Obamacare crosses its first hurdle

What happened

President Obama declared victory this week as the first open enrollment period of the Affordable Care Act came to an end, amid a last-minute sign-up surge that pushed enrollment in private health insurance plans beyond 7.1 million—higher than the White House’s original goal for the first year. “Armageddon has not arrived,” said Obama in a Rose Garden ceremony, in reference to Republican predictions that Obamacare would be a disaster. “Instead this law is helping millions of Americans, and in the coming years it will help millions more.” The law required individuals to have health insurance by March 31 or face a fine of the greater of either $95 or 1 percent of their taxable income. The technical meltdown of the HealthCare.gov website in October meant that only 106,000 people were able to sign up in the opening month of the state and federal exchanges. In just the final week of enrollment, 1 million signed up. “The Affordable Care Act is here to stay,” Obama said. “The lengths [Republicans] have gone to scare people—I don’t get it.’’

Republicans greeted the latest enrollment figures with skepticism, pointing out that the Obama administration had given no details about how many of the 7.1 million were previously uninsured or had actually paid for policies. “We don’t know, of course, exactly what they have signed up for,” said Senate Minority Leader Mitch McConnell (R-Ky.). “We don’t know how many have paid.” The administration expects millions more to sign up in the next open enrollment period in the exchanges, starting Nov. 15.

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What the editorials said

“Suddenly Obamacare is a roaring success,” said The Wall Street Journal. But there are “more than a few reasons to doubt this new fairy tale.” Though the White House claims to have hit its original sign-up target, these unverified numbers say nothing about the Affordable Care Act’s long-term viability. To determine that, the administration needs to disclose some “crucial contextual data”—such as whether enough young, healthy people have signed up to keep insurance prices from spiking next year.

Clearly, “a lot of Americans really, really want health insurance,” said the San Jose Mercury News. On top of the 7.1 million who signed up on the exchanges, another 4.5 million Americans signed up for Medicaid under the ACA’s expansion of eligibility, and 3 million young adults ages 18 to 25 gained insurance under their parents’ coverage. The ACA may be imperfect, but it’s providing millions of Americans with the security of knowing they won’t lose health insurance if they lose their jobs or get sick.

What the columnists said

“It was never going to be hard to reduce the uninsured,” said James Capretta in NationalReview.com. Offer massive public subsidies, as Obamacare does, and people who couldn’t afford insurance before will come running. But at what price? “For every newly insured American, there are several others”—and as many as 5 million in total—“who are now getting far worse coverage than they did last year,” with higher premiums and higher deductibles.

“The trade-offs are real and significant,” said Jonathan Cohn in NewRepublic.com, but they are worth it. Obamacare will save literally millions of people from being bankrupted by uncovered medical costs, while lowering the cost of medical spending at the same time by giving doctors and hospitals incentives to be more efficient. Republicans simply can’t admit any of these benefits are real, said Jonathan Chait in NYMag.com,because it threatens their “theological certainty that Obamacare will fail.” The news of the enrollment surge has left them stunned and sputtering that surely the White House “is cooking the books.”

Round one of this battle is over, said Kevin Drum in MotherJones.com, but it will continue for years. The earliest Republicans can hope to repeal the ACA is 2017, and then only if they hold both Congress and the White House. By then, there’ll be an estimated 24 million Americans in Obamacare’s private insurance plans and 12 million covered by Medicaid expansion. Does that make the law invulnerable? No. But it makes it a “mighty big nut to crack.”