Hooray for Obamacare, a right-winger’s nightmare

Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies?

No. I was pacing the room, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.

It didn’t. And that means we can focus on the reality of health reform.

The Affordable Care Act is now in its second year of full operation; how’s it doing?

Better than even many supporters realize.

Start with the act’s most basic purpose, to cover the previously uninsured. Opponents of the law insisted that it would actually reduce coverage; in reality, 15 million Americans have gained insurance. Many of those still uninsured are in that position because their state governments have refused to let the federal government enroll them in Medicaid.

The law was never expected to cover everyone. Undocumented immigrants aren’t eligible, and any system that doesn’t enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.

Suppose we use 5 percent uninsured as a benchmark. In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent.

But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are better than no coverage at all. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.

What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent.

Opponents have consistently warned that helping Americans afford health care would lead to economic doom. But the U.S. economy has added more than 240,000 jobs a month on average since Obamacare went into effect, its biggest gains since the 1990s.

Finally, what about claims that health reform would cause the budget deficit to explode? The deficit has declined, and the Congressional Budget Office recently reaffirmed its conclusion that repealing Obamacare would increase, not reduce, the deficit.

Put all these things together, and what you have is a portrait of policy triumph.

Now, you might wonder why a law that works so well and does so much good is the object of so much political venom. But what conservatives have always feared about health reform is the possibility that it might succeed, and in so doing remind voters that sometimes government action can improve ordinary Americans’ lives.

That’s why the right went all out to destroy the Affordable Care Act. But Obamacare has survived, and it’s working. The great conservative nightmare has come true. And it’s a beautiful thing.