Some politicians and pundits have hailed what they consider to be the triumph of the Affordable Care Act. “This is a very big deal indeed,” wrote New York Times columnist Paul Krugman. “Conservative thinking and Republican political strategy were based entirely on the assumption that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.”
The cause for this celebration, which mirrors the self-congratulatory tone of the president’s Rose Garden remarks the day after the deadline passed, is the government’s report that 7.1 million people signed up for coverage prior to April 1. Does that constitute a genuine “success story?”
To answer “yes,” one has to radically redefine the definition of success.
The stated purpose of the Affordable Care Act was to provide coverage for all Americans, over 40 million of whom, by most estimates, have no health insurance. The 7.1 million signups constitute less than one-fifth of that number. In academic terms, a score less than 20 percent is clearly a failing grade.
We do not share the conspiratorial view that the 7.1 million figure is fraudulent. Rather, our concern is that some proponents of the ACA are making misleading claims about this number in their attempts to make Obamacare look more robust than it actually is.
How many of these 7.1 million sign-ups, for instance, are people who were previously uninsured? According to a recently released report prepared by the RAND corporation, that number is only 1.4 million. Indeed, many of those who signed up for a new plan were forced to do so because the ACA cancelled their old one. Given that the goal of the ACA was to cover all of the uninsured, it’s difficult to see how the enrollment of only 1.4 million previously uninsured people constitutes an impressive benchmark on the road to universal coverage.
There are other numbers to consider, too.
In order for Obamacare to function properly, a large percentage of young and healthy people need to sign up and pay for insurance to subsidize the care of everyone older and sicker. According to a Gallup poll, the number of sign-ups in the desired 18-34 year-old demographic was well below initial expectations. Historically, those in this age bracket have chosen to be uninsured because they weigh the risk of serious injury or disease and determine that it doesn’t justify the cost of insurance. Obamacare doesn’t seem to have altered that equation as much as it will need to if the ACA is going to work.
Rosy assessments aside, we tend to agree with Wall Street Journalist columnist Peggy Noonan, who has a less sanguine view of the reality of Obamacare. “What the bill declared it would do—insure tens of millions of uninsured Americans—it has not done,” Noonan wrote. “There are still tens of millions uninsured Americans.”
And that’s certainly not a success story.