The Affordable Care Act has insured 20 million more Americans and come in so far under budget that Washington is spending less on health care now than it was expected to spend before Obamacare passed into law. And yet the ranks of Obamacare haters trudge on nonetheless, carrying the flame for a core tenet of the conservative credo that faithful adherents dare not abandon. The latest grist for the anti-Obamacare mill is news that UnitedHealthcare is pulling out of the state-based exchanges, which has produced headlines in the conservative media like “Obamacare on the skids” (Washington Times) and “Obamacare disaster will be Obama’s enduring legacy” (Marc Thiessen).
Is the law finally, once again, about to collapse into the puddle of dysfunction conservatives have been foreseeing for the last six years? No, it’s not. UnitedHealthcare is one insurer, and not the largest insurer in the exchanges. More competition is always good, so when any insurer pulls out, it’s bad. As Larry Levitt calmly explains, United turned out to be bad at the new individual health-insurance market. Because it already had trouble competing, its plans were not priced competitively, so their absence won’t do much to raise costs. (People tend to shop for the cheapest plans, though sometimes they get unhappy when they discover the low premiums come with restricted choice of doctors and hospitals.)
Premiums on the exchanges initially came in 15 percent less expensive than the Congressional Budget Office forecast. Some of that unexpected affordability turned out to be insurance companies underpricing the market, and they’re correcting the mistake. Still, prices remain well below forecast, and health-care inflation remains at historically low rates. As Levitt notes, “the ACA marketplaces appear viable and sustainable with or without United.”
So why is this a “disaster,” as opposed to the normal oscillations one might find in any market? Thiessen insists it is evidence that the individual marketplace was ruined by Obamacare:
This is a catastrophe for people stuck in Obamacare. According to a 2014 McKinsey survey, about three-quarters of those in the exchanges were previously insured on commercial plans, either through their employers or the individual market. They were doing fine without taxpayer-subsidized insurance but were pushed into Obamacare.
This is an astonishing claim. The idea that people on the exchanges were “doing fine” before Obamacare came along and ruined everything rests on the assumption that they had good insurance beforehand. To justify that assumption, Thiessen cites a McKinsey survey that came out a few months after the exchanges had opened, purporting to show three-quarters of the customers already had insurance. This data point drew widespread, delirious coverage in the right-wing press. But as more data came in, it became clear that the vast majority of exchange customers were previously uninsured. The initial right-wing insistence that Obamacare was merely shifting people onto different kinds of insurance has been overwhelmingly refuted by a mountain of evidence that is utterly unanimous on the bottom line that the law is reducing the uninsured rate.
Now, it is true that the insurance on the exchanges is inexpensive and forces customers to pay more if they want their choice of doctors and hospitals. Most people prefer the more expensive insurance offered by Medicare or most employer plans, which gives more choice. But it’s worth noting that the kinds of alternatives to Obamacare proposed by conservatives wouldn’t give people the kind of expensive insurance they want. It would give them ultra-skimpy catastrophic plans that cover virtually nothing. The reason, of course, is that paying for subsidized health care is hard, and Republicans hate paying for public goods way more than Democrats do (which is why the GOP has failed to throw itself behind the skeleton Obamacare alternatives that have been floating around the margins of the debate for years).
Most Republicans still refuse to accept the theory of anthropogenic global warming despite decades of scientific consensus. For that matter, you still have white Southerners denying the Civil War was about slavery. So the cause of decrying Obamacare as a disaster will go on and on and on. But the law’s future is secure because it’s making life better for millions of people, and Republicans have no politically viable alternative.