So the 2014 enrollment deadline for the private insurance purchasing exchanges set up by the Affordable Care Act of 2010 sorta kinda ended last night (anyone claiming a need for more time will actually have until April 15), with a characteristic burst of heavy consumer interest and website dysfunction. If, as seemed likely yesterday, enrollment tops 7 million—the original Congressional Budget Office estimate before the massive problems encountered by healthcare.gov last fall—that will be welcome news for the administration. But then we need to see how many of those 7 million pay premiums and actually become insured, and then we’ll have to figure out how many previously uninsured actually got covered by one of ACA’s provisions, and then we’ll get a better sense “winners” and “losers” under the law, and we get to go through the whole cycle of alarms, true and false, over 2015 premiums towards the end of the year.
At TNR today, Jonathan Cohn reminds Obamacare supporters to keep their eyes on the big picture of an epic fight to expand health insurance coverage while getting control of health care costs (this latter challenge is important to all sorts of progressive goals, including long-term budget priorities):
Nobody ever imagined that Obamacare alone would accomplish the goals. The best hope of supporters was that it would produce progress towards them. That’s why Senator Tom Harkin, whose committee helped write the bill, famously referred to the law as a “starter home.”
Four years after enactment, and six months into the final stage of implementation, the starter home may not look great. But it’s weathered the political and technological storms, albeit better in some parts of the country than others, and it is still standing. People are using the new marketplaces to get insurance. And the available evidence—a combination of state-specific data from places like Washington, Kentucky, and New York, along with fuzzy polling data and fuzzier anecdotes—suggests strongly the number of people without insurance is declining.
It’s impossible to tell by how much, so you should ignore anybody, left or right, who claims to know the answer. But the fact that enrollments through the marketplaces are approaching what the Congressional Budget Office and other experts once predicted ought to make you more confident about their other projections. And these authorities predicted the law would mean many more people had real, stable health insurance coverage. One reason, often overlooked in this debate, is that lots of people are getting coverage through other sources—like Medicaid or, if they are young adults, through their parents’ employers—that would not have been available without Obamacare. Another is that conservative stories of several million people losing coverage because insurers cancelled plans last year overlook one key fact: Nearly all of those people got new insurance, usually through the same carriers as before.
At Plum Line yesterday, Paul Waldman argued that we are about to enter a lull in which news of or arguments about Obamacare won’t generate screaming headlines. A day later, CBO issued a new report on the impact of the law on employment that will undoubtedly dwarf positive news about the enrollment numbers at many conservative news outlets. Let’s face it: our friends on the Right have managed to keep the embers of Benghazi! glowing for a year-and-a-half. They will find ways to demonize Obamacare every day at least through November.
So in reality, and certainly in the distorted lens of politics, it’s not time to take stock of the successes or shortcomings of the Affordable Care Act in any definitive way and then move on to other issues. But it’s good to know that despite technological glitches and the complexity of the law and the extraordinary efforts of so many Republicans to gum up the works, Obamacare remains that “starter home” for an effective system of universal health coverage it was intended to be.
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