High school, Social Security … Obamacare
Obamacare endured a grueling first decade of existence. Its launch was famously clunky. It was unpopular in its early years. It narrowly escaped repeal at both the Supreme Court and in Congress.
But the law — passed in 2010 and more formally known as the Affordable Care Act — has survived. It’s more than survived, in fact. It now stands as a monument to a particular theory of progressive lawmaking: When the federal government enacts a new benefit that makes life easier for millions of people, the program tends to endure. That describes universal high school, Social Security, Medicare, Medicaid and now Obamacare.
President Biden yesterday signed a package of executive actions on health care, and many experts described them as steps to undo Donald Trump’s attempted sabotage of the law. Which they are. But the modest scope of the actions is also a reminder of how little progress Trump made in undermining the law.
Consider this chart:
The New York Times | Source: United States Census Bureau, via Center on Budget and Policy Priorities
The number of Americans without health insurance did rise during the Trump presidency, because of his attempts to diminish the law. His administration did little to advertise Obamacare policies and weakened some of its provisions, like protections for people with certain medical conditions. But this increase in the number of uninsured reversed only a small portion of the decline caused by Obamacare.
Even after Trump, an additional 20 million or so Americans have health insurance today largely because of Obamacare. Others have better benefits — like maternity care and addiction treatment — or face lower costs.
What Biden did yesterday
Biden’s orders still matter, because Trump’s actions mattered.
Biden will try to strengthen protections for people with medical conditions. He will also create a new three-month sign-up period for Obamacare, starting next month, aimed partly at people who lost their jobs during the pandemic. The most recent sign-up period was in the fall.
Perhaps most significant, the Biden administration plans to promote the sign-up period heavily, through advertisements, email and other outreach, according to my colleague Margot Sanger-Katz, who’s been covering Obamacare for most of its existence. “Biden’s people think the Trump people bungled the regular enrollment period,” Margot told me.
By the end of Trump’s presidency, the uninsured rate probably rose close to 10 percent, from 8.6 percent in the Obama administration’s final year. Through executive action, Biden may be able to reduce it to about 8 percent over the next four years, according to my reporting.
The bigger question is whether Biden can persuade Congress to pass a new law that would go further than Obamacare did, by making coverage less expensive for more people. Otherwise, at least 25 million Americans are likely to remain uninsured.
“There are still millions of poor, uninsured Americans in states that didn’t expand Medicaid,” Margot says, “and millions of middle-class Americans who find Obamacare insurance unaffordable.”
The big picture: “The Affordable Care Act is a highly flawed, distressingly compromised, woefully incomplete attempt to establish a basic right that already exists … in every other developed nation,” Jonathan Cohn, another longtime health care journalist, writes in “The Ten Year War,” a forthcoming book. “It is also the most ambitious and significant piece of domestic legislation to pass in half a century.”
The New York Times