While successfully urging Congress to pass a sweeping health-care law in 2009 and early 2010, President Obama and his allies made three main promises. The law would reduce premiums, dramatically expand coverage, and leave people who liked their insurance plans and doctors undisturbed. With the official sign-up period for Obamacare’s exchanges now over, we can say that none of those promises have been kept.
We have, it is true, gotten a modest increase in insurance coverage. Gallup suggests that the percentage of Americans with health insurance has been rising from a recession trough but has not yet recovered to its level before Obama took office. Even the most favorable accounts of Obamacare’s effects suggest, first, that the increased coverage is well below the initial projections. They suggest as well that many more people have gotten coverage through Medicaid and through staying on their parents’ plans than through the law’s vaunted exchanges (which appear mostly to have signed up the already-insured). Moreover, many of the new Medicaid enrollees are from states that have not participated in the law’s expansion of the program, raising the possibility that a publicity campaign could have replicated part of the law’s effect on enrollment.
Among the things we do not know about the new exchange enrollees: How many of them have paid their premiums, how many were uninsured, and how healthy they are. Thus we also do not know whether taxpayer subsidies will be needed to protect the insurance companies selling policies on the exchanges from losses.
The main benefit that the newly insured have gotten is the peace of mind that comes from knowing that medical events cannot bankrupt them. That benefit could have been won more cheaply, and for more people, by modifying public policy to make catastrophic insurance more affordable. The federal government would not have had to mandate essential benefits for everyone, and trample on consciences in the process, or to create a constitutionally suspect board to try to centralize medical practice, or to tax medical devices, or subsidize abortion, or make an ongoing mockery of the rule of law by executing it with an editor’s pen. There were better alternatives. There still are.