tuesday, however, he claimed that he’s not “running to terminate” the law but instead to make it “MUCH, MUCH, MUCH BETTER FOR FAR LESS MONEY.”

Trump’s hedging could be a response to how much the public’s opinion of the ACA has improved since the GOP tried to repeal it. Some Republicans even worried that Trump’s criticisms could hurt him and the party in the 2024 election.

Passed in 2010, Obamacare made major changes to how the U.S. health care system works. It prohibits insurers from denying coverage because of preexisting conditions, established a list of “essential health benefits” that must be covered, ended annual and lifetime spending caps, created exchanges for patients to find a health care plan and expanded Medicaid eligibility so millions more low-income Americans qualify for government-funded health insurance.

Opposition to Obamacare was one of the defining issues for the GOP in the early 2010s, and the GOP's message — some of it based on false claims about what was in the bill — resonated with the public. In 2013, just one-third of Americans had a favorable view of Obamacare. Today, nearly 60% of voters approve of the law.

Why there’s debate

While Obamacare seems to have become a net positive for Democrats politically, there’s still plenty of debate over whether the ACA improved the American health care system.

Obamacare’s proponents say it’s been a major success in its number one goal: making health insurance more accessible. Since the law was passed, the rate of Americans without health insurance has been cut by more than half and last year a record 40 million people got coverage through provisions created by the ACA. Advocates add that the law also ended some of the most egregious practices of the insurance industry.

Obamacare’s detractors are quick to point out that the U.S. still spends about twice as much on health care — and gets worse results — than other wealthy countries.

Arguments for why that’s the case differ based on political ideology. Conservatives contend that the ACA has contributed to skyrocketing health care costs because it reduced consumer choice and robbed insurers of important mechanisms they were using to keep premiums down. Critics on the left, however, say Obamacare is a failure because it left the country’s for-profit health care industry in place, rather than establishing a truly universal system.

What’s next

Democrats view protecting Obamacare as a winning message for them in the upcoming election, but the GOP’s apparent hesitance to engage on the topic could limit how much the issue resonates with voters when they cast their ballots in November.

Perspectives

Increasing coverage isn’t enough if people can’t afford care

“Above all, one thing remains clear: ACA supporters fail to recognize that increased access to health insurance does not simply equal access to affordable health care services. Surely, the American people deserve better.” — Brian Gomez, CT Mirror

The ACA would be more effective if the GOP hadn’t spent a decade making it weaker

“Not everyone who wants insurance is able to purchase it, and many who have insurance are still struggling with out-of-pocket costs. Some of these challenges are because of shortcomings in the drafting of the ACA; others are a consequence of the GOP’s relentless sabotage efforts.” — Catherine Rampell, Washington Post

Obamacare is far from perfect, but we’re still better off because of it

“Without a replacement health care program — which the Republicans have never proposed — the old system in which health plans in the individual market were empowered to reject coverage for people with preexisting conditions or charge them inflated premiums would return.” — Michael Hiltzik, Los Angeles Times

Republicans have had to invent criticisms because the ACA is so effective in reality

“Conservatives spent years attacking Obamacare for a series of mostly imagined design flaws. They claimed it would create death panels, or drive up health-care costs, or fail to reduce the number of uninsured people. None of these predictions came true. Indeed, the cost of health care has come in significantly lower than the law’s designers forecast.” — Jonathan Chait, New York magazine

Under the ACA, we pay more for the same quality of insurance

“The reality is that ObamaCare has increased healthcare costs while producing few tangible benefits for patients.” — Editorial, Wall Street Journal

Obamacare shouldn’t be eliminated, but it needs to be rolled back significantly

“With Obamacare now entrenched, it would be inapt to frame the conversation in terms of root-and-branch ‘repeal.’ Instead, Republicans should seek a health-care system that is more decentralized, patient-centered, and efficient — and be willing to undo aspects of the health-care law that get in the way of achieving this.” — Editors, National Review

The ACA’s heavy-handed government intervention has made health care even less affordable

“No one would believe a politician who claimed that new government-mandated regulations, features and amenities on new cars would lower car prices. The new features and amenities might be nice, they might even make a car safer, but they would increase a car’s cost. And that increase would price some people out of the market. The same is true of health insurance. Government insurance mandates come with a cost. And a lot of mandates come with a big cost.” — Merrill Matthews, The Hill

Americans have less power to decide what health insurance is best for them

“Big Government is a home game for Big Business. Obamacare means consumers have fewer choices.” — Timothy P. Carney, Washington Examiner

Any reforms that leave the for-profit insurance intact are bound to fail

“Over a half-century of such well-intentioned, piecemeal policies has made clear that continuing this approach represents the triumph of hope over experience. … The only solution is universal coverage that is automatic, free and basic.” — Liran Einav and Amy Finkelstein, New York Times