Testing Paul Ryan's damning attack on the Affordable Care Act: 'Obamacare has failed'

When U.S. House Speaker Paul Ryan describes repealing and replacing the Affordable Care Act, he gives the signature legislation of President Barack Obama a damning assessment.

Here’s a typical version, from his weekly press briefing on Jan. 5, 2017:

"We’re going to get this law repealed, we’re going to get this law replaced, and we’re going to have a transition period so that people do not have the rug pulled out from underneath them while we get to a better place. Obamacare has failed, is getting worse, and we have to provide relief. And we will have a transition period so that people don’t get hurt."

Ryan earned a Mostly True rating for his November 2016 claim that Obamacare "is not a popular law" -- though it’s worth noting that a January 2017 poll by the Kaiser Family Foundation, a leading nonprofit research group on health care, found a split, with 49 percent saying Congress should repeal the law and 47 percent saying Congress should not.

Our rating was False when the Wisconsin Republican in January 2017 said Obamacare "is in what the actuaries call a death spiral," given that conditions didn’t match the definition of what is an established term.

But perhaps no Ryan attack on the law has been as audacious as "Obamacare has failed," a declaration he has made several times. He even went so far as to say on Jan. 27, 2017 that it is "basically a spectacular failure," though three days later he went softer, saying in a tweet: "For many Americans, it has already failed."

So, let’s put Ryan’s claim to the test.

There are many ways, of course, to evaluate the Affordable Care Act, which became law in 2010 though many changes were phased in later. But two of the major ones are coverage (Do more people have health insurance?) and costs (How much do you pay for insurance and what does it cover?)

"There were things that succeeded and there things that didn't go as planned," said Donna Friedsam, health policy programs director at the University of Wisconsin Population Health Institute.

Said economist Gail Wilensky, a senior health and welfare adviser to Republican President George H.W. Bush: "To say it’s a failure is problematic because it requires a more nuanced answer."

This table highlights some of our findings. It’s followed by a more detailed analysis.

Coverage

Costs

20 million Americans gained health insurance

Total health expenditures grew at record low rates in first three years after Obamacare

8.9% of Americans did not have health insurance in 2016, down from 16% in 2010

Employer plans: Family premiums up 99% under George W. Bush, 59% under Barack Obama

Millions no longer at risk of being denied coverage due to pre-existing conditions

22% in 2017 in cost of the average mid-level Obamacare plan

"If you like your health care plan, you can keep it": 2013 Lie of the Year

Cut the typical family's health insurance premium up to $2,500: Promise Broken

The coverage

More gained coverage: The U.S. Department of Health and Human Services has estimated that during the first six years of Obamacare, 20 million Americans gained health insurance as a result of the law -- a figure acknowledged by Donald Trump’s administration. Similarly, the nonpartisan Congressional Budget Office projected in January 2017 that a 2015 bill that would have repealed key portions of the law would have increased the number of uninsured by 18 million in one year.

On a related note, the President’s Council of Economic Advisers credits the law for what it says is a one-third drop nationally since 2010 in the share of Americans reporting that they have forgone medical care due to cost.

Fewer are uninsured: As one might expect, far fewer people are uninsured. Defending Obamacare during the 2016 presidential campaign, Hillary Clinton said a record 90 percent of Americans had health insurance. PolitiFact National rated that True. A month later, in November 2016, a U.S. Centers for Disease Control and Prevention report, based on its annual survey, found 8.9 percent of Americans did not have health insurance in 2016. That was down from 16 percent in 2010, the year the ACA was passed.

How it’s been done: The 20 million who have gained insurance includes people covered through the law’s expansion of Medicaid, the creation of the Health Insurance Marketplace, where individuals buy policies, and changes in private insurance -- one that allows young adults to stay on their parents’ insurance plans and one that requires insurers to cover people with pre-existing health conditions.

When former GOP presidential candidate Carly Fiorina said in a Milwaukee debate in December 2015 that "Obamacare isn't helping anyone," she earned a Pants on Fire. At the time, 10 million people had been put on Medicaid as a result of Medicaid’s expansion under the law; and 9.5 million were enrolled in policies bought on the marketplace (including 8 million who were receiving subsidies under the law).

In addition, the law as it stands now has meant millions of Americans are no longer at risk of being denied coverage due to pre-existing conditions (a Promise Kept for Obama); or are no longer at risk of being kicked off policies for developing expensive medical conditions.

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Broken promises: It’s worth noting that the gains in coverage have not all gone as planned. Obama and others had said repeatedly about the ACA -- "If you like your health care plan, you can keep it" -- and that became PolitiFact National’s 2013 Lie of the Year. Obamacare rules were strict, so that even if existing plans deviated a little, the plans were not grandfathered in under the law, and by the fall of 2013 insurers canceled coverage for millions of Americans.

"Access to a ‘no-frills’ plan is a huge improvement on what low-income people experienced prior to the marketplaces," said a Vox critique of the ACA. "But it's still a far cry from what health wonks envisioned just a few years ago when they saw the health care marketplaces reshaping the industry.

Referring to the 20 million, Wilensky, now a senior fellow at Project HOPE, an international health foundation, said of the ACA: "Saying it’s a failure is too harsh because it got that part done."  

The costs

An Obama pledge made during the 2008 campaign to cut the cost of a typical family's health insurance premium by up to $2,500 a year was rated a Promise Broken. As they have for years, health care costs have continued to increase, but there has been some moderating.

Premiums rising: Premiums have gone up -- a cumulative 11 percent between 2013 and 2016 for the average full-family, employee-sponsored plan; and 38 percent between 2014 and 2017 for Obamacare plans. But the results are mixed, if you consider how much premiums went up before the ACA:

• On employer-sponsored plans, family premiums increased by a cumulative 99 percent under the eight years of Obama’s predecessor, President George W. Bush, while under eight years of Obama, the increase was smaller -- 59 percent -- according to Kaiser. Kaiser’s latest annual employers survey found that the average family premium in 2016 for their plans rose just 3 percent from 2015, while the premium for single coverage stayed essentially flat. That’s not to say the premiums aren’t substantial: Workers on average contribute $5,277 annually toward their family premiums.

• For individual market policies, in the three years before the ACA, premiums rose on average 9.9 percent in 2008, 10.8 percent in 2009 and 11.7 percent in 2010, according to the nonprofit Commonwealth Fund. The higher increases under Obamacare include a projected 22 percent increase nationally in 2017 in the cost of the average mid-level Obamacare plan, which is the most popular choice, though Kaiser says the increase would be as high as 145 percent (for customers in Phoenix).

Critics have also pointed out that people who buy insurance on their own in the federal marketplace have fewer choices. Some major insurers, because they suffered losses, have dropped out of the marketplace, leaving nearly one in five Americans who are eligible for Obamacare with only one insurer in 2017, according to research done by the McKinsey Center for U.S. Health System Reform for the New York Times.

Big picture-wise, total expenditures on health care nationally grew at record low rates in 2011, 2012 and 2013, the first three years after the ACA was adopted, according to the President’s Council of Economic Advisers -- even if there is debate over a number of factors as to why. Health care costs are rising much more slowly than they did during the past 50 years, two former Obama health care advisers wrote in the Washington Post. But Wilensky said much of the slowdown can be attributed to the global recession, given that increases in health spending were even lower on average in other industrialized nations.

Deductibles rising: Ryan and other Republicans have said many people feel they don’t really have health insurance because their deductibles are so high. It’s worth noting that one ACA provision ensures that nearly all Americans with employer coverage have a limit on their annual out-of-pocket spending. But the Kaiser survey of employers found the average deductible for workers covered by an employer plan was $1,221 in 2016, up 13 percent from $1,077 in 2015.

And deductibles can run high for Obamacare plans. In a story headlined, "Many Say High Deductibles Make Their Health Law Insurance All but Useless," the New York Times found that in many states, more than half the plans offered through HealthCare.gov had a deductible of $3,000 or more.

Our rating

Ryan said: "Obamacare has failed."

The Affordable Care Act did not meet all its promises, including a big one -- that you could keep your insurance plan if you liked it. But health care costs have risen more slowly since the law took effect and the law has met its major goal of getting more people insured -- an estimated 20 million. That’s not a failure.

The biggest problem with Ryan’s statement is that he, and Obamacare critics, take a nuanced situation and turn it into a black-and-white statement. The same problem would face those who say Obamacare is a great success.

Our definition of Mostly False is "a statement that contains some element of truth but ignores critical facts that would give a different impression." That fits here.

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Politifact Rating:

"Obamacare has failed."

Paul Ryan

U.S. House speaker, R-Wis.

In a press briefing

Thursday, January 5, 2017

-01/-05/2017

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