By Elise Viebeck and Jonathan Easley - 03/31/14 06:00 AM EDT
The deadline for ObamaCare’s first-year enrollment has arrived, four years after one of the most far-reaching and divisive pieces of domestic legislation became law.
Here’s a measure of how well the healthcare law has met its objectives.
How many more people are insured?
The central argument for ObamaCare’s passage was the need to cover the uninsured; 48 million people lacked coverage in 2012, according to the Census Bureau.
The administration last week said 6 million have signed up on the federal or state exchanges. Officials say they don’t know how many of these people previously lacked coverage, but independent estimates range as low as just 1 million, just 2 percent of those previously uncovered.
As many as 1.2 million may not have paid their first bill, which is a prerequisite for using a policy.
The law allows people up to the age of 26 to stay on their parents’ coverage, which a 2012 study by the Commonwealth Fund said added 6.6 million people to insurance rolls the previous year.
ObamaCare also expanded Medicaid, providing insurance to about 3 million additional people, according to Avalere Health.
If those totals were accurate, ObamaCare would be contributing to the insurance coverage of about 15.6 million people this year.
But because of ObamaCare, an estimated 4.7 million people have received cancellation notices for their existing policies.
Many were shifted to other plans or signed up for the exchanges, but some may have dropped health insurance for this year as they confronted higher-than-expected costs.
A Gallup survey released this month found the percentage of people who say they lack coverage fell in March to 15.9 percent — the lowest point in five years and more than two percentage points lower than the 18 percent recorded in mid-2013.
The Census Bureau’s annual report is usually published in September, so official insurance data for this year will probably not be available until after Labor Day of 2015.
Will it reduce or add to the budget deficit?
Republicans have always denied claims that ObamaCare would reduce the federal deficit.
The CBO says it is doing so now as ObamaCare’s tax revenues outpace the provision of new health benefits.
Washington will collect hundreds of billions of dollars in new taxes over the next 10 years under the healthcare law. Higher Medicare payroll taxes will hit wealthier households and the government will collect new revenue from mandate penalties on individuals and employers.
Still, Republicans say the law’s subsidies for coverage and its expansion of Medicaid will eventually swamp the budget in red ink.
The CBO agrees that ObamaCare will add to deficits by $7 billion in 2016 and 2017, but says this will be followed by consistent deficit reduction after the so-called “Cadillac” tax ramps up in 2018.
This is a 40 percent excise levy that will hit companies that provide the most generous health insurance plans. The explanation given for this tax is that it will curb overuse of medical services in plans where patients don’t foot most of their medical bills.
Over time, ObamaCare’s cost-control policies, such as the Independent Payment Advisory Board (IPAB) are designed to reduce deficits. But there’s no guarantee that the board’s Medicare spending recommendations will become law.
Healthcare groups, Republicans and some Democrats want the panel abolished. That and a move by Democrats to scrap limits on the growth of premium subsidies could lead to higher spending and deficits.
Is it reducing healthcare costs?
Democrats promised the law would bend the healthcare cost curve downward.
To do this, the reform created several programs explicitly aimed at restraining spending and slowly moving Medicare away from a fee-for-service model.
The success of these programs can’t be properly measured yet, especially because healthcare cost increases began a historic slowdown before ObamaCare was passed. Centers for Medicare and Medicaid Services (CMS) economists said healthcare spending rose less than 4 percent in 2012, less than half the rate of 10 years ago.
The White House credited Obama-Care, but most economists, including those at CMS, said the slow economy was the main reason for the decline.
The real test for ObamaCare’s cost policies will come during more robust economic expansion, which could spur inflation.
Meanwhile, insurers expect premiums on the exchanges to jump by an average of 10 percent for consumers next year. At least one company may triple its rates, making it plain that price spikes could be much higher in some plans.
During his run for the presidency, Obama promised his healthcare law would cut a typical family’s premium by $2,500 a year. There is not sign yet of that happening.
Is the healthcare law choking the economy?
ObamaCare’s boosters argued that it would help the economy, but critics say the tepid recovery is proof of the opposite.
It’s tough to gauge the truth because the administration has twice delayed the mandate obliging businesses with at least 50 employees to offer health insurance to workers who put in at least 30 hours a week.
Republicans say this rule will prompt businesses to slash work hours to below the threshold. Some employers have already done this.
Critics also warn that the mandate could deter companies from hiring, and that ObamaCare taxes on small businesses and capital gains will discourage investment. It will be easier to assess these claims over time as the law’s effects take shape.
The Congressional Budget Office earlier this year reported that ObamaCare would reduce the size of the labor force by 2 million people by 2020.
Opponents say this showed that the law was costing the economy jobs, but supporters argue it proves the law is giving people freedom to leave jobs and still maintain health coverage.
Since then, the Commerce Department offered some good news for ObamaCare supporters, stating that the law’s Medicaid expansion and tax credits boosted consumer spending and personal incomes in January.