Progressive Critics of Obamacare Still Not Happy: Is Glass Half Empty or Half Full?

Now that the U.S. Supreme Court has saved Obamacare—the Affordable Care Act—for the second time and signs of relief from its supporters have subsided, there is a certain amount of buyer’s remorse circulating in liberal media circles.

“In the post-ACA era, you can be insured but have little or no coverage for what you actually need,” writes Trudy Lieberman in Harper’s July issue, in a feature titled, "Wrong Prescription? The Failed Promise of the Affordable Care Act." “The ACA’s greatest legacy may finally be the fulfillment of a conservative vision laid out three decade ago, which sought to transform American health care into a market driven system.”

Writing in the Nation (and posted on AlterNet), Kai Wright listed three steps that must happen for a better “functioning and equitable healthcare system.” He cited expanding enrollment in Medicaid—state-subsidized care for poorer people—in the 22 states that have not done so; making sure the coverage offered is sufficient and is not undermined by unaffordable co-pays; and hoping that state insurance regulators will do more to prevent predatory price hikes.

Chief among the gripes, however, is that Obamacare is not the long-sought dream of universal health care—a right, not a privilege or a profit center. In other words, now that Obamacare is not going to be swept away by Republicans who are unable to get past a White House veto or win in the highest courts, what remains is not so wonderful, affordable or even historic—unless what’s historic is the missed opportunity.

Whenever a federal reform involves one-sixth of the U.S. economy, which is the size of the health care sector, it’s always possible to cherrypick gripes and praise. But it seems like the latest whacks at Obamacare from the liberal left are a bit unfair, as they overly emphasize what’s long been dysfunctional in the political process and in the insurance industry’s middleman role, while ignoring what the law has actually achieved.

For idealists like Harper’s Lieberman, Obamacare is not just a cup that’s half empty, it’s a trail of tears and fears and political cowardice. As she enumerates, nobody read the bill before it passed. The public doesn’t understand it. There’s been no criticism of it from the left. Its messaging was shaped by Democratic pollster Celinda Lake. It is not offering citizens what other industrialized nations have. Yes, it’s aimed at the poor, but Obama’s promise that nobody would lose coverage was a lie. It’s “fattening up the health care industry and hollowing out coverage for the middle-class.”

It’s hard to know if Lieberman realizes her criticisms echo Republican talking points spread coast to coast by the Koch brothers' propaganda. She barely acknowledges the multi-millions spent on political messaging trashing it, which shapes public misunderstanding. She grimaces that Democrats didn’t do more to stand up for a better reform, even though plenty of progressives called for Medicare-for-all, which Obama rejected.

But worst of all, she says it isn’t really helping the poor because even with subsidies, too many people can’t afford co-pays to get followup care. “Having failed a substantial part of the population it was actually designed to help, the ACA is also wreaking havoc on the middle class, much of which had good insurance to begin with,” she writes.

I don’t know what benevolent universe of wonderful middle-class health insurance policies she is refering to. I have been self-employed for most of my life. That means ever-increasing premiums—with 25 percent or more spikes every five years after turning 50. That means not being able to buy a new policy, because no one would sell one because of advancing age—the excuse was pre-existing conditions. That means paying high COBRA rates—110 percent of your prior premium to keep a health plan. Many of my friends went years without any health coverage, relying on diet and exercise and hoping they didn’t end up in a hospital. In all of those instances, Obamacare has created options or softened blows.

You can judge if the cup is better described as half-full or half-empty. The White House issued an Obamacare fact sheet after the Supreme Court upheld its federal subsidies. It said more than 137 million Americans “now have access to preventative care, including immunizations, well child visits, certain cancer screenings, and contraceptive services, with no additional out-of-pocket costs as well as no more annual caps on essential benefit coverage and new annual limits on out-of-pocket costs.” The last time such a high percentage of Americans had coverage was in the early 1970s, it says.

You’ve surely heard the administration’s other numbers. Sixteen million uninsured now have coverage, including 4 million young adults. “Over 85 percent of individuals newly covered by the ACA like their coverage.” Safer hospital stays, with lower death and infection rates; and 8.7 million people receive a subsidy averaging $272 a month. “Hospitals saved an estimated $7.4 billion in 2014 because of less uncompensated care… Reduced hospital uncompensated care means less of a ‘hidden tax’ for insured Americans.”

If you want to look at independent assessments of Obamacare’s impact and performance, go to the Kaiser Family Foundation’s website where there’s reams of data and analysis about how the law is unfolding across the country. Yes, compared to 2014 and 2016, it looks like premiums are going to go up by more than what’s been seen in recent years, at least in 10 states where that information is now available. But Kaiser analysts say a savvy shopper will find savings during the annual open enrollment period. That may be frustrating to have to do that, but it’s better than having no coverage at all.    

Kaiser also reports that deductibles are rising—and gives a good reason why. It’s not just because insurers are greedy and are trying to skim every dollar, but because under the law there are fewer older “grandfathered” policies offered by employers with more limited coverage. In other words, newer health plans have become more comprehensive.

Kaiser’s fall 2014 nationwide survey found that “26 percent of covered workers are in 'grandfathered' plans as defined by the ACA, down from 36 percent last year and 48 percent two years ago. The shift means a rising share of workers will benefit from specific reforms affecting the employer market, such as covering preventive benefits without cost sharing and offering an external appeals process.”

It’s easy to bash Obamacare and the health insurance industry. Progressives like Sen. Bernie Sanders have been calling for universal health care for decades, and they say it’s an American embarassment that our health care system is so costly and still overlooks millions. But before jumping on the Obama-sold-us-out bandwagon, think about where the American health care system would be if the law did not exist. Imperfect as Obamacare is, we do not want to go back in time.