It’s been nearly two years since former Obamacare consultant Jonathan Gruber’s impolitic comments on the health care law led to a storm of outrage from critics of the Affordable Care Act. Now, the MIT health economist and Obamacare lightning rod reviews the law’s performance so far. We asked him to share some things that have surprised him and other experts as the ACA has unfolded — and to offer a look at the law’s future.
The Affordable Care Act was not only the most important expansion in health insurance coverage of the past 50 years; it was also the one that everyone weighed in on. Dozens of experts — and non-experts — made their own finely calibrated projections about just what the ACA had in store for health insurance coverage, health insurance costs and the overall U.S. economy. And while politicians have rendered their verdicts, those of us in the research world know we have to wait a little longer for definitive assessments, given that much of the ACA didn’t go into effect until the start of start of 2014.
Still, we do have 2.5 years of experience with the coverage expansion — and that’s enough to tell us something. More people are in Medicaid than anticipated; fewer bought health plans through the exchanges. The reasons why this has happened — including the stability of pre-ACA employer coverage and unwavering GOP opposition — include some surprises, even for those of us who have tracked the law closely and rooted for its success.
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