The Broken Promises of the Affordable Care Act

Proponents of the Affordable Care Act (ACA) made several promises before and since the law passed. The most notorious of these was President Obama’s assurance that people could keep their insurance plan if they liked it. However, other important promises were made that have garnered less media coverage, including how many people would enroll for coverage in the new health insurance exchanges, the law’s effect on health insurance premiums, the amount of choice and competition in health insurance markets, and the law’s impact on overall costs and the deficit. These promises arguably helped ensure some of the votes necessary for the controversial legislation to pass Congress.

More than six years after the ACA’s passage, these promises can be juxtaposed against reality. It turns out that:

  • while the percentage of individuals without insurance has declined, enrollment in the exchanges is far below projections;
  • exchange enrollees are much older and poorer than expected;
  • competition in the individual market has decreased rather than increased;
  • rather than falling, premiums have increased significantly in both the individual and employer-sponsored markets;
  • the law’s Medicaid expansion, which is responsible for the vast majority of rate decline in uninsured Americans, came at a far higher cost than expected;
  • the law has increased, rather than decreased, overall healthcare spending; and
  • the ACA has negatively affected economic growth, despite promises to the contrary.

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