The health care law is defying Democrats’ dreams and Republicans’ warnings.
When President Obama signed the Affordable Care Act into law five years ago, many Republicans essentially predicted it would grow up to be a serial killer—that seniors, Medicare, private insurance companies, jobs, and the American Dream would die by its hand.
It has turned out to be far more well-adjusted.
On the other hand, many Democrats thought the law would quickly make it through its awkward phase and turn into the most popular kid in school—liked by most, respected by all, a sophisticated winner possessed of all the latest technology but also with unassailable principles.
It has turned out to be a much bigger screw-up.
On Obamacare's fifth birthday, here are five predictions about its future that turned out to be way off the mark:
It would be dead by now
Say what you will about Obamacare, but if nothing else, it's a survivor. It was declared dead numerous times before it even got to Obama's desk. Then the newly elected Republican House was going to defund it. Its second birthday, March 23, 2012, was just a few days before the "train wreck" Supreme Court arguments that once again put the law at death's door. When that didn't work, Mitt Romney was going to oversee its repeal.
Some critics didn't even think they'd need to kill it—just that they could help it along. The law's opponents argued for years that the law would never work—predictions that reached new intensity when HealthCare.gov launched in 2013. Rep. Paul Ryan, among many others, has predicted that the law would "collapse under its own weight." Sen. John Barrasso said during the initial enrollment period that, "It looks to me like we are going to end up in what's called an insurance death spiral."
And yet, here we are. Republicans in Congress couldn't kill it; the Supreme Court chose not to; and the website failures weren't fatal. There was no death spiral.
On each of Obamacare's birthdays, there have been big, looming questions about whether it would live to see the next one. And this year, though the substance of the law is more firmly in place than ever before, the tradition of existential threats is still intact. The Supreme Court will decide this summer whether to invalidate the law's insurance subsidies in most of the country. The ruling could make Obamacare's complex system of reforms unworkable in many states, causing premiums to skyrocket and some individual insurance markets to become unsustainable, even outside the exchanges.
It would get popular
"I think as people learn about the bill, and now that the bill is enacted, it's going to become more and more popular," Sen. Chuck Schumer said in 2010, just a few days after Obama signed the law. "I predict … by November those who voted for health care will find it an asset, those who voted against it will find it a liability."
Schumer was hardly the only one expressing this optimism. The process of getting Obamacare passed was brutal for Democrats, but many in the party truly thought the heat would die down between 2010 and 2014, when the law's central provisions kicked in. The debate got to a point where there was no way to win the rhetorical wars over health care, so Democrats' plan was largely to get it done, wait it out, and hope people warmed up to the law once it transitioned from a political abstraction to a set of real-world policies, most of which are pretty boring.
It didn't work.
The Kaiser Family Foundation has been measuring public approval of the health care law every month since it was signed, and the bottom line has stayed the same: people are closely divided over the law and lean against it. This month, Kaiser's poll found 43 percent disapproval for the law, compared with 41 percent approval, which is within a few points of most months. There have been a few blips, where approval topped disapproval or where one side cleared 50 percent, but they're never lasted. Public opinion seems deeply ingrained.
It would be the end of Medicare
"The legacy for Medicare is going to be devastating. If you're a senior citizen in South Carolina and New York, you're going to lose your Medicare Advantage," Sen. Lindsey Graham said in 2010, debating Schumer on "Meet the Press."
Similarly, Mitt Romney and Paul Ryan aggressively attacked Obamacare in 2012 for its Medicare cuts, arguing that they undermined the program's stability. And critics from both parties have taken aim at the Medicare Payment Advisory Board, a new cost-cutting board, arguing that it will eventually lead to "rationing" or Medicare benefit cuts.
But the bipartisan Medicare trustees say the Affordable Care Act has actually extended the program's solvency, perhaps by more than a decade. That's mainly a product of the cuts Republicans have criticized, which come from payments to doctors and other providers (not directly from benefits).
And enrollment in Medicare Advantage — the privately administered plans Graham referenced — is growing, despite the law's cuts to MA plans. Medicare Advantage enrollment has grown by more than 40 percent since Obamacare passed, according to the Kaiser Family Foundation. But insurers say further cuts to Medicare Advantage will force them to scale back benefits or increase premiums.
It would be the end of private insurance
This prediction never made much sense, but some of the law's critics embraced it anyway: that the law would eviscerate the health insurance industry and could, ultimately, put it entirely out of business.
"There will be no insurance industry left in three years," then-Sen. Tom Coburn said in October 2010. A little more than four years later, the insurance industry not only exists, but is doing well. Even during the rocky HealthCare.gov rollout, insurers' stocks were making double-digit gains and outperforming the S&P 500.
Some of Obamacare's critics painted the law as a first step toward a single-payer system that would leave no room for private insurance companies. But Obamacare's basic structure was almost guaranteed to be a big boon to insurers: Its primary purpose is to create millions of new customers for them, by making their product mandatory and offering subsidies so people can afford it.
A similar line of attack argued that the exchanges would only benefit large insurers, causing the industry to consolidate and reducing consumers' options. That didn't happen, either. According to HHS, 191 insurers offered plans in the states using HealthCare.gov in 2014; that numberincreased by 25 percent for 2015.
If you like your plan, you can keep it
Obama also made some predictions he probably shouldn't have—including his promise that people wouldn't lose their coverage because of Obamacare. For starters, policies sold in the individual insurance market were largely one-year contracts before the Affordable Care Act. In other words, there was never a guarantee that consumers could keep their same policies.
Moreover, though, Obamacare did cause insurers to cancel millions of individual policies, and it wasn't an accident or a side effect. The law set new standards for policies in the individual market. They have to cover a set of "essential" benefits, for example, and can't impose annual or lifetime caps on benefits.
A lot of plans that existed before Obamacare didn't meet those criteria, hence, passing a law to make them. Those policies could, technically, seek "grandfathered" status, but it was hard to get—they could barely make any changes in their plan designs without losing that status. And it was hard for a reason: the law set new standards for insurance, and it wanted to shift people into plans that met those standards.
All of this was entirely foreseeable in 2010, and was even spelled out in subsequent regulations. The political uproar might not have been as bad if HealthCare.gov had been working when people started to receive their cancelation notices, but the actual cancelations were an inevitable product of the law's requirements.