Obamacare at Five Years

March 26th, 2015

Blogging and writing a book are very different enterprises. A blog post is an immediate, visceral reaction to a new story. The book is a delayed, retrospective reaction to events in the past. Writing a book about a current topic, such as Obamacare, blends the two. I have to provide the sort of daily analysis that I provide as a blogger, with the 30,000 foot perspective of a novelist. It isn’t easy, and something I hope to improve from Unprecedented to Unraveled.

The 5th Anniversary of the signing of Obamacare presents just such an opportunity. This week has been a flurry of activity. Ted Cruz announced his presidency, promising to repeal “every word” of the ACA. Press Secretary Josh Earnest reminded us that Mitt Romney made the same promise. Then Ted Cruz announced that he would probably be signing up on Obamacare. Then Justice Kennedy made comments that may (or may not) implicate King v. Burwell. At the moment, all of these events may be relevant in the long run, or may not be. It’s too early to tell for sure, but I’ll likely have to make that judgment prematurely for the book.

One event that happened this week, that will almost certainly make the book, is the President’s remarks on the fifth anniversary of the ACA. Always read the transcript of these remarks, rather than the press accounts.

In fact, just five years in, the Affordable Care Act has already helped improve the quality of health care across the board. … It’s making health coverage more affordable and more effective for all of us.  And in a lot of ways, it’s working better than many of us, including me, anticipated.  (Laughter.)

The President rattled off some of the key benefits of the law:

If you don’t have health insurance, you can go online to the marketplace and choose from an array of quality, affordable private plans.  Every governor was given the option to expand Medicaid for his or her citizens, although only 28 have chosen to do so — so far.  But after five years of the ACA, more than 16 million uninsured Americans have gained health care coverage — 16 millionIn just over one year, the ranks of the uninsured have dropped by nearly one-third — one-third.

If you’re a woman, you can no longer be charged more just for being a woman.  And you know there are a lot of women.  (Laughter.)  Like more than 50 percent.  (Laughter.)  Preventive care, like routine checkups and immunizations and contraception now come with no additional out-of-pocket costs.

If you’re a young person, you can now stay on your parents’ plan until you turn 26.  And if you want to turn that new idea into a business, if you’re going to try different jobs, even a different career, you now have the freedom to do it because you can buy health care that’s portable and not tied to your employer.  Most people have options that cost less than 100 bucks a month.

If you’re a business owner — because when we put forward the Affordable Care Act, there was a lot of question about how it would affect business; well, it turns out employer premiums rose at a rate tied for the lowest on record.  If premiums had kept growing at the rate we saw in the last decade, then either the average family premium, paid by the family or paid by the business, would be $1,800 higher than it is today.  That’s 1,800 bucks that businesses can use to higher and invest, or that’s 1,800 bucks that stays in that family’s bank account, shows up in their paycheck.


Next, the President turned to explain that many of the fears over the law have not come to fruition.

If you’re a senior — more than 9 million seniors and people with disabilities have saved an average of $1,600 on their prescriptions, adding up to over $15 billion in savings.  There were fears promoted that somehow this was going to undermine Medicare.  Well, it turns out the life of the Medicare Trust Fund has been extended by 13 years since this law has passed. …

But the bottom line is this for the American people:  The Affordable Care Act, this law, is saving money for families and for businesses.  This law is also saving lives — lives that touch all of us. It’s working despite countless attempts to repeal, undermine, defund, and defame this law.

It’s not the “job-killer” that critics have warned about for five years.  When this law was passed, our businesses began the longest streak of private-sector job growth on record:  60 straight months, five straight years, 12 million new jobs.

It’s not the fiscal disaster critics warned about for five years.  Health care prices are rising at the slowest rate in nearly 50 years, which has helped cut our deficit by two-thirds since I took office.  Before the ACA, health care was the single biggest driver driving up our projected deficits.  Today, health care is the single biggest factor driving those projections down.

Next, with a bit of glee, the President faulted Republicans for all of their predictions, and the failure to provide an alternative.

I mean, we have been promised a lot of things these past five years that didn’t turn out to be the case:  death panels, doom.  (Laughter.)  A serious alternative from Republicans in Congress.  (Laughter.)

The budget they introduced last week would literally double the number of the uninsured in America.  And in their defense, there are two reasons why coming up with their own alternative has proven to be difficult.

First, it’s because the Affordable Care Act pretty much was their plan before I adopted it — (laughter) — based on conservative, market-based principles developed by the Heritage Foundation and supported by Republicans in Congress, and deployed by a guy named Mitt Romney in Massachusetts to great effect.  If they want to take credit for this law, they can.  I’m happy to share it.  (Laughter.)

And second, it’s because health reform is really hard and the people here who are in the trenches know that.  Good people from both parties have tried and failed to get it done for 100 years, because every public policy has some trade-offs, especially when it affects one-sixth of the American economy and applies to the very personal needs of every individual American.

And he did what evaded every President since TR. And he knows it–any change would result in people losing coverage.

On the other hand, for folks who are basing their entire political agenda on repealing the law, you’ve got to explain how kicking millions of families off their insurance is somehow going to make us more free.

Specifically, the President charges, how is fighting back Obamacare going to make us more free, give us more liberty?

Or why forcing millions of families to pay thousands of dollars more will somehow make us more secure.

For progressives, liberty and security is a state the government creates to ensure people do not want. The Solicitor General made this point forcefully in NFIB v. Sebelius.

Or why we should go back to the days when women paid more for coverage than men.  Or a preexisting condition locked so many of us out of insurance.


Ironically, the law was sold on a lie about people being able to keep their policies. Now, any changes that runs into cancellation notices will suffer even bigger political costs. (Stay tuned for the 2018 Cadillac Tax).

The President’s most striking remarks came at the end, when eh said that health care was “not a privilege, but a right.” This was a standard line from Senator Ted Kennedy.

Five years ago, we declared that in the United States of America, the security of quality, affordable health care was a privilege — was not a privilege, but a right.