A New Round of Enrollment Amid Ongoing Debates
Enrollment for the next round of Obamacare is set to begin on November 1. This timing is particularly interesting, considering there’s a partial government shutdown currently happening, largely due to discussions surrounding the Democrats’ aim to broaden this contentious 2010 legislation.
Back in the day, then-President Barack Obama, along with his fellow Democrats, made several promises regarding the Affordable Care Act, which is commonly referred to as Obamacare.
Here are four key promises from the Obamacare law that many feel have not been fulfilled.
1. ‘Your Premiums Will Go Down’
During his 2012 reelection campaign, Obama insisted that once the Affordable Care Act was in place, it would lower prices for insurance. He had previously claimed back in 2008 that he would sign a health care bill during his first term aimed at ensuring coverage for every American, all while cutting the average family’s premium by up to $2,500 annually.
In 2012, he reiterated views on the newly passed law, saying it would allow individuals to purchase insurance through groups, thereby reducing premiums. “You’re going to get the same good rates folks at big companies get,” Obama said during a campaign event in Cincinnati.
However, a report from the Heritage Foundation in August 2024 revealed that the average monthly premium for individual market coverage shot up from $244 in 2013 to $568 in 2022—a staggering 133% increase. The report also indicated an increase in average deductibles for bronze-level plans.
Interestingly, 15 states managed to get federal waivers from certain Obamacare rules, which helped decrease premiums there. Still, overall, in 40 states, average monthly costs for individual market coverage have more than doubled. Some examples show that premiums rose by 213% in Missouri, a whopping 309% in Alabama, and a striking 323% in West Virginia, all detailed in the same Heritage report.
2. ‘Competition Where There Wasn’t Competition’
Obama claimed back in October 2013 that the Affordable Care Act would foster a more competitive insurance marketplace. “We created competition where there wasn’t competition before,” he said, adding that insurers would show more interest and offer more options.
However, the numbers tell a different story—34 states and the District of Columbia reported fewer insurers providing coverage in 2024 compared to a decade earlier. On a more positive note, eight states had more insurers than before, with some states seeing an increase in available plans. Yet, this still does not match the nearly 400 insurers that existed in 2013.
In 2026, about 95% of enrollees will have access to at least three qualifying health plan issuers, which is a slight drop from the previous year but much improved from 2020. A notable point raised by a senior research fellow at the Heritage Foundation is that any potential benefits that could have come from competition were overshadowed by a subsidy design that essentially insulated enrollees from real costs.
3. Not ‘One Dime to Our Deficits’
During a September 2009 speech, Obama vowed that he “will not sign a plan that adds one dime to our deficits, either now or in the future.” Initially, the Congressional Budget Office anticipated that the Affordable Care Act would even reduce federal deficits. Unfortunately, as the actual costs of Medicaid expansion and subsidies surged, particularly during the pandemic, that expectation fell through.
The COVID-era subsidies, included in various legislative acts, are projected by the CBO to result in a $380 billion rise in costs for taxpayers if made permanent. The prediction is that about 6.9 million individuals could end up on the exchanges, many of whom would already have insurance. Conversely, enrollment nearly doubled from 13.7 million in 2019 to 26.7 million by the first quarter of 2025.
Critics, like Brian Blase from the Paragon Health Institute, argue that Obamacare is not truly affordable, noting that it has limited access to certain doctors and hospitals. Most users are, for the most part, dependent on massive subsidies.
4. ‘Savings’ From Medicaid Expansion
Obama mentioned in March 2010 that reforms depend on everyone having coverage—and that without addressing emergency care costs for the uninsured, real savings wouldn’t materialize.
From 2013 to 2023, nearly 20 million able-bodied adults became eligible for Medicaid, a stark contrast to the more modest increases for children and the elderly. Issues have arisen, as new enrollees often crowd emergency rooms, making it harder for existing Medicaid users to secure appointments. A report released by the Paragon Health Institute pointed out these complications, showing how accessibility for prior enrollees deteriorated after expansion.
Overall, Medicaid and Children’s Health Insurance Program enrollment soared from 61.1 million to 85.4 million during the last decade, with notable increases in several states.
