Obamacare displaying good health

After a rough incubation, birth and infancy, the Affordable Care Act is a sturdy 5-year-old, showing increasing signs of achievement and acceptance. But growth could come to a sudden halt if the Supreme Court throws out the subsidies that enable more than 8 million Americans to pay their health insurance.

That would energize opponents, who have spent six years fighting Obamacare. But the negative fallout would extend beyond President Barack Obama to millions of beneficiaries.

Recent progress makes it much harder to justify contentions the controversial law is fundamentally unsound. The number of uninsured Americans has dropped dramatically, the rate of health care cost increases is trending down and some less-publicized, longer-term benefits are starting to show up.

Divided public

The overall public remains divided on the law itself. But support has risen and, among recipients, even a majority of Republicans are satisfied with their health care, a recent Reuters/Ipsos survey disclosed.

“One still sees a lot of noise in the system, but the facts and the traction of the substance of it working are beginning to take hold,” Health and Human Services Secretary Sylvia Mathews Burwell said in an interview.

The Kaiser Family Foundation’s latest monthly tracking poll showed a narrow margin of the public views the law favorably. While a slight majority in the Reuters/Ipsos poll was unfavorable, 60 percent of those covered by the law were favorable and two-thirds of them were satisfied with their health care, including 53 percent of Republicans.

Nevertheless, opponents remain undeterred. Congressional Republicans included Obamacare repeal in their budget, while GOP presidential candidates vow its replacement. But the Supreme Court poses the principal threat to its continued growth – even its existence.

Burwell and other administration officials express confidence the court will uphold subsidies in the 34 states where state inaction forced recipients to purchase insurance through the federal government’s exchange. They feel the legislative history makes clear Congress’ intent, despite language specifying recipients as those in exchanges “established by the state.”

The nonpartisan Urban Coalition says a negative ruling could deprive 9.3 million Americans of tax credits – including 1.5 million Texans receiving $4.3 billion – and cost 8.2 million their health insurance. The federal government would be unable to respond administratively. It would detract from ongoing efforts to do what Congress mostly can’t do: make the complex law work better.

When I covered Congress in the 1960s and 1970s, and even later, lawmakers from both parties worked with administrations on “technical corrections” to fix inevitable problems in complicated laws.

In today’s hyper-partisan world, that’s largely impossible, though some things are happening: administration officials recently testified before a Senate committee where Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington have created a working group to improve the health records system the law expanded.

Improved website

HHS has improved its rightly criticized signup website by reducing the number of screens through which enrollees must scroll from 76 to 16, and sharply reduced technical glitches. It’s working to refocus the Medicare to pay for value received, not volume of visits and tests.

Meanwhile, Obamacare’s impact is growing. The government says a net total of 16.4 million people have gained health insurance – despite another 6 million losing it – since ACA’s enactment. Nearly 30 percent picked up coverage from an expanded Medicaid, and almost as many were young adults who gained eligibility to stay on a parent’s plan. The Gallup-Healthways quarterly index says the uninsured rate has dropped by one-third, to 11.9 percent of adults.

Predicted long-term financial benefits are emerging. Annual health care cost growth has slowed to 3.2 percent, the lowest in four decades, reducing Congressional Budget Office long-term cost estimates. The rates of both Medicare hospital readmissions and hospital-acquired conditions have declined.

Carl P. Leubsdorf is the former Washington bureau chief of the Dallas Morning News. Distributed by Tribune Content Agency, LLC.