Can we finally agree that Obamacare is working?

Texas Gov. Rick Perry: This anti-Obamacare thing isn't working out like he expected.
(Charlie Neibergall / Associated Press)

At the end of a war, some people will remain holed up in the trees, thinking they can still turn the tide of a lost cause. Increasingly, that’s the best description of the anti-Obamacare dead-enders, including congressional Republicans, who continue to depict the Affordable Care Act as a failure despite facts like these:

--Nearly 60% of enrollees in ACA-compliant exchange health plans this year were previously uninsured--most of them for two years or more. (Source: Kaiser Family Foundation.)

--Obamacare cut costs for buyers eligible for subsidies by an average of 76% compared with non-subsidized premiums. More than 80% of buyers are eligible for government subsidies, and for them the average premium is $82 a month. (Source: Department of Health and Human Services.)


--Most people can save money by choosing plans offering narrower provider networks, and there’s “no meaningful” difference in health outcomes between plans with narrow hospital networks and those offering broader networks. (Source: McKinsey & Co.)

--Projected rate increases for 2015 are coming in well below expectations. Anthem Blue Cross rates will rise by less than 10% next year, about in line with health plan rate increases in the individual market in the pre-ACA era. (Source: Anthem Blue Cross.)

Here’s the Republican approach to these trends. On Thursday, Sens. Orrin Hatch, R-Utah, and Charles Grassley, R-Iowa, issued a report attacking the administration for its botched rollout of That happened eight months ago, and in the end didn’t seem to affect overall enrollments. Is that all they’ve got?

Texas Gov. Rick Perry fired up his state’s Republican convention by calling the expansion of Medicaid, which he’s refused to implement, “federal blackmail.” Number of Texas residents left without health insurance by his stand: 1.1 million.

It’s proper to note that the statistics cited above demolish some of the most cherished claims of the anti-Obamacare right. Their estimates of the percentage of enrollees who were previously uninsured dipped as low as 27%; obviously their calculations were deeply flawed. All the emerging statistics indicate that the Affordable Care Act has materially reduced the number of Americans without insurance, which after all was its goal.

Critics’ assertions that the act would produce eye-popping premium increases were based often on numerical magic tricks. The conservative Manhattan Institute released a study alleging that Obamacare increased premiums 49%.


But as expert ACA-tracker Charles Gaba spotted, the study cited unsubsidized premiums, which obviously don’t reflect what most customers are paying. It also incorporated into its analysis pre-Obamacare “mini-med” junk plans, which weren’t health insurance at all--they were just discount cards that might cut the price of a doctor visit or a prescription, but did nothing in the case of hospital stays or serious medical procedures. Comparing average costs of these bogus health plans to the real coverage required by the ACA, even at the minimum levels, is the essence of putting your thumb on the scale.

McKinsey’s finding on hospital outcomes is important, since one of the popular raps on the ACA has been that (contrary to President Obama’s supposed promise) people have been unable to “keep their doctors and hospitals.”

Of course, the narrowing of provider networks by health insurers aiming to lower costs is a decades-old trend. McKinsey found that broad networks were available to 90% of eligible buyers of ACA plans, though at premiums 13% to 17% higher on average than those charged for narrower networks. The key fact is that McKinsey found “no meaningful performance difference” in Medicare and Medicaid metrics on medical outcomes, patient experience or clinical processes between the broad and narrow networks.

None of this is to suggest that the ACA is perfect, but no one said it would be in its first months. Among other flaws to be worked out is that doctor networks offered by insurers may be narrower than required. As my colleague Chad Terhune reports, California insurance regulators have launched an investigation of complaints against Anthem and Blue Shield on that score. That’s as it should be; the existence of Obamacare isn’t a guarantee that insurance carriers won’t try to squeeze costs to the breaking point, and regulators shouldn’t stop watching them like hawks.

But on the general proposition of whether Obamacare has or hasn’t worked, the figures are in, and they show that it has changed American healthcare dramatically, for the better.

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