We looked back at our favorite Obamacare predictions to see how they hold up in 2020. The results weren’t always pretty, but would you have ever guessed how important that one season of reality TV would be for Blagojevich?
10. 25 million people would sign up for Obamacare plans
Not even close
The law’s insurance marketplaces never came close to hitting the projection from the nonpartisan number-crunchers at the Congressional Budget Office.
Sign-ups have never topped 12.7 million, and enrollment has shrunken mildly since that peak in 2016, suggesting the marketplaces have, for now, hit a ceiling. The market never really expanded beyond those who received generous federal insurance subsidies. The CBO predicted that 4 million people would entirely pay their own way on the federal exchanges by 2016, but the actual number was closer to 1.3 million last year.
“Arguably, Congress was overly stingy” said Sabrina Corlette, a researcher at Georgetown University’s Center on Health Insurance Reform, arguing that the subsidies just didn’t reach enough people. Case in point: California saw new enrollment in its marketplace soar 41 percent this year after it began providing premium subsides to more middle-income people.
At least two other important factors limited marketplace enrollment. The individual mandate penalty, before it was repealed, never pushed people to get covered as much as predicted. Also, employers were reluctant to dump workplace plans and send people onto the exchanges to buy their own coverage.
9. Obamacare is a job killer
Depends on who you ask
Republicans warned the law’s mandates and new taxes would shrink the economy and kill jobs. Hardly. The private sector has grown every month since the law’s passage — at least until the virtual nationwide shutdown from coronavirus. Health care industry jobs fueled much of that growth in the past decade.
In the law’s early years, Republican seized on a 2014 CBO projection that Obamacare would mean the equivalent 2.5 million fewer employers within a decade. Republicans for years claimed that was proof the law would kill jobs, but the CBO was accounting for people who would voluntarily stop working or log fewer hours because they would have a new affordable source for health insurance.
In 2017, Stanford University economists found the law’s impact on jobs was close to nil. While some workers reduced their hours, a nearly equal number increased their hours to move off Medicaid and onto the exchanges, they said.
Casey Mulligan, a conservative economist at the University of Chicago, argued the law’s employer mandate, requiring businesses of at least 50 full-time workers to provide coverage, kept a lot of small businesses from hiring more. And that the growth in health care jobs isn’t necessarily a good outcome, since that may have pulled money away from other sectors of the economy that might have benefited.
8. Obamacare would save the government $143 billion
Only if Congress kept the unpopular stuff
During Obamacare’s drafting, central to Democrats’ argument for the law was the idea that it would actually be a budget saver, despite its hefty new spending on insurance subsidies and Medicaid expansion.
It doesn’t seem to have worked out that way, in large part because Congress has repealed or delayed many of the provisions that would have raised revenue. Roughly half of the projected CBO savings came from a long-term care insurance program that was quickly shelved when the Obama administration determined it was financially unworkable. Congress on a bipartisan basis had also delayed taxes on health insurers and medical devices in the past decade until killing them off for good last year, blowing an estimated $373 billion hole in the budget the next decade.
All of this has made it impossible to discern the law’s effect on the federal deficit. The CBO has long since given up, telling Congress in 2016 that such estimates were becoming “more challenging and less meaningful.”
7. Families would save $2,500 per year on health insurance
Not so much
Candidate Barack Obama in 2008 repeatedly claimed that his health care plan would save families up to $2,500 per year on their premiums.
Obamacare critics have spent more than a decade pointing to rising premiums in workplace health plans — now over $20,000 for the average family — as proof Obama was wrong. Obama’s defenders say he didn’t mean people would see a $2,500 cut in their premiums — rather, the slower than expected growth in health costs would translate to savings. The math was always fuzzy, but opponents had an easy attack line.
Here’s one way to think about this: The average employer premiums increased 26 percent between 2009 and 2014, when the Obamacare exchanges opened, but grew at a slightly slower pace of 22 percent in the following five years, according to the Kaiser Family Foundation. That slowdown in growth saved the average family about $1,000 per year. Not bad, but definitely not $2,500.
Of course, it’s hard to say how much of those savings could be attributed to Obamacare measures promoting more efficient care. Economists have cited other factors, including hangover effects from the Great Recession and other changes in the industry, like the explosion of high-deductible plans requiring patients to pay more from their own pockets for care.
6. Long waits to see a doctor
Worst fears never materialized
Some of the law’s critics predicted there just wouldn’t be enough doctors to care for all of the law’s new insured patients. Some Obamacare proponents argued the law’s plan to boost pay for primary care providers would alleviate the physician shortage.
That didn’t quite work out. The nation is still facing a shortage of primary care physicians and wait times did increase. Two 2017 studies, from JAMA Internal Medicine and the New England Journal of Medicine, found that Medicaid and privately insured patients experienced a slight increase in wait times since Obamacare’s coverage expansion took effect in 2014. But the NEJM study found more appointments were available to Medicaid patients and the rate stayed about the same for privately insured patients.
The upshot: Obamacare certainly didn’t buckle the health system. While wait times in some areas may have increased, there has also been a boom in urgent care clinics to help meet demand.
5. Obamacare was a step toward single payer
Stay tuned
In a rare instance of a bipartisan agreement, top congressional leaders at the time said Obamacare laid the foundation for single-payer — albeit for different reasons. John Boehner said the ACA set up the infrastructure for the government “to eventually take control of all of our health care.” Harry Reid, a few years after the law’s passage, said it was a “step” toward nationalized health care.
Many on the left, fed up with ever-climbing health care costs and that 30 million Americans remain uninsured, are embracing a Sen. Bernie Sanders-style “Medicare for All” plan that would provide generous government insurance to virtually everyone. But many Democrats still view the idea skeptically, wary of its price tag and taking away private insurance.
Still, a government-run insurance alternative known as a public option, which a decade ago was considered too radical for Obamacare, now has broad support among moderates. And you’ll find many progressives who say a public option is the next logical step to single payer — that was essentially Sen. Elizabeth Warren’s health care plan. So, put this prediction in the TBD column.
4. The Supreme Court settled Obamacare for good
The jury is still out
There were many who thought the Supreme Court decision upholding Obamacare in 2012, followed by Obama’s reelection that fall, would end existential threats to the law. The first indication that prediction wouldn’t pan out came two days after the 2012 election, when Boehner’s declaration that Obamacare was “the law of the land” sparked outrage on the right.
Since then, Obamacare survived another major threat at the Supreme Court, when the justices in 2015 upheld the law’s insurance subsidy scheme, and a failed repeal effort during Trump’s first year in office. But it’s not out of the woods yet.
Trump still muses that Republicans could repeal Obamacare if they retake full control of Washington. And there’s a more immediate threat to the law: The Supreme Court later this year is set to hear another case that could upend Obamacare.
Ironically, the seeds of the latest challenge were sowed by Chief Justice John Robert’s 2012 decision upholding the individual mandate penalty as a tax. A group of red states, with the full support of the Trump administration, argue Congress’ decision to eliminate the penalty in its 2017 tax cut invalidated the individual mandate — and that the entire law must be struck.
The lawsuit was once seen as a longshot, but it’s gained traction with Republican-appointed judges who have reviewed it. Roberts, just like in 2012, could hold the fate of the law in his hands.
3. Medicaid expansion too good a deal for states to pass up
Not for some
When the Supreme Court in the same 2012 case also ruled the federal government couldn’t force states to expand Medicaid, few Obamacare supporters predicted that even red states opposed to the law would refuse the program. After all, the federal government was paying at least 90 percent of the program’s costs — what state could pass that up? Some liberal pundits dismissed early refusals from Republican governors as brinksmanship, but the resistance has remained strong for a bloc of states.
“I don’t think anybody anticipated the breadth and depth of political opposition that arose against this,” said Corlette, the Georgetown researcher.
Fourteen states still have not expanded Medicaid, leaving about 4.5 million people without access to the program in those states. There are cracks in the resistance though. Since Trump’s election five states have expanded Medicaid, including four through ballot measures. Three more states — Kansas, Missouri and Oklahoma — could join the program this year.
2. You can keep your insurer/doctor if you’d like
Epically wrong
This is the most infamous prediction tied to the law. Obama’s assurances that people wouldn’t lose their doctor or insurer under the law were far too sweeping, and an estimated 4 million people received cancellation notices from health plans in 2013 as the law’s robust benefit requirements kicked in. PolitiFact labeled it “Lie of the Year,” and Obama apologized for the promise.
The law did grandfather plans for people who purchased insurance before Obamacare was enacted, but the plans lost their protection if relatively minor changes were then made. To deal with the political uproar over plan cancellations, the Obama administration allowed an exception for these plans to continue — an allowance that exists today. Roughly 1.3 million people still have health plans that don’t conform to the law’s requirements.
Insurance experts think that politically calculated decision to extend the old plans may have hurt Obamacare’s marketplaces in the early years. The older plans did not have to comply with many of the law’s requirements, such as protections for preexisting conditions, meaning the younger and healthier in those plans were likelier to keep the coverage while older and sicker customers gravitated toward robust Obamacare coverage.
1. Obamacare’s demise
The law keeps going
Republicans predicted the law would collapse under its own weight. Trump during his first year in office said the law was “imploding” before later declaring against all evidence that it’s “dead” and shouldn’t even be talked about anymore.
Obamacare is still very much with us, and in many respects is stronger than it’s even been — unless the latest lawsuit kills it. Years of skyrocketing premiums have given way to modest declines in the past two years, and more insurers are signing up to sell coverage. HHS Secretary Alex Azar, who previously said Obamacare was “circling the drain,” boasts about how well the administration is running the law, even though insurance experts say the marketplaces have matured as they always expected.
Despite turbulence around the law — the repeal efforts, the court challenges, the early HealthCare.gov struggles — the marketplaces seem to have stabilized. That’s largely thanks to its generous insurance subsidies, which have created a reliable base of customers shield from high premiums.
Democrats not thrilled about Medicare for All have called for extending subsidies to more of the middle class. There’s little support for the idea among Republicans, who say Obamacare is too expensive and people need cheaper options.
So, as Obamacare leaves its first decade, there’s one prediction we feel confident making about its second: You can keep your partisan fight over health care.
Source: politico.com
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