Obama Care Report Card: Mixed Results for Year One

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By Steve Max

The second full year of health insurance coverage under President Obama's Affordable Care Act kicked off on Jan. 1, 2015. In light of this anniversary, here is an article by Steve Max examining the role that the Act played in the elections last fall. - Eds.

Unlike in past years, the Affordable Care Act was not a major factor in the 2014 elections. When asked what the most important issue in the election was, only 25% of voters told a CNN poll that it was health care, and of those, 59% were Democrats who probably supported the act. 

Only 49% of voters told the pollsters that they thought federal health care went too far, and 84% of them were Republicans. Of course any issue can make a difference in a close race, but this year was far from 2010, when senior citizen voters broke two records, the first for the largest senior turnout, and the second for seniors voting Republican. Obama Care was quite unpopular among seniors, as some believed the lies about death panels, but many correctly understood that Obama had paid for the plan by cutting a half-trillion dollars from Medicare.  There is good reason to believe that the Affordable Care Act cost the Democrats the House that year.

There will, of course be fights in Congress and the courts as the right attempts to dismantle Obama Care, but here again Republican small-government philosophy puts them on the wrong side of major capitalist elements who are quite happy with large government handouts and bailouts. The health care industry, which wrote much of the act in the first place, is no exception, as the New York Times reported.

"[I]nsurers may soon be on a collision course with the Republican majority in the new Congress. Insurers, often aligned with Republicans in the past, have built their business plans around the law and will strenuously resist Republican efforts to dismantle it. Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70%.  … [S]ince the Affordable Care Act was enacted in 2010, the relationship between the Obama administration and insurers has evolved into a powerful, mutually beneficial partnership that has been a boon to the nation’s largest private health plans and led to a profitable surge in their Medicaid enrollment."

While the Affordable Care Act has been great for the insurance industry, the question remains, how well is it doing in providing insurance for the uninsured? Unlike single payer, the Affordable Care Act was never intended to be comprehensive.  That made it essentially a program for lower-income people, which is why Republicans hate it and why it hasn't really gained solid majority support. 

In all, the first year seems to have brought only modest improvement in reducing the number of uninsured, and many of the gains that were made came through Medicaid expansion, the public part of the program, according to a New York Times review.  

Just how well is the Act providing insurance to the uninsured? Although the Times devoted two full pages to the topic, we still don't exactly know. The Times said, "The number of uninsured Americans has fallen by about 25% this year, or about 8 million to 11 million people."  (The range reflects the five different polls from which their data is derived.) The article goes on to say that, "Several million more are expected to sign up in the coming year, but the total number of uninsured is projected to remain around 30 million for years."  

This is somewhat consistent with the most recent estimate of uninsured people from the Centers for Disease Control (CDC), which found that in the first quarter of this year, 41 million people had no health insurance and 55.5 million had been without insurance for some part of the previous year. The Census Bureau says that 15.4% of the population had no insurance in 2012, and the CDC says that the uninsured figure was 13.1% in the first quarter of this year. This does not appear to be a tremendous decrease. 

More interesting, the Times reports that over half of the newly insured came in through the Medicaid system, the part of the program most like single payer. This is astonishing, considering that 23 states have refused to expand Medicaid under the Act. Had they done so, the overall record for the year would have been far better, with public health care an even greater proportion of the whole.

The number of uninsured young people (19 to 25 years old) has dropped dramatically to the lowest on record (since 1997), which the Times attributes to a change in the law allowing young people to remain on their parents’ plans until age 26. 

When it comes to cost, remember that there is really no one national plan—the situation differs in every state. Recent company surveys indicate that premiums will rise an average of 4% in 2015, according to the Times. CNBC reports, however, that in 38 states where rates have already been approved for 2015, the average increase is 6%.  In nine of these states, rates will rise more than 10%. 

On the positive side, a Commonwealth Fund poll reported in July 2014 that 73% of the people who bought insurance through the exchanges and 87% of those who signed up for Medicaid said they were somewhat satisfied to very satisfied with their plans. Even 77% of newly enrolled Republicans liked their plans.

It appears that the major problems in implementing the Act relate to the sale, cost and subsidies of private for-profit insurance—just as single payer advocates predicted.  Despite deliberate Republican sabotage, the Medicaid expansion part seems to be doing well. 

Steve Max, is a DSA Vice Chair and one of the founders of the legendary community organizing school, The Midwest Academy.

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