Solid news about the Patient Protection and Affordable Care Act keeps coming. It's almost as if the myths about the law — the idea that it was a failure and about to collapse — were junk.
PPACA was designed to achieve two goals, according to its advocates: it was supposed to increase the number of people with health insurance, and to cut health-care costs.
Increasingly, the former looks like a solid achievement, and there are increasing signs the latter is being accomplished, too, though it isn't clear the PPACA deserves the credit.
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The latest evidence is a bunch of new survey data on the newly insured. In short, after years of people losing insurance, there's been a dramatic increase in the number of insured. Yes, there are still plenty of arguments about whether PPACA is a bit behind or a bit ahead of its targets (these are statistical studies, and the evidence is far from clear when it comes to specific numbers). And, yes, we're only one year into full implementation, and there's plenty of uncertainty about how well the next phases will go. But the PPACA essentially is doing what it was designed to do.
See also: Uninsured rate remains at record low
On the question of costs, we know that something is changing for the good, and in a significant way. Compared with the coverage numbers, it's a lot harder to pin down why medical inflation is way down: it could be the PPACA, it could be technology, or the broader economy, or something else entirely. In any case, it's hard to look at the numbers and determine that reform is causing problems.
Meanwhile, it appears so far that those who have new insurance through expanded Medicaid or the exchanges like what they have. That shouldn't be a surprise because the exchange plans aren't a radical departure from normal insurance — except to those who bought scare stories that weren't really based on much. Although it now appears that some scare stories may have backfired.
Now, a few conclusions. First of all, I don't expect most Republicans to believe any of this, mainly because the party's opinion leaders and partisan media aren't going to report it (with some notable exceptions).
Second, I don't expect PPACA to begin polling well, for reasons I've been over many times.
Third, straight-up repeal has been dead for months, and it remains highly unlikely that Republicans will ever adopt a real "repeal and replace" plan other than one that entails relatively minor and cosmetic changes to the status quo.
Fourth, "working more or less as planned" certainly doesn't mean people should stop being tough on the White House and the Department of Health and Human Services about implementation. Smart, reality-based critics, liberals or conservatives, are an important part of how things can go right. No one should begin blindly accepting White House spin.
And even if PPACA winds up working perfectly, that still won't prove it was a good choice. As with everything, there are costs and benefits; it's reasonable to accept that the PPACA has benefits without agreeing that it was worth it, or is the best way to deliver those benefits. I would expect liberals and conservatives to place differing values on expanding coverage, for example.
The debate over PPACA and how to continue to improve health care will proceed a lot better if it's reality-based. Unfortunately, I doubt that's going to happen.
To contact the writer of this article: Jonathan Bernstein at [email protected].
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