ObamaCare proves surprisingly resilient

ObamaCare is showing its resilience after a year where it took a beating but survived.

A surprisingly high number of people signed up under the law in the enrollment period that ended last week: 8.8 million, just short of the 9.2 million from last year.

And that was despite the Trump administration’s attacks on the health-care law, cutbacks on outreach and an enrollment period that was half as long as previous ones.


The enrollment numbers suggest that a core group of people, though smaller than what architects of the law originally imagined, wants health insurance and will sign up despite any obstacles in their way.

“The ACA seems to have more lives than your neighborhood cat,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation.

“It’s a smaller and less functional program than supporters had originally hoped, but it’s still doing the job of [keeping] the uninsured rate at the lowest level ever,” he added.

In Congress, the zeal among Republicans for repealing the law appears to be fading somewhat. Some lawmakers are still pushing to revive repeal efforts next year, but important figures are signaling that would be difficult and it could be time to move on.

“I think we’ll probably move on to other issues,” Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellDemocrats slide in battle for Senate McConnell and wife confronted by customers at restaurant Pelosi, Schumer: Trump 'desperate' to put focus on immigration, not health care MORE (R-Ky.) told NPR.

He later acknowledged at a news conference that Sens. Lindsey GrahamLindsey Olin GrahamThe Memo: Trump in a corner on Saudi Arabia Trump should stick to his guns and close failed South Carolina nuclear MOX project CNN's Smerconish: What do Saudis have over American presidents? MORE (R-S.C.) and Bill CassidyWilliam (Bill) Morgan CassidyTrump signs bills banning drug pricing 'gag clauses' Dem ad accuses Heller of 'lying' about record on pre-existing conditions GOP senator suggests criminal referral for third Kavanaugh accuser's 'apparently false affidavit' MORE (R-La.) will keep pushing their repeal and replacement legislation in the new year, but said simply, “I wish them well.”

With a 51-49 majority, he expressed doubts there would be enough votes to pass it. Then there are the polls that show ObamaCare’s approval above 50 percent, and exit polls suggesting health care played a role in bringing out Democratic voters in Virginia’s off-year election in November.

Republicans did deal a major blow to ObamaCare this month by repealing the mandate that requires people to buy insurance or face a tax penalty.

Most experts don’t think it will be a death blow to the law, but some expect it could lead to premium hikes or insurers dropping from the marketplace.

Ironically, the surprisingly high enrollment numbers announced this week are in part due to an action President TrumpDonald John TrumpDemocrats slide in battle for Senate Trump believes Kushner relationship with Saudi crown prince a liability: report Christine Blasey Ford to be honored by Palo Alto City Council MORE took that seemed aimed at hurting ObamaCare, experts say.

Trump cut off key payments to insurers known as cost-sharing reductions. To make up for the lost revenue, insurers raised premiums, but cleverly used the structure of ObamaCare to raise prices only on certain plans. That had the effect of increasing government subsidies that help people afford insurance.

The end result was a convoluted way to increase subsidies, which actually made plans more affordable for many people, helping to entice them to buy coverage.

Another unexpected factor helping to boost signups could have been all of the publicity this year around the law — even if it was negative.

“The negative publicity from the Trump administration, every newspaper had a story on a regular basis,” said Joe Antos, a health-care expert at the right-leaning American Enterprise Institute.

“Maybe it’s just the reminder that there’s health insurance out there,” he added.

The countervailing forces were the Trump administration’s cutbacks in outreach and grants to outside groups that help people enroll, along with an enrollment period that was half as long.

But as long as there are still subsidies available to help people afford coverage, experts think there will be substantial numbers of people signing up.

“The premium subsidies are what's holding this program together,” Levitt said.

Congress, meanwhile, might actually take bipartisan steps aimed at stabilizing the law next year, something that has not happened since ObamaCare was enacted.

“We want to steady the insurance markets if we can,” McConnell said in the NPR interview.

He pointed to bipartisan bills backed by Sen. Susan CollinsSusan Margaret CollinsConservatives bankrolled and dominated Kavanaugh confirmation media campaign The Hill's Morning Report — Presented by the Coalition for Affordable Prescription Drugs — Health care a top policy message in fall campaigns Susan Collins and the mob mentality MORE (R-Maine) that would provide funding aimed at lowering premiums.

There are still doubts about whether those bills can get through the House, given opposition from conservatives.

Speaker Paul RyanPaul Davis RyanPelosi, Schumer: Trump 'desperate' to put focus on immigration, not health care Trump urges Dems to help craft new immigration laws: ‘Chuck & Nancy, call me!' Sanders, Harris set to criss-cross Iowa MORE (R-Wis.) also appears more eager to get back to ObamaCare repeal.

“I don’t think the health care issue is done,” Ryan, who has suggested his main focus next year will be welfare reform, told The Weekly Standard.

Rep. Mark MeadowsMark Randall MeadowsConservative rep slams Rosenstein's 'conflicts of interest' The Hill's Morning Report — Presented by the Coalition for Affordable Prescription Drugs — Trump, Obama head to swing states with Senate majority in balance Five takeaways from the first North Dakota Senate debate MORE (R-N.C.), chairman of the conservative House Freedom Caucus, is also not optimistic about the chances of getting back to ObamaCare repeal next year.

“I think it is on the table, but to be honest I don't know that there’s a path to repealing it with a 51-vote majority in the Senate, and knowing that anything that you touch with the Affordable Care Act generally gets zero Democrat votes,” Meadows told reporters Thursday.

“But it is on the table, but it would have to be more from an administrative fix and then to see how we can fix it legislatively in a bipartisan way,” he added.

One administrative action is already on the way: an executive order that Trump signed in October. The move will loosen the rules to allow an expansion of short-term plans that don’t have to meet the same standards as ObamaCare. Some experts warn that will siphon healthy people away from ObamaCare plans.

For the most part, though, Trump has been less vocal recently about the need to return to ObamaCare repeal. Trump said Friday that he wants to move to the bipartisan topic of infrastructure next. And he is pointing to the elimination of the individual mandate that has already occurred.

In fact, Trump said Friday that with the mandate gone, ObamaCare had already “essentially” been repealed.