Predictions about the health care law were a dime a dozen back in 2010. Supporters contended that virtually everyone around the country would soon have access to affordable insurance. Opponents said the law would cost a fortune by adding to the national debt and killing jobs.
Actually, none of those things have happened.
As the Affordable Care Act marks its fifth anniversary on Monday, the law has taken twists and turns, moving off course from where everyone thought it would be.
Once expected to insure 32 million new Americans by the end of the decade, the projected target has been downgraded to 27 million — far from the universal coverage many proponents hoped for.
Unforeseen developments, like significant changes in health cost trends and a sweeping Supreme Court decision on Medicaid expansion, have meant the insurance provisions in the law will cost $139 billion less over the next five years than it was supposed to back in 2010. That has quieted some critics who expected massive, deficit-inflating costs.
In five years, the law has steadily navigated toward its overall goal of decreasing the number of uninsured Americans, without dramatically disrupting the overall health care industry, for better or worse.
“The whole thing has been in much slower motion that what was predicted,” said Michael Tanner, health care analyst with the libertarian Cato Institute. “Whether you thought something good was going to happen or something bad, you sort of thought it would have happened by now. Instead, it’s just been creeping along.”
One of the warnings that the law’s opponents issued repeatedly in the months leading up to passage was that the health care law would kill jobs. In 2011, Republicans titled the repeal legislation they were pursuing the “Repealing the Job-Killing Health Care Law Act.” But independent studies didn’t back up the claims that the law would end up reducing employment, so PolitiFact has rated such statements False.
Last year, the GOP seized on a talking point that 2.3 million jobs would go away because of the health care law. But that, too, was a misreading of evidence. A nonpartisan report actually showed that some people would stop working if they no longer had to work for insurance. PolitiFact rated the claim Mostly False.
In the years since passage, employment in both the United States and Florida has been on an upward trajectory as the economy has recovered from a recession.
Bruce Rueben of the Florida Hospital Association said that the threat of job losses was one of the things that hasn’t come true in Florida. “Florida has steadily gained jobs and unemployment has decreased since the law was implemented,” he noted.
Short of universal coverage
On the other hand, the law’s supporters saw some of their predictions fizzle as well.
“You have turned, Mr. President, the right of every American to have access to decent health care into reality for the first time in American history,” enthused Vice President Joe Biden at the Affordable Care Act bill signing in 2010 and also predicted, “Tens of millions of Americans would be a whole lot healthier from this moment on.”
Undoubtedly, the law has led to fewer uninsured Americans. The percentage of uninsured adults in the United States in 2010 was 16.4 percent; at the end of 2014, it had fallen to 12.9 percent, its lowest point since Gallup started tracking the insured population in 2008.
However, the nonpartisan Congressional Budget Office projects there will still be roughly 31 million uninsured adults in the United States by 2025, demonstrating that any notion the law would create universal coverage was a pipedream.
There is also a coverage gap unintended by those who wrote the law: People who live in states that didn’t accept Medicaid expansion. The law essentially required states to expand eligibility and agreed to pay 100 percent of the expansion for the first three years, declining to 90 percent in 2020 and beyond.
But following the U.S. Supreme Court’s 2012 intervention, states now have the option to expand Medicaid, a health insurance program intended for the very poor.
“I don’t think anyone anticipated when the law was written that states would have the opportunity to opt-out of the Medicaid expansion,” said Christine Eibner, senior economist at the Rand Corporation.
Twenty-two states — including Florida — have so far refused expansion, and health care advocates continue to hope legislatures will act to embrace provisions of the law affecting Medicaid. Florida is one of six states currently considering a Medicaid expansion; it’s estimated that embracing the program would cover 800,000 more people.
When early signs indicated many people signing up were older, the law’s critics warned of a “death spiral” — a situation where premiums soar to cover the costs of insuring so many unhealthy people, further disincentivizing young people from buying coverage. The end game would be insurers leaving the marketplace and those left charging exorbitant rates.
That didn’t happen. About 28 percent of customers during the 2014 enrollment period were ages 18 to 34. And there were 70 more insurance companies participating in the 2015 marketplaces than the previous year, according to data collected by the management consulting firm McKinsey and Company.
There’s still uncertainty about the ultimate fate of the marketplace plans, however, as the Supreme Court considers King vs. Burwell, in which plaintiffs allege the law says people are not eligible for subsidies if they buy from a marketplace run by the federal government, as opposed to a state. The law’s supporters say the argument is without merit, but it’s not clear if the court will see it the same way. A decision is expected in June.
If the court does rule against the Obama administration, millions of people could lose their subsidies for coverage. The RAND corporation estimates that sort of change would lead to a 47 percent increase in individual market premiums in the affected states, and 8 million people could become uninsured.
Health care costs flat
Detractors of the law have long speculated that the Affordable Care Act will cause health care costs to soar. In 2012, with the Supreme Court about to rule on the law’s constitutionality, Republican House Speaker John Boehner posted on Facebook that “Obamacare is only making our economy worse, driving up health costs and making it harder for small businesses to hire.”
Remarkably, the growth of health care costs has slowed down significantly in recent years, enough so that budget analysts are having to reconsider their fiscal outlook of the law.
It remains to be seen whether the health care law is the cause of these sweeping changes within the industry, and it may be too early for advocates of the law to claim victory.
The law’s unpopularity has been fairly consistent.
Public opinion of the health care law was underwater even before the bill fully materialized, and it hasn’t recovered.
“Most observers thought in 2010 that the (Affordable Care Act) would be politically in the clear by now, but it isn’t,” said Jonathan Oberlander, professor of health policy at the University of North Carolina-Chapel Hill. “There is still a partisan divide.”
Politifact Florida is a partnership between The Tampa Bay Times and the Miami Herald to check out truth in politics.
Affordable Care Act: Five years later
By 2019, 32 million gain insurance, leaving 23 million uninsured (includes illegal immigrants)
By 2019, 27 million gain insurance, leaving 26 million uninsured (includes illegal immigrants)
Medicaid and CHIP enrollment
16 million by 2019
15 million by 2019
Reduces deficit by $143 billion between 2010-19
Reduces deficit by $152 billion between 2015-24 (2014 projection)
Cost of insurance coverage provisions
$710 billion between 2015-19
$571 billion between 2015-19
Polling (via Pollster.com)
Opposed 50.2 percent; in favor 41.8 percent (March 22, 2010)
Opposed 45.9 percent; in favor 39.1 percent (March 5, 2015)
Sources: Congressional Budget Office, Pollster.com