A Tsumani of Fake Good News
Really, the ACA is Getting Us There! Just Give Us 500 years!
Today is the fourteenth anniversary of passage of the Patient Protection and Affordable Care Act, better known as the ACA or Obamacare. President Joe Biden, the DC-based NGO world and the healthcare press are geared up for a wave of distorted reporting on “progress” made under the 2010 law.
President Biden is joining former President Barack Obama and former House Speaker Nancy Pelosi for campaign healthcare events this weekend, built around the Obamacare anniversary. Here’s a quick reminder of the data that matters when it comes to the ACA.
Since the ACA passed in 2010, the percentage of American adults who have health insurance that actually protects them from financial ruin has barely changed. According to biennial Commonwealth Fund surveys, the percentage of U.S. adults who are insured all year but who aren’t underinsured only grew from 56% to 57% between 2010 and 2022. As reported earlier, that pace leads to everyone in the U.S. being fully covered in around 500 years.
Nevertheless, President Joe Biden’s re-election campaign has embraced the fourteen-year old law for campaign purposes. Earlier this week, Biden launched ads reminding voters of President Donald Trump’s failed attempt to repeal the law. As campaign season ramps up, NGOs like the Center on Budget and Policy Priorities and the Kaiser Family Foundation are busy publicizing this year’s “record enrollment” in ACA marketplace insurance plans.
While CBPP says Obamacare plan enrollment has been “Spurred by Affordability and Outreach Efforts”, KFF at least notes that it’s also “…Driven in Part by Medicaid Unwinding…”
Many states have worked hard to maximize the availability of affordable exchange insurance. However, as Healing and Stealing reported in A Normal Catastrophe: The Great Medicaid Purge of 2023, the end of pandemic eligibility rules has had a much more powerful effect on overall insurance coverage. The number of people who have been kicked off Medicaid over the past year far outstrips the year-to-year increase of roughly 5 million people enrolled in private Obamacare exchange plans.
It’s also true that several million fewer people were uninsured in 2023 than 2014, so we can expect to hear phrases like “the national uninsured rate reached an all-time low” nearly as often as “record ACA enrollment” for the rest of the year. At the same time, the ACA’s failure to control costs has driven deductibles, copays and coinsurance to record heights in employer-sponsored health insurance, Medicare and many of the ACA exchange plans. This dramatic increase in the number of people who are undersinsured largely cancels the gains from the reduction in the uninsured rate.
In the end, what matters about health insurance is whether or not it allows people to get the health care they need. The number of adults ages 19-64 who report skipping at least one of four different types of health care due to cost in the past year is higher now than it was when Obama signed the ACA in 2010.*
The combined un- and underinsurance rate and the data on how many people are skipping care come from the same source - surveys conducted every two years by the Commonwealth Fund. They’re usually released in the summer or early fall. While it’s possible that this year’s data dump will show unexpected improvements in insurance coverage or the number of people forced to skip care due to cost, it’s unlikely. In the meantime we’ll be deluged by a huge wave of fake good news about the ACA’s supposed successes in expanding access to health care.
Beyond expanding coverage through Medicaid and the exchanges, many of the ACA’s broader consumer protections also have struggled to fulfill their promises. Despite the law’s “mandate” requiring insurers to pay for preventive care, the percentage of U.S. adults receiving all of their priority preventive care each year declined from 8.5% in 2015 to 5.3% in 2020.
Biden and federal Democrats are fortunate to be opposed by the Republicans, whose approach to health care consists largely of market platitudes, incoherent screeching that What Democrats Did is Bad, generous helpings of ritual deficit spending denunciation and a decades-long assault on women’s reproductive rights.
All Democrats have to do is ignore the fact that their signature law has done virtually nothing to improve Americans’ ability to see their doctors without going bankrupt, and conjure a few exaggerated numbers. If Trump were somehow to repeal the ACA, 45 million people wouldn’t lose insurance as Biden’s ads claim. That number assumes there was no individual insurance market pre-ACA, among other helium containing assumptions.
But millions of people would, in fact, lose coverage no matter how flimsy or tenuous ACA and Medicaid coverage might be. It’s a gift to Biden that he can campaign effectively just by reminding people that Trump’s signature health care policy is a dumb critique of a failed law that he failed to repeal last time he was in the White House.
The weakness of Biden’s opponent can’t turn the ACA into a credibly successful law. Fourteen years after passage, more adults than ever before are skipping treatment or prescriptions because of cost, even though we still spend twice as much as other wealthy countries on “healthcare”. That won’t stop the tsunami of fake good news from washing over us for the next 8 months.
*The graphic in the original version of this story showed data comparing 2014 to 2022, and the text read “…higher now than it was when Obama signed the ACA in 2014.” The number for 2014 was 36%. Both years were lower than 2022. Healing and Stealing regrets the error.
One minor problem with being young and in relatively good health and is that employer-sponsored insurance is, from a philistine microeconomic perspective, irrational. In 2023, and (god willing) 2024, without major illness, I did not exceed my deductible. Because an (uninsured) annual physical is less than the cost of my deductible and the sole prescription I'm on is relatively cheap for uninsured patients, it would simply be cheaper for me to be uninsured than to have health insurance. Doubtless, I'm one of (maybe) a few million people for whom that's true, but that's a condition that's indicative of the underlying insanity in treating healthcare as a consumable good purchased by rational actors in a free market, rather than a social right.