For the past year and a half, Democrats have repeatedly warned that President Donald Trump is trying to sabotage Obamacare.
The administration has made a number of changes to the administration of the health law, including slashing most of its advertising and promotions budget, cutting funds for enrollment assistance, and stopping the payment of subsidies to insurance companies. (The law calls for the subsidies but they were not authorized by Congress and were ruled illegal by a court.) These changes, Obamacare's boosters charge, amount to a sustained effort to undermine the health law and its goal of providing insurance coverage to Americans.
This week, the Census Bureau released new data on changes to the uninsured rate under Trump. They represent the first official numbers for the full year of 2017, and they show the impact of Trump's changes to the program.
Trump's efforts to sabotage Obamacare resulted in…no change to the overall uninsured rate, which remained at 8.8 percent, the same as in 2016. In fact, there were 2.3 million more people insured in 2017 than in 2016. (The percentage of uninsured stayed the same because of population growth.)
The Census figures, of course, account for all types of insurance coverage, not just those covered through Obamacare's exchanges or Medicaid expansion. But enrollment through the exchanges dropped only slightly during the 2017 open enrollment period, even after a significant reduction in the advertising budget. ("It's not collapse. It's incredible stability," the head of California's state-run insurance exchange said earlier this year when those figures were released.)
The new numbers show minor changes to overall mix of insurance types: In 2017, a slightly larger percentage of Americans were insured through their employers than in 2016, and a slightly smaller percentage were insured through Medicaid, probably as a result of increased employment and the general strength of the economy. The percentage of individuals covered by Medicare, meanwhile, has increased.
It is possible, of course, that had the Trump administration not altered the operation of the health law, the uninsured rate would be even lower. And the rate could still rise over time. Trump could take further actions in the future that would affect Obamacare enrollment, or overall health coverage numbers.
But while health policy conterfactuals may be interesting to entertain, they do not change the reality that Trump's supposed sabotage appears to have led to several million more people with insurance, and no statistically significant change to the overall percentage of Americans with coverage.
At the same time, after years of substantial increases, premium hikes in Obamacare's exchanges for the coming year appear, on average, to be relatively modest (although some individual plans may still see big hikes).
President Trump and the Republican party have certainly demonstrated a hostility toward Obamacare, and a general indifference to the particulars of health policy. There is little question that Trump has not managed the program the way a Democratic president would, or the way the health law's supporters would like. One can reasonably take issue with some of the specific choices his administration has made.
But the primary goal of the law was to facilitate health insurance coverage for Americans, and the best evidence we have is that Trump's actions, whether or not they were intended to undermine the law, have had remarkably little effect on the overall rate of insurance coverage. If this is sabotage, it does not appear to be working very well.