After President Trump signed the massive Republican Party tax cut, which includes the repeal of the Affordable Care Act’s individual mandate to buy health insurance, he boasted that he had finally achieved one of his longstanding, revenge-fueled policy goals. “We have essentially repealed Obamacare and will come up with something that will be much better,” he said on Wednesday.
But Americans’ enthusiasm for the law tells a different story.
As the Trump administration grudgingly admitted the next day, 8.8 million people signed up for Obamacare’s individual marketplaces through the federally run Healthcare.gov website during this year’s open-enrollment period, almost matching last year’s total of 9.2 million – in half the time. (Another 2.5 million people signed up through 11 state exchanges, a number that will rise in the coming weeks, since the states allow people to sign up for weeks longer than than the federal government.)
That number counts as a remarkable achievement for the Affordable Care Act, considering the Trump administration’s multifront battle to undermine it throughout the year.
Not only did the Trump administration cut the open-enrollment sign-up period in half, from 90 to 45 days, it slashed outreach programs by 90 percent, and all but stopped advertising the law on television. The Trump appointees filling offices that normally push for signups were silent. And in October, President Trump cut off key cost-sharing payments to insurers, a decision that has helped contribute to sharply higher premiums for many customers in the coming year.
All the while, congressional Republicans were trying to repeal the law — though their efforts ended in ignominious failure each time — as the president and prominent voices like Speaker of the House Paul Ryan continued to insist, falsely, that Obamacare was collapsing, and the government used money it could have spent promoting the law advancing anti-Obamacare propaganda.
And yet, somehow, 2.4 million new customers flocked to Healthcare.gov, one million of them in the final six days of eligibility. Republicans’ continued efforts to take away Americans’ health care have made the law popular for the first time since it was enacted, and it now seems to have served as its own advertising campaign for coverage, too. (A concerted effort by prominent Obamacare boosters probably helped.)
Or maybe Americans are just sensitive to good deals. The vast majority of people who signed up on the federal marketplace receive subsidies — and in a perverse piece of irony, Trump’s efforts to damage the law actually made health care more affordable for some of them.
There was another significant Obamacare success story in 2017: Medicaid expansion. In the first instance of a state expanding the program via referendum, Maine voters overwhelmingly defied their anti-Obamacare governor to give health care to a swath of lower-income individuals and to open the door for more states to join in.
But despite the fact that public opinion is finally on Obamacare’s side, the near future looks no less dicey for the law than the turbulent present. For one thing, there’s the individual-mandate repeal, which may or may not throw a monkey wrench into the entire system. The Congressional Budget Office has projected that, without the threat of a penalty for going without insurance, premiums will rise for those who need health care the most, and millions will eventually be left uninsured. (The mandate will still be in effect for 2018.)
The Trump administration is also attempting to further dent the law by relaxing regulations for certain plans, the effect of which would likely mean fewer people with insurance. And the full-repeal effort isn’t over, either. After evincing little enthusiasm for returning to health care this year, Senate majority leader Mitch McConnell quickly changed his tune, and some lawmakers are eager for another crack at killing Obamacare altogether.
Still, at this point, it may be foolish to bet against the law’s survival. The Affordable Care Act has faced two Supreme Court near-death experiences, eight years of Republican misinformation, multiple repeal efforts, and now a year of the Trump administration’s sustained sabotage. After all that, Obamacare has taken more than its share of blows. But it is very much still standing.