Obamacare at Four: Still a "Winner"?

Fractures appear as Democrats begin to fear running in defense of the unpopular law in 2014.

Obamacare’s fourth anniversary is upon us. House Minority Leader Nancy Pelosi assured reporters “it’s a winner” for Democrats, but her testiness suggested otherwise.

“[I]t’s called the Affordable Care Act,” she corrected a reporter. “It’s called the Affordable Care Act.” And why? "Affordable. Affordable," she replied. "There's a reason. Affordable. Affordable. Affordable. Affordable. Affordable."

Except that in some parts of the country, premiums are expected to double. A report by eHealthinsurance found that premiums in the individual and family markets have already increased more, before factoring in taxpayer subsidies, since early 2013 than in the previous eight years combined.

The most common reason cited by people who have yet to purchase insurance under Obamacare, McKinsey & Company found in a marketing survey, is that they can’t afford the premiums. As many as four of five companies surveyed by Mercer LLC may raise deductibles on their employees to offset costs imposed by Obamacare regulations.

Pelosi’s sparsely attended press conference may be to Obamacare as “Mission Accomplished” was to the Iraq war.

Anyone taking bets as to when she becomes speaker again?

The most obvious indication that something has gone wrong is that Republicans are running against Obamacare with the same intensity they were four years ago. In 2010, they retook the House. Despite needing a pickup of six seats, it’s not inconceivable they regain the Senate this November.

Behind closed doors, Democratic elected officials complain about Obamacare. One of its main architects, Sen. Max Baucus, has called its implementation a “train wreck” and declined to run for reelection this year. His Senate seat could fall to the Republicans.

At the beginning of the year, more people had insurance plans cancelled by Obamacare than signed up for private insurance under the exchanges. The administration has been forced to delay numerous provisions of the law and allow people to keep noncompliant insurance policies longer, though some states and insurers haven’t gone along with this administrative reprieve.

Things have improved somewhat since then, but the White House has taken to counting anyone who has selected an insurance plan as “enrolled” in Obamacare regardless of whether they’ve actually paid. They claim not to have any reliable figures about how many people haven’t paid, despite making six announcements about enrollment data.

Press secretary Jay Carney said Tuesday that major insurers “have placed that figure at 80 percent, give or take, depending on the insurer.” But if 20 percent or more haven’t paid, that means the administration’s enrollment figure of 5 million is off by at least 1 million, maybe more. Goldman Sachs is estimating that the administration will announce coverage for 5.5 million to 6 million people under Obamacare, but that only 4 million will have paid.

Surveys suggest that less than 30 percent of those obtaining private health insurance through the Obamacare exchanges were previously uninsured. McKinsey found that 27 percent had been uninsured, Goldman Sachs 25 percent.

Much, if not most, of the new coverage has come from the Medicaid expansion. Despite campaigns calling antiexpansion Republican governors killers, some research suggests that the substandard care Medicaid beneficiaries receive due to the program’s low physician reimbursement rates isn’t much of an improvement from being uninsured.