Obamacare’s Secret Success

By Ezekiel Emanuel, Cathy Zhang, and Aaron Glickman

The Democratic campaign has crackled with energy around “Medicare for All,” with one candidate after another jumping into the argument about how best to bring health care to all Americans.

Lost in all the back-and-forth is that much of this revolution has already happened. Under the Affordable Care Act, several states have already achieved near-universal coverage, and without anywhere near the national disruption that a full system reboot would cause. As of 2018, six states and Washington, D.C. have achieved over 95 percent health care coverage for their residents.

This coverage triumph does not mean that the American health care system does not need reform. But it does demonstrate that the ACA can catalyze near-universal coverage. And by adopting some modest policy reforms, every state, and the country as a whole, can get there, too.

This has happened despite the fact that the Trump administration has tried to sabotage health care expansion. The administration has cut the insurance exchange open enrollment period by 50 percent, reduced advertising and navigators to help people buy insurance by nearly 90 percent, added requirements to Medicaid to discourage enrollment, and authorized “skinny” insurance options with bare-bones coverage designed to lure healthy enrollees away from comprehensive plans in the ACA insurance pools.