Last week, Barack Obama joined President Biden at the White House to mark the 12th anniversary of the Affordable Care Act, also known as Obamacare. Yet it was unclear what there was to celebrate. The ACA failed to increase insurance coverage as much as expected, imposed mandates that raised costs, reduced choice, and forced people to buy insurance that many neither wanted nor needed—all while doing little to improve health.
Obamacare increased health-insurance coverage through highly subsidized individual plans on state-based insurance exchanges and by expanding eligibility for the Medicaid program. The percentage of Americans uninsured fell from 15 percent before the ACA’s passage to 9.7 percent in 2020. This gain, however—roughly 16 million Americans—was far less than the 25 million predicted by the Congressional Budget Office. And nearly all the ACA’s net coverage gains came from increased Medicaid coverage, which affords small, uncertain benefits and limited access to care.
Only 10.7 million were enrolled in the ACA exchanges in 2020. This coverage increase was offset by losses in the off-exchange, non-group market and employer-provided insurance. About 15.5 million more people enrolled in Medicaid.