WASHINGTON -- The Affordable Care Act survived a near-death experience, made major progress and faced some significant setbacks in 2015, the fifth year since President Barack Obama's historic health care reform program became law.
These were the biggest Obamacare stories of the year about to end.
Obamacare haters got another chance to deal a devastating blow to the law before the Supreme Court, and came up short, just as they had three years before. Chief Justice John Roberts again sided with the high court's four liberals, along with Justice Anthony Kennedy, to reject a lawsuit that was conceived and underwritten by libertarian and conservative activists. King v. Burwell was based on a fictitious history of the Affordable Care Act that attempted to gut the law by singling out a handful of words and claiming Obamacare only permitted health insurance subsidies in states that created their own health insurance exchanges, not in those with federally run marketplaces. The case threatened to rob millions of their health coverage, but in the end, all it did was rob a lot of people of time, attention and effort.
The Uninsured Rate Plummets
There's a whole mess of stuff in the Affordable Care Act, but the chief and most measurable aim of the law is to get more people covered, and it's doing that. The Department of Health and Human Services estimates 17.6 million more people have health coverage than before Obamacare benefits kicked in on Jan. 1, 2014. Survey after survey from the U.S. Census Bureau, the Centers for Disease Control and Prevention, Gallup and others show the percentage of Americans without health insurance is the lowest ever measured. Thanks, Obamacare.
March Of The Medicaid Expansion
When the Supreme Court upheld the Affordable Care Act in 2012, justices also ruled that states could opt out of the law's expansion of Medicaid coverage to low-income adults. Republican-led states like Florida and Texas continue to refuse these benefits to their poorest residents, but 2015 saw the list of states not expanding Medicaid shrink. Alaska, Indiana and Montana signed on, and now 30 states plus the District of Columbia are participating. Republican governors in South Dakota, Utah, Wyoming and elsewhere are still struggling to persuade state legislators to set aside their vehemence over Obamacare and adopt the expansion, but to no avail so far.
Congress Finally Repeals Obamacare (Sort Of)
One of the favorite pastimes of House Republicans is voting to repeal the Affordable Care Act, but 2015 brought a GOP majority to the Senate, too, enabling the upper chamber to get in on the fun and pass a budget bill that cuts out big chunks from the law. Next week, the House is slated to vote for it, too, and Obama will get a chance to veto a repeal bill for the first time. And then congressional Republicans can high-five each other and get back to not having a replacement for Obamacare.
Lawmakers Take A Bite Out Of Obamacare
The dozens of repeal votes from 2011 to 2015 didn't actually ding the Affordable Care Act, and the changes Obama actually signed into law were pretty minor -- until this year. First, they undid part of the law that would have classified a lot of small businesses as big companies when it came to health benefits. But the biggest change -- and a significant loss for Obamacare and for the White House -- came with the enthusiastic support of congressional Democrats. Legislation Obama enacted this month delays the "Cadillac tax" on high-cost health insurance plans (a major source of revenue and a key tool in containing health care costs) along with taxes on medical device companies and health insurers. Bipartisanship!
Obamacare Enrollment Is Up!
The health insurance exchanges closed out the 2015 sign-up period with nearly 12 million enrolled, surpassing federal officials' projections (but falling short of the Congressional Budget Office's expectations). The growth was a positive indicator of the viability of these new marketplaces, and contributed to the declining uninsured rate.
Obamacare Enrollment Is Down!
During the course of 2015, the exchanges shed almost 2 million customers. Hundreds of thousands lost coverage because they didn't prove they were legal U.S. residents, and about a million saw their subsidies adjusted because their real income didn't match what they reported when they applied. And others cycled off the exchanges either to become uninsured or to obtain coverage from another source, like a job or Medicare. The market for individual health insurance has always been volatile, but this shrinkage raised worries about the future of the exchanges.
Obamacare Enrollment Is Up (Again)!
Health and Human Services Secretary Sylvia Burwell sought to manage expectations before 2016 enrollment began by predicting meager growth on the health insurance exchanges. But preliminary enrollment figures appear promising. More than 8 million people have signed up with a month to go in the enrollment period. And it looks like a lot of them are new customers and, crucially, younger and less costly than those already covered by exchange plans. So the marketplaces are either on track to beat projections, or Burwell did a nice job spinning everyone beforehand.
Obamacare premiums came in lower than Congressional Budget Office projections in 2014, and average increases in 2015 were in the mid-single digits. But ahead of the 2016 enrollment period that started last month, it became clear that pattern wouldn't repeat itself. Average premium increases were higher, and individual plans hiked prices by a whole lot more. Health insurance companies complained that Obamacare customers were sicker and more expensive than they expected, prompting fears that enrollment would stagnate as prices rose and drove out those who needed the coverage less, provoking even higher rate increases in the future. This led to a bunch of snide comments on Twitter about the name "Affordable Care Act."
Health Care Spending Quickens
The jury is still out on whether historically low year-over-year growth in national health care spending in recent years was all (or mostly) the result of the recession and slow recovery, or whether Obamacare and private sector innovation are making the health care system more efficient. But what we do know now is that spending sped up in 2014, primarily driven by expanded health coverage through the Affordable Care Act. Turns out spending a ton of money giving people health care spends a ton of money.
Long Live Death Panels
Several parts of the Affordable Care Act have been described as "death panels" to scare people into thinking their medical care would be rationed by bureaucrats. But the most infamous example was when former Alaska governor and GOP vice presidential nominee Sarah Palin used the moniker in a feverish Facebook rant to describe a provision of the legislation that became Obamacare that would allow Medicare to pay doctors who discuss end-of-life options with patients. Scaredy-cat Democrats pulled the policy from the bill, but the Obama administration did it through a regulation this year. Polls show the public supports it -- sorry, Gov. Palin!
UnitedHealth Gets Cold Feet
UnitedHealth Group is a minor player in the exchanges, but it's also the largest health insurance company in America. So when the company told investors it was losing money on Obamacare and might pull out, it raised eyebrows. Although other big insurers quickly said they had no intention of bailing on the exchanges, the UnitedHealth news was a reminder that Obamacare is still new -- and vulnerable.
Collapse Of The Co-Ops
As a consolation prize of sorts to liberals who wanted the exchanges to include a government-run "public option" health care plan to compete with private insurers, Congress included seed money in the Affordable Care Act to found new, nonprofit health insurance cooperatives that were supposed to increase competition and keep prices down. It sort of looked like it might work at first, but then Congress cut their funding, these new companies started bleeding money, and half of them shut down, leaving hundreds of thousands of consumers scrambling to find replacements. You can't spell "co-ops" without "oops."
Trouble In Kentucky
There was no bigger champion of the Affordable Care Act than Steve Beshear, the Democrat who was governor of Kentucky until this month. Under Beshear, Kentucky expanded Medicaid; erected Kynect, a state-run health insurance exchange that stood as a model for other states; and slashed the uninsured rate. But Beshear couldn't run again because of term limits, and Republican tea party favorite Matt Bevin bested his Democratic opponent and now is in charge. While Bevin has backed off his vows to repeal the Medicaid expansion, he still wants to radically change the program and to scrap Kynect. Kentuckians may not agree with those aims, but they voted for him anyway.
One of the lesser-known goals of the Affordable Care Act is to enhance patient safety, especially in hospitals, where preventable errors kill tens of thousands of people every year. In a promising sign, the federal Agency for Healthcare Research and Quality reported this year that these fatal episodes have been on the decline since Obamacare became law in 2010, and brought with it new policies including Medicare payment penalties for hospitals that don't improve patient safety. Good news for people who prefer not to die in the hospital for no good reason.
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