When the dust had settled in the Democratic presidential nomination contest of 2020, the last remaining defender of the Affordable Care Act, Joe Biden, had won. And though his more progressive opponents had succeeded in pushing Biden toward expanding Medicare, his policy goal remains to “protect and build on” the ACA.
What the other Democratic candidates agreed upon, though, was that the ACA was a massive failure—that’s why nearly all pushed for some form of Medicare-for-All.
And they were right—at least in the diagnosis, if not the prescription. The ACA was never really health reform; it was only ever health insurance reform. And in its sweeping, arbitrary and haphazard way, it failed to live up to the promises Democrats—led by President Obama—made to the American people.
Here’s how. First, President Obama solemnly pledged to the American people—the vast majority of whom were happy with their own health care and insurance—that they could keep their health care plans. According to PolitiFact, he and members of his administration made that promise no less than 37 times.
“If you like the plan you have, you can keep it,” he said in his June 6, 2008 weekly radio address. “If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold.”
Of course, millions of Americans learned this was a lie. As many as 9.3 million families had their policies canceled, and while many of these families went on to the exchanges to seek coverage, many found themselves “in a tough position,” as Obama himself acknowledged in a 2013 interview, in which he apologized for breaking this promise.
Next, Obama said “you can keep your doctor.” But more than 214,500 physicians declined to participate in exchange plans, largely due to reimbursement rates. CNN fact-checked Obama’s statement as “false.”
The president also promised that the typical family’s health insurance premiums would go down by $2,500. Instead, premiums increased from $2,524 for an individual to $12,040 for a family (headed by a policy holder over 60). In general, the ACA increased premiums by about 60 percent.
Then there’s the promise that those with pre-existing conditions would be protected, shielding patients from paying exorbitant bills or risking death from a lack of care. Yet the ACA did not decrease bankruptcies related to medical bills, nor did it result in better health outcomes (measured in mortality rates among the non-elderly).
But by far, the most disappointing breach was the ACA’s promise that it would increase access to care. This promise was broken in many ways. The plan was for the ACA to get more people into their primary care doctor’s office more often, and sooner. This would help cut costs by ensuring that ailments were addressed more quickly.
But because reimbursement rates were set so low, hundreds of thousands of doctors opted out of the exchange plans, and the number of doctors who accept new Medicaid patients hasn’t risen along with the demand (and remember, the expansion of Medicaid is the backbone of the ACA). There’s further evidence that the ACA failed to reduce the use of emergency rooms (a big cost driver).
The fact is that more than half of those who are the uninsured are eligible for some kind of government assistance (Medicaid, ACA Tax Credits, or other public programs). It’s the failure of the ACA that many remain uninsured.
Despite these broken promises, Biden doubles down on his campaign website, pledging to build on the “success” of the ACA by “giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate.”
But we’ve heard this pitch before. We don’t need more of the same broken promises.
Instead, we should put patients in charge by requiring the cost of all health services to be disclosed in advance, and eliminating surprise medical bills. We need to fix Medicaid by giving low-income Americans more options for care. We need a guaranteed coverage pool for those who are ineligible for financial aid but still can’t afford insurance. And we should try promising new models such as Direct Primary Care that take government and the insurance companies out of doctor-patient decisions.
Enough of the promises. It’s time to take action.
David Balat is the director of the Right on Healthcare initiative at the Texas Public Policy Foundation.