That’s a remarkable milestone — and if you’re keeping score, 1 million more people than the Congressional Budget Office projected would enroll in the Affordable Care Act’s health care exchanges this year, and 2 million more than the CBO predicted following the insanely botched website rollout that sunk the president’s approval ratings and imperiled the entire 21st-Century liberal experiment, such as it is. (It’s worth noting here again, as so many have before, that Obamacare is at its core a retread of an idea that emerged from the right-wing think tank The Heritage Foundation in the ’90s.)
About 28 percent of those 8 million fall within the magic 18-34 demographic — young and presumably healthy people the risk pool needs to keep premiums down — which is less than we hoped but probably good enough. Forthcoming data will give us a deeper picture of the ACA’s successes and shortcomings, but for now you can hardly fault the White House for taking a victory lap.
As it turns out, if you offer people quality (if imperfect), reasonably priced (especially if they qualify for subsidies) health insurance, a lot of them will take it. All told, factoring in the law’s accompanying Medicaid expansion and a provision than enables young adults to remain on their parents’ insurance plans until the age of 26, thanks to the ACA 12 million more Americans will have insurance than would otherwise. And more will have it in the future: The CBO projects that the number of uninsured Americans will decline from 42 million this year to 30 million by 2016.
That number is still far too high. For many of them — about 65 percent — there’s not much we can do. These people, the CBO projects, will either decline private insurance or not sign up for Medicaid even though they’re eligible. About a third will go uninsured because they’re undocumented immigrants — blocked from the exchanges and Medicaid by federal statute — who will continue driving up costs by showing up at the emergency room for a cold (or, worse, foregoing health care altogether until a serious and pricey malady arises).
And then there are the 5 percent: those left out in the cold by this and other states’ refusal to accept billions in federal dollars to offer Medicaid coverage to the working poor — a spiteful move that has already led to actual poor people actually dying [News, “Falling Into the Gap,” Billy Manes, April 16]. (As the Florida Legislature’s annual session careens to a May 2 close, Senate President Don Gaetz is making noise about revisiting the Medicaid expansion; I’d wager my firstborn on a snowball surviving perdition before throwing a penny at Gaetz’s success, at least this election year. Watching Tallahassee for any length of time makes one cynical.)
There’s something else at play here, a larger, overarching trend more likely than anything else to cement the ACA’s place in American society: the rise of the freelance culture. Today, one in three Americans is self-employed. By decade’s end, an estimated one in two will be. That alone will fundamentally decouple health care from employment — and make the ACA indispensable. And that’s why, Republican petulance aside, the war is over.