8 ways Obamacare has proved its critics wrong

8 ways Obamacare has proved its critics wrong

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Back in the fall of 2013, it wasn’t exactly a bold move to predict Obamacare would turn out to be a complete disaster. Healthcare.gov was busted. Sign-up numbers were dismal. Americans are “not interested” in buying what the president was selling, talk radio host Rush Limbaugh declared on his radio show in late October.

House Speaker John Boehner was a bit more pointed. “When you step back and look at the totality of this,” he said at a November press conference, “I don’t think it’s ever going to work.”

These days, Obamacare seems to be working reasonably well. The Obama administration announced Wednesday that 11.4 million people signed up for private coverage in 2015, an increase of about 3 million from 2014.  We can definitively say that more people have coverage after Obamacare than did before. We also know that people who bought Obamacare say they’re generally pretty happy with their health insurance plans and that they can mostly get a doctor appointment within two weeks.

Looking back at expectations set during the first enrollment shows how terribly pundits and politicians expected Obamacare to go — and how much of the predicted disaster never actually happened.

1) Nobody wants to buy Obamacare

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(William Thomas Cain / Getty Images News)

Rush Limbaugh predicted on his October 24 , 2013 show that Americans would never sign up for the insurance expansion, regardless of whether Healthcare.gov got fixed. He pointed to states like New  York that had functional websites yet, in the first month of open enrollment, few sign-ups.

“There are states out there that are not having any troubles whatsoever on their websites for people to get health insurance,” Limbaugh says in the same show. “The thing remarkable about those states is nobody’s signing up. New York state, nobody has gone to that website to sign up.”

About 8 million people signed up for private insurance coverage in 2014. That number rose to 11.4 million in 2015. This likely had to do with the fact the law has lots of strong incentives to purchase insurance, from government subsidies to a mandate that most Americans need to carry coverage.

It was hard to sign up for Obamacare in 2014. But what too many insured pundits forgot is it’s much worse to be uninsured, or underinsured. And that’s true, too, for the people who saw their plans canceled by Obamacare and then needed to decide whether to sign up for a new one.

2) Obamacare will “never” meet its enrollment goal

“At this pace, the Obama administration will never be able to meet their enrollment goals,” Sen. Orrin Hatch’s office declared in (R-Utah) a November 13 ,2013 press release. The senator described the 106,000 enrollees as “a far cry from the hundreds of thousands of Americans the Administration said would sign-up for ObamaCare by the end of the month.

The disparity between the Obama administration’s projected sign-ups — and the actual people enrolling in coverage — persisted through the end of 2013, as did predictions that the 7 million enrollees goal was unattainable. As my then-colleague at the Washington Post (and now colleague here at Vox) Ezra Klein wrote in November, “Obamacare won’t get 7 million enrollees in 2014 — and that’s okay.”

Those predictions ultimately missed the surge in sign-ups that would happen in late March. When it came down to the deadline, lots of shoppers rushed to buy coverage.

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Enrollment

It is true that Obamacare’s sign-ups did dip below 7 million in mid-2014, a fact that was initially obscured when the federal government wrongly counted sign-ups for dental plans in its figures. But at least at the end of open enrollment, the law was on track with expectations.

So it wasn’t that Obamacare completely missed its sign-up targets. Forecasters, instead, seemed to have missed how strongly the final deadline would motivate enrollment. People who couldn’t get the website to work at the start of open enrollment for 2014 came back later when the site was functional.

3) Obamacare will wreak havoc on the economy

Descriptions of Obamacare as a “job-killing” law have been par for the course ever since the health care law became a law. Politifacts ran the numbers on one Boehner press conference from 2011 and found he used the phrase “job-killing” an average of once every two minutes in describing the Affordable Care Act.

Another version of this argument has to do with part-time workers: since Obamacare only requires employers to offer coverage to employees who work 30 or more hours per week, some expected that companies would slash hours to 29 and dodge the requirement. Obamacare incentives are “creating part-time, not full-time jobs,” the National Federation of Independent Businesses declared last month.

Looking back over the past five years of Obamacare, its hard to find much evidence of Obamacare’s job-killing wrath. As Dan Diamond has written on Forbes, the United States has had 59 consecutive months of job growth since October 2010, the longest stretch on record.  All of this happened just after the Affordable Care Act passed. 2014 — the year that Obamacare’s big provisions kicked in — was the biggest year of job creation in more than a decade.


Does Obamacare get credit for all this job growth? Of course not. The law might have stimulated a bit of growth among health providers (as doctor offices and hospitals prepared for newly-insured customers) but it’s unlikely that health reform is the main driver. Instead, it’s more fair to see this as a rebuttal of the idea that Obamacare would be terrible for job growth.

On the issue of employers slashing work hours, there certainly are anecdotal evidence of some companies making these types of decisions, particularly among school districts. When you look at national level data, however, no particular pattern of reduces hours shows up. This graph shows the number of Americans working part-time jobs who would prefer more hours has declined steadily in recent years.*


obamacare hours

(FRED)

You can also look at the average length of the work-week, which took a nose-dive during the recession but recently recovered to pre-2010 levels.


part time jobs

(FRED)

Here’s how Bloomberg News recently summarized the effect of Obamacare on major American businesses. “The biggest entitlement legislation in a generation is causing barely a ripple in corporate America,” Michelle Fay Cortez and Alex Wayne write. The law “is putting such a small dent in the profits of U.S. companies that many refer to its impact as “not material” or “not significant,” according to a Bloomberg review of conference-call transcripts and interviews with major U.S. employers.

4) The website will never work

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(Joe Raedle / Getty News Images)

“Obama’s healthcare.gov will never work as specified,” Forbes contributor Bill Frezza argued on October 28. He made the case there was no way that the Obama administration could fix the Helathcare.gov mess legally.

“It can only be fixed by breaking the law-the ‘settled law’ Democrats seem so fond of these days,” he writes there. “Someone has to decide which rules and regulations to ignore and which to enforce, which to enact and which to delay, who is to be exempted and who is to be railroaded.”

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Frezza’s warning was among a chorus of the first wave of failure predictions: that Healthcare.gov wouldn’t be fixed any time soon — if ever.

Healthcare.gov was definitely a disaster during its first two months; only six people managed to sign up on its first day. But it was essentially fixed by the end of November, when most people were able to use the website to purchase health insurance coverage.

The White House kept working on Healthcare.gov into this new open enrollment period. It simplified the application. The form that, last year, took applicants through 76 different screens of questions and answer boxes has been pared back to 16 pages.

“In the old application, someone would submit an answer, it would get sent to the data services hub and then it might hourglass or [users would] have to wait between questions,” says Andy Slavitt, principal deputy administrator at the Centers for Medicare and Medicaid Services.

Now, the questions are submitted on a few forms – and sent to the data hub in one big batch. That is, as Slavitt put it, “how a modern website should work.”

As recounted in Steve Brill’s Time magazine cover, the story behind Healthcare.gov’s turn around was a bunch of tech geeks getting into a room and figuring out how to make a website work. It wasn’t about throwing rules overboard.

5) Only people who already had coverage are signing up

This was a three-pronged argument that showed up in late 2013. Even if Healthcare.gov were fixed and people signed up for insurance, it would just be the people replacing old insurance plans. Nobody new would actually gain private insurance.

“What you have basically done is a churn where you’ve knocked people off their old insurance and then gotten them on the exchanges,” the National Review’s Rich Lowry argued on Meet the Press. “There’s not much upside to that.”

Much of this prediction was fueled by an early report from the consulting firm McKinsey, which showed only one in ten Obamacare enrollees were newly insured.

Subsequent data, from McKinsey and other groups suggests that a larger chunk of exchange enrollees were gaining new insurance coverage.

Exchange_enrollees

The estimates range between different surveys for reasons explained here. The best data is arguably from the Kaiser Family Foundation, which went out and surveyed exchange enrollees after open enrollment. It found that about six in 10 (57 percent) did not have coverage at the time they bought a plan in the exchange.This suggests there is definitely a sizable population of exchange enrollees lacked insurance coverage prior to signing up through Healthcare.gov or a state exchange.

6) Obamacare would cause a net-loss of insurance

House Speaker John Boehner argued in March that it was possible fewer people had health insurance after the health law’s insurance expansion than prior to it.

He said there that the most recently available data would indicate “indicate to me a net loss of people with health insurance. And I actually do believe that to be the case.”‘

The math behind his statement: Obamacare had, at that point, 4.2 million enrollees in the the exchanges. An estimated 6 million people had received cancellation notices from the plans they used to — ergo, there were more people receiving cancellation notices than signing up for Obamacare.

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What that misses, however, are the people who were purchasing insurance outside of the marketplace. Shoppers who didn’t qualify for subsidies could access the exact same insurance plans with fewer technical glitches by going to an insurance broker.

It also completely ignores Medicaid, which has expanded by 9.1 million enrollees since the Obamacare expansion began. All available data very strongly suggests that Obamacare has led to a significant net decrease in the number of Americans who lack insurance coverage.


7) Premiums will skyrocket

About in the summer of 2013, there were lots of predictions that some people who buy their own health insurance would see their rates more than double under Obamacare. Then these predictions showed up again for 2015 rates, with headlines like “O-Care Premiums to Skyrocket.”

What actually happened with health insurance premiums was much more modest. Prices on the exchange in 2014 actually came in 18 percent lower than budget forecasters had initially expected.

But its possible that insurers just screwed up in 2014. After all, they didn’t know who would sign up. They might have set prices way to low to cover the costs of their first enrollees — and could have to jack up prices in year two as a consequence.

That doesn’t seem to have been the case either: in 2015, premiums for Obamacare’s mid-level plans rose by an average of 2 percent. In 48 major cities, prices for these benchmark plans actually fell by 0.2 percent. Compare this to before Obamacare, when premium increases around 10 percent were the norm in the individual market.


premium increases

(Commonwealth Fund)

8) Obamacare just can’t work

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(Chip Somodevilla / Getty Images News)

“When you step back and look at the totality of this,” Boehner declared at a November 2013 press conference.  “I don’t think it’s ever going to work.”

There are a few metrics to measure Obamacare’s success — and, on the ones we have data for right now, the information seems to be positive. One is the uninsured rate, which seems to have fallen since the health care law’s insurance expansion started.

Another is access to health care — an insurance card isn’t much fun if it can’t help get an appointment with a doctor. On this front, preliminary data also seems to suggest Obamacare is working: a report last summer from the Commonwealth Fund survey shows that most enrollees say they can get an appointment within two weeks. Commonwealth5

Last, the health care law also aimed to control health spending growth. This is one area where there’s just not a lot of data yet. We know that Obamacare has coincided with a period of real slow health cost growth, and that means the law has cost less than forecasters initially expected. In April 2014, the Congressional Budget Office reduced its budget forecast by $100 billion. It’s also notable that the federal government is spending less on health care now than it expected to back in January 2010 — before Obamacare was even a law.

“The simple fact is that the federal government is spending less on health care with Obamacare than it expected to spend without Obamacare,” my colleague Ezra Klein wrote recently.” “That’s remarkable.”


Where there is data on health spending, and other subjects, it tends to suggest that Obamacare is doing what it was meant to do  — and not realizing the disastrous Obamacare predictions.

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