Obamacare just turned 10. Take a look at how it has held up to its promise

Monday marked the 10th anniversary of former President Barack Obama signing the landmark Affordable Care Act, aka Obamacare. Ever since, the health law has faced incessant legislative, legal, and political attacks from the Republican-controlled Congresses and Trump. Obama addressed these challenges on the occasion of the anniversary, tweeting: Ten years ago today, I signed the Affordable Care Act into law. It protected preexisting conditions, cut the uninsured rate in half, and lots more. But it's still under political attack right when we need care the most. We have to protect it, build on it until we cover everyone.

The political attack the former President warns about shows no signs of letting up even now—when the country is going through a pandemic that threatens the lives of every single citizen. On the eve of the 10-year anniversary of the passage of Obamacare, President Trump reaffirmed his commitment to pursuing the lawsuit against the AKA, saying: "what we want to do is terminate it." According to Protect Our Care, if the Trump administration succeeds in its attempts to overturn the law, it would rip coverage away from 20 million Americans and leave 135 million individuals with pre-existing conditions unprotected in the midst of an unprecedented health care crisis.

While the political forces battle it out, the burning question right now is how well the law has worked in its first decade. According to The New York Times, although Obamacare did not achieve universal coverage, it did bring about a historic drop in the number of Americans without health insurance. "In addition to making medical treatment available for many who already had chronic and infectious conditions, the A.C.A. offered preventive care to millions of people who otherwise might have become ill," said John Auerbach, president and chief executive of Trust for America’s Health—a nonpartisan health policy group. "It’s also resulted in improved access to coverage and care for people of color, reducing — although not eliminating — longstanding disparities."

A drastic drop in the uninsured rate for low-income Americans

The biggest advance of the Affordable Care Act has been the huge increase in coverage of poor people. While the law originally required states to expand Medicaid, the Supreme Court ruled against it in 2012, making the provision optional. Despite the move creating a disparity that remains stark, save for 14 states, all others have now expanded the program. Medicaid enrollment increased by about 13 million—34 percent—in these states between 2013 and 2019. The uninsured rate for low-income Americans with no dependent children dropped to 16.5 percent in 2015 from 45.4 percent in 2013.

However, over the last couple of years, this rate has started creeping back up. According to the Census Bureau, 8.5 percent of the population did not have health insurance in 2018—an increase from the 7.9 percent the year before. This increase was the first since the ACA passed in 2010 and came at a time when the economy was doing well. Researchers are now trying to measure just how much the Trump administration's efforts to undermine the law has influenced this rise.

For many Americans, Obamacare didn't hold up to its "affordable" promise

Despite its promises of being affordable, healthcare continues to be an extraordinary burden for millions of households. Many middle-class people who don’t qualify for Medicaid or federal subsidies to help buy an individual policy are still struggling to afford medical aid. The average premium for a mid-level plan for a 40-year-old who doesn’t qualify for a subsidy climbed from $273 in 2014 to $462 a month in 2020. The law has done little to protect citizens from soaring prescription drug costs and staggering deductibles. "The affordability problem is different from the coverage problem. Health care has just become so expensive," said Katherine Hempstead, a senior policy adviser for the Robert Wood Johnson Foundation.

Made Americans healthier and reduced mortality rate

A recent series of studies indicate that Obamacare has made people healthier. "At this point now there is enough evidence that we can say confidently that giving people health insurance produces health impacts and positive health changes," said Benjamin Somers, a physician and researcher at the Harvard T.H. Chan School of Public Health. Craig Garthwaite, a health economist at the Kellogg School at Northwestern—who had counted himself a skeptic before seeing the recent results—agreed, saying: "If you put all of it together, it seems like the A.C.A. did have a positive effect on health and caused a reduction in mortality."

Deductibles: its biggest flaw

Obamacare allowed insurers to set deductibles—an amount that patients need to pay before coverage kicks in—significantly higher than those Americans who get health insurance at work typically face. While individual deductibles can go as high as $8,150, the limit rises to $16,300 for families. "We obviously made a huge mistake. We were under a lot of pressure to keep the price under a trillion dollars," said Ezekiel J. Emanuel, who advised the Obama administration on health policy at the time. "That was constraining everything we did, from the size of the subsidies to what type of care could have no co-pay."

Meanwhile, some of those who worked on the law say that they'd anticipated the issue. "There was an acknowledgment at the time that affordability was likely going to be a concern," said Frederick Isai, who worked on the law as a congressional staffer in 2009 and 2010. Although they'd expected that the health law’s subsidies would be enhanced over time, rather than making tweaks and adjustments to it, Republican legislation focused primarily on attempting to repeal the health law and starting anew.