A Checkup for Obamacare

"In a few moments, when I sign this bill, all of the overheated rhetoric over reform will finally confront the reality of reform."

--President Obama, March 23, 2010

WASHINGTON -- Not exactly. Five years after the Affordable Care Act became law, the reality of reform remains hotly contested.

When it comes to the wisdom of the law, that's not surprising. After all, there is a legitimate ideological debate about whether it is a wise use of federal power to require individuals to obtain health insurance, or a wise use of federal resources to spend so much on subsidizing coverage.

What's more puzzling, and more disturbing, is the still-raging division over the real-world effect of the ACA. "It is important that everyone understand how absolutely fantastic it was for the people of this country," said Senate Minority Leader Harry Reid last week.

"It just isn't working," insisted Utah Republican Sen. Orrin Hatch. "In fact, it is, by most objective accounts, an unmitigated disaster."

Here's my take, after talking to numerous health care experts and examining the data: Notwithstanding its bumpy rollout, the law has accomplished its goal of expanding coverage -- at significantly lower cost than expected.

Certainly, the president overpromised when he told people that if they liked their health insurance they could keep it; by its own terms, the law set new standards for required coverage. Certainly, some individuals, particularly younger and healthier customers, find themselves paying more; again, such winners and losers were an inevitable consequence of the individual mandate and minimum coverage rules.

Meantime, the scariest warnings -- of employers rushing to drop coverage and insurance markets ensnared in death spirals of ever-rising premiums -- have not come to pass.

Where the law has yet to fully deliver on its promises -- and some wonder whether it will -- is in the area of cost containment and quality improvement. Health care cost growth has slowed dramatically, but there is a continuing debate about what role the ACA played. In any event, health care continues to consume an unacceptable 17 percent of GDP.

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