Obamacare turns five years old this week, and to mark the occasion, President Obama took after critics of the health law, noting their ongoing opposition while briefly laying out the reasons he believes it to be a success. "It's time to embrace reality," he said, according to The Hill.
The president ticked off a string of points in support of the law: an additional 16 million insured, 50,000 fewer preventable deaths, slow growth in health premium costs, and lower deficit projections as a result.
The law, he said, is "working even better than expected."
One could reasonably quibble with much of this, because not all of the points President Obama cited are clearly or fully attributable to Obamacare.
Health spending growth, for example, is indeed down, and this is driving much of the decline in the deficit, but at least a sizable portion of the decline—perhaps most of it—can be attributed to the recession. One study in Health Affairs last year concluded that about 70 percent of the health spending slowdown is a result of the economy, not any structural changes to health care delivery. Obamacare may be due some credit, but not too much.
Similarly, it's true that a government report estimated that between 2010 and 2013, deaths from "hospital-acquired conditions" were reduced by about 50,000. But it's hard to fully pin this on Obamacare when the report states up front that "the precise causes of the decline in patient harm are not fully understood."
Meanwhile, the 16 million insured figure comes from a March report by the Department of Health and Human Services, and it is a total of those who gained coverage through Obamacare's exchanges, Medicaid, employment, and the individual market place, which means it's not wholly attributable to the law. And it tallies those who signed up for coverage rather than those "effectuated enrollment"—those who have already paid their premiums. The actual number is probably not too far off from what President Obama stated, but, once again, Obamacare isn't the entire story here.
So Obama is overstating the case, and, of course, leaving out points against the law.
For example: About half of the people who received subsidies through the law last year will have to pay them back through their taxes this year, according to a Kaiser Family Foundation study this week. On average, those who owe will have to pay a little more than a quarter of their subsidy back. A few will have to pay back the entire subsidy.
On the flip side, a little less than half will end up getting money back, but even that will be complicated by the fact that the federal government and California, which runs the biggest state exchange, sent out nearly a million tax forms related to the health law with incorrect information, leading the administration to ask many to delay filing their taxes as a result. California has already issued 120,000 correct tax forms, but there are still "tens of thousands" who haven't gotten updated forms, according to the L.A. Times.
Beyond that, there are additional questions about whether the Internal Revenue Service is even equipped to handle all the new paperwork required by the law. According to the Chicago Tribune, roughly a quarter of tax filers will have extra filing requirements due to the health law.
And then there are the poll numbers for the law, which is still unpopular, just as it has been throughout the five years it has been law. Polls differ on the exact contours of public opinion about the law, but all the polls in the Real Clear Politics opinion survey show that oppositions outweighs support by at least seven points; on average, the opposition is 10.5 points higher than the support.
If the law is truly working so well for so many people, if it is, as Obama has now taken to saying, working better than expected or anticipated, then why does it remain so stubbornly unpopular?
When the law was being debated in Congress, many supporters of the law argued that it would grow popular once it passed. When that didn't happen, Obamacare backers insisted that it polled poorly because the major benefits had yet to kick in. When the major benefits kicked in, they argued that the botched launch of the exchanges was killing support.
These excuses no longer work. The coverage expansion has arrived, and while the precise numbers aren't clear, there's no denying that far more people are covered now than two years ago. The exchanges are still incomplete on the back end, but the consumer-facing part of the system works well enough. The health insurance subsidies have arrived, and are being doled out to millions, and so have the insurance rules restricting insurers from charging or denying coverage based on preexisting conditions.
Obamacare's major benefits have gone into effect and had time to work their way through the system—and yet the law remains widely disliked. Obama's message about the law, meanwhile, remains the same as always: It's great, and people should stop resisting and recognize how great it is.
After five years, in other words, President Obama has not changed his message, even in the face of consistent broad public opposition, even as the various theories for why it remains unpopular have fallen away. Obamacare is simply not well liked. This is the political reality—and President Obama still refuses to embrace it.