REPUBLICANS WILL PAY a heavy price for breaking their promise to repeal the Affordable Care Act. For seven years, the GOP vowed to eliminate the unwise, unpopular law, and during Barack Obama's years in the White House, Republican legislators voted for repeal dozens of times. But once there was a president prepared to sign repeal legislation, Republicans choked.
The GOP was handsomely rewarded for its opposition to Obamacare. Some 1,100 elected Democrats at every level of government were replaced by Republicans; eight years of public disenchantment with Obama left the GOP stronger than at any time since the 1920s. If voters now turn against Republicans for keeping Obamacare on the books, no one should be surprised.
President Trump says the collapse of the repeal bill in the Senate isn't the end of the story. "I'm not going to own it," he told reporters. "We'll let Obamacare fail." Naturally that set off liberal palpitations. "This. Is. Stunning." was CNN editor Chris Cillizza's appalled reaction. Bloomberg columnist (and Harvard law professor) Noah Feldman declared that any move by Trump to hasten Obamacare's failure would constitute "a violation of the president's oath of office." Senator Elizabeth Warren tweeted that Trump's plan to let Obamacare fail involves "sabotaging it from inside."
But for Obamacare to fail no sabotage is required. Failure was built in to it. From Day 1, the Affordable Care Act's complexities, contradictions, and political concessions ensured that it would never work as advertised. That doesn't mean no one is better off: With the federal government annually doling out tens of billions of dollars in subsidies to induce people to get insurance through the ACA exchanges, some Americans have obviously benefited.
But many more have been hurt by Obamacare's failures, which is why Republicans kept winning elections by promising repeal. With Trump now saying he's prepared to "let Obamacare fail," this is a timely moment for recalling all the ways in which it is already doing just that.
Obamacare is failing to hold down premiums. Obamacare's architects repeatedly claimed the law would reduce the typical family's insurance premiums by $2,500 a year. But year after year, in state after state, premiums have gone up. Double-digit increases have become routine, and even triple-digit hikes are not unheard-of: The premium for a middle-tier health plan in Arizona this year soared 116 percent. In the 39 states using the federal Obamacare exchange, the Department of Health and Human Services reports, the cost of health insurance has more than doubled since 2013, from an average monthly premium of $224 in 2013 to $476 today.
Obamacare is failing to curb out-of-pocket medical costs. "Affordable" care? In November 2015, a New York Times review found that a majority of Obamacare policies carried deductibles of $3,000 or more, leaving many "newly insured feeling nearly as vulnerable as they were before they had coverage." And the sticker shocks keep coming. According to the insurance-data firm HealthPocket, the average deductible for a "bronze" Obamacare plan (the least expensive) rose to $6,092 in 2017. Out-of-pocket costs for "the plans most likely to be purchased by people without subsidies," the report said, "are still considerably beyond what the average family has saved for medical bills."
The Affordable Care Act was supposed to reduce the typical family's insurance premiums by $2,500 a year. But in state after state, premiums have jumped.
Obamacare is failing to provide choice and competition. Democrats and their allies depicted every proposal to reform Obamacare as a virtual death sentence for millions of Americans who would supposedly find themselves without insurance. These hysterical attacks distracted attention from the real disappearance of insurance — the one already underway. Despite skyrocketing premiums and deductibles, insurers selling health plans through Obamacare exchanges have lost billions, forcing many of them to pull out of the markets. Humana, to cite one major example, has announced that as of 2018 it will leave the Obamacare exchanges. In large sections of the country, including at least five entire states, only one insurer still sells health plans on the Obamacare exchanges. In many places next year, the options will likely fall from one to zero.
Obamacare is failing to do more good than harm. Since 2012, Gallup has been asking Americans whether the ACA "has helped you and your family, not had any effect, or hurt you and your family." About half say the law hasn't affected them. But of those who have been affected, most have been hurt. In September, 29 percent of respondents said Obamacare had hurt their families; only 18 percent thought it had helped.
The failures don't end there. Obamacare failed to curb emergency-room use. Failed to reduce overall health-care costs. Failed to ensure access to high-quality care for those with serious diseases. Failed, even, to keep the US death rate from rising.
"Let Obamacare fail," says Trump. Its failures are manifest, and steadily worsening. Shame on Republicans for not repealing such a misbegotten law. Shame on Democrats for passing it.
(Jeff Jacoby is a columnist for The Boston Globe).
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