What the critics rarely said in 2009, 2010, 2011, 2012, or most of 2013 was that nobody would sign up for coverage on the exchanges, or that the law would fail to increase the percentage of Americans with coverage. They said that much of the increased coverage would be of low quality, and that the coverage expansion could be accomplished at a lower cost. Some of them talked about the possibility of a “death spiral” in which Obamacare’s regulations reduced the incentive to buy insurance so much that the market collapsed — but for the most part they thought of this as something that would take a long time to happen if it happened at all. The argument over Obamacare, that is, has mostly taken for granted that more subsidies for health insurance could lead to more people having it.
Our experience of the law has not been quite what either side predicted. In part that’s because the law has not been implemented as written. The employer mandate, which critics put at the center of their case that the law would kill jobs, has not been put into effect. (The Congressional Budget Office has, however, found that other features of the law, such as its reduced subsidies as people move up the income scale, will discourage work by the equivalent of 2.5 million jobs a year.) The administration has put regulations that threatened to cancel many existing plans into a kind of legal limbo.
By the standards President Obama set, however, the law is closer to a failure than a success. Its biggest achievement is a modest decline in the percentage of Americans without insurance. And it is modest: Even the highest estimate of the increase in coverage (the one derived from Gallup polling) suggests that the percentage of Americans uninsured has dropped merely to around the level of 2008. At this point at least, even the projection the CBO made just a year ago (of 14 million fewer uninsured) seems implausibly optimistic.