evidence that most of the dramatic gain
in the number of Americans with health
care coverage is due to President Barack
Obama's law, and not the gradual
recovery of the nation's economy.
That could pose a political risk for
Republicans running against
"Obamacare" in the GOP primaries as
they shift to the general election later
this year. While the health care law
remains highly unpopular in the party,
the prospect of taking away health care
coverage from millions of people could
trigger a backlash if the eventual GOP
nominee's plan to replace it is seen as
coming up short.
"There are different phases of the
campaign," said GOP pollster Bill
McInturff. Playing to like-minded voters
in the primaries, Republican front-
runner Donald Trump doesn't have to
spell how he'd replace Obama's law.
"When you get to the general election,
the demand for what you are going to do
different starts to escalate."
Under "Obamacare," the share of
Americans without health insurance has
dropped to a historic low of about 9
percent, with room to go even lower. But
even as the economy has expanded,
major government surveys point to a
lackluster rebound for employer-based
coverage.
"It's very clear that the Affordable Care
Act has done most of the work in
decreasing the number of uninsured,"
said economist Robert Kaestner of the
University of Illinois at Chicago.
The numbers vary across different
government surveys, but the overall
pattern is strikingly similar:
— The Census Bureau's American
Community Survey found about 3
million more people gained employer
coverage between 2010, when the health
law passed, and 2014. But the number of
uninsured people dropped by more than
10 million during that same period. The
strongest gains appeared to come from
Medicaid, which was expanded under
Obama's law. The percentage of
Americans covered by employers stayed
about the same.
— The National Health Interview Survey
from the Centers for Disease Control and
Prevention also found that employer
coverage was essentially flat between
2010 and 2014. But the same survey
found 12.6 million more people with
health insurance during that period.
— The Census Bureau's Current
Population Survey found no statistically
significant change in the number of
people covered by employers from 2013
to 2014, while the number of uninsured
people dropped by nearly 9 million as
the law's main coverage expansion got
under way during that time.
"This kind of shift in insurance I don't
think can be explained by the economy,"
economist Christine Eibner of the RAND
Corporation said. "The increase (in
coverage) is large enough that it can't be
driven by just economic recovery."
Kaestner said "most of the heavy lifting"
seems to be coming from Medicaid
expansion.
Employer-provided insurance plans
remain the mainstay for workers and
their families, covering an estimated 150
million to 170 million Americans. But
even before the 2007-2009 economic
recession, workplace coverage was
steadily shrinking because of rising
medical costs.
Obama's law provides subsidized private
insurance for those who don't have
access at work, along with a Medicaid
expansion geared to low-income adults
in states that agreed to do so. Most
individuals are required to have
coverage, and larger employers must
offer it or face fines.
The health care law has been difficult to
navigate for consumers, and its skinny
policies can expose patients to high
medical bills. But it's becoming a
backstop for millions of Americans in a
changing economy.
On the campaign trail, Republican
presidential candidates denounce
"Obamacare" for a litany of woes. But
some prominent conservative experts
recognize that the law has increased
coverage, even as they propose other
approaches to meet that goal.
"Repealing the law without a plausible
plan for replacing it would be a
mistake," said a policy paper from 10
leading GOP health policy experts,
published by the business-oriented
American Enterprise Institute.
Democratic front-runner Hillary Clinton
has already previewed how Democrats
might use the issue this fall, frequently
reminding voters they risk losing some
popular benefits if the health care law is
eliminated. Meanwhile, a nonpartisan
analysis of Trump's initial outline for
repealing and replacing the health care
law found it would push millions back
into the "uninsured" category.
The analysis last week from the
nonpartisan Committee for a
Responsible Federal Budget found that
the Trump plan would increase the
number of uninsured by about 21
million people while costing the
government nearly $500 billion over 10
years.
Replacing Obama's law with a
conservative alternative that delivers
comparable coverage would require
considerable taxpayer dollars, something
few Republicans seem ready to accept.
"Any repeal has to have a way to
increase coverage and not just by a few
million," said economist Gail Wilensky,
who ran Medicare under former
President George H.W. Bush.
Obama's law "is obviously not the only
way to do this_but it is important that it
gets done" Wilensky added.
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