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The 5 Key Questions About Obamacare, Answered

There are real flaws and they aren't the whole story


To Ted Cruz, John Boehner, and the nitwits on Fox News, the Affordable Care Act is a “disaster.” The law’s smarter critics know better. They acknowledge that Obamacare has not collapsed and is probably not going to collapse, as some conservatives warned. They even acknowledge that the law has some positive effects. The problem, they say, is that these benefits don’t outweigh the costs.

Peter Suderman of Reason is one of those writers. His new article references the now-familiar signs of success, like the 7.3 million paid enrollment in the new marketplaces that the Administration announced a few weeks ago. But the statistics are a bit misleading, he says. That enrollment figure was for the middle of August, before a few hundred thousand people lost coverage because they could not verify residency status. Premiums in the new marketplaces will, on the whole, rise at low rates next year. But that’s because insurers are jostling for position and underbidding each other; many people will find that premiums for the plans they currently have are rising next year. Meanwhile, there are cost overruns for building the system and new reports of security problems. A large portion of the people getting health insurance are getting it through Medicaid, which means many of them have difficulty finding doctors who will see them.

Some of these claims rely on dubious evidence or could use more context. It’s true, for example, that Medicaid beneficiaries frequently struggle to find physicians. It’s also true that people on Medicaid are much better off than if they had no insurance at all. Studies have shown that Medicaid beneficiaries end up more financially secure and probably healthier as well, although there's a lot of debate about the latter point. That's a big reason why people who actually have Medicaid like it.

Still, many of the flaws and complications that Suderman chronicles are very real and need to be accounted for. Take the issue of premiums in the marketplaces and what's happening with them. Even though premiums overall are rising slowly and even declining in a few places, prices for some individual plans are going to rise substantially. That’s the nature of a competitive marketplace—an idea that came from conservatives—and, as noted in this space previously, not all consumers may realize that right away. That's a real problem that needs attention from officials.

But if you want to step back and evaluate Obamacare as a whole—to decide whether the law is “working”—then it makes sense to focus on the law’s overall goals and whether it’s meeting them. That was my argument last week, in an article that is more or less a mirror image of Suderman’s. My accounting went roughly like this:

Do significantly more people have health insurance and are these people better off? Yes and yes.

Are there more “winners” than “losers” from changes in the individual insurance market? Probably, though we can't be certain.

Are overall premiums skyrocketing? No.

Is the deficit lower as a result? Yes.

Are there credible signs that health care costs are rising more slowly? Yes, though we won't know for a long time how real or significant those signs are.

Suderman raises questions about specific data, particularly when it comes to enrollment. But he doesn't fundamentally challenge any of these premises. And this is about as good a critique as I've seen. That should tell you something.

As with stocks and other investments, past returns are not a guarantee of future performance. This year’s open enrollment could have plenty of glitches. Research could show that the reduction in the uninsured has been smaller than previous research existed. Some, if not all, of the marketplaces could deteriorate over time. Health care inflation could return to previous levels. And so on.

Reporting on Obamacare’s flaws, even harping on them from time time, is not only wise but necessary. But the overall perspective matters, too. Whatever the law's problems, Americans on the whole are better off than they were before the law took effect.