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Nevertheless, the Affordable Care Act persisted

To a very real extent, 2020 served as a test for the ACA and the existing system. There's fresh evidence that "Obamacare" passed the test nicely.


Over the last four years, the Trump administration has taken a variety of steps to undermine the Affordable Care Act, outside of legal efforts to tear down the existing health care system altogether. But the law sometimes known as "Obamacare" is persisting anyway.

As a political matter, as we discussed a few weeks ago, the ACA's popularity has never been better. But more important is the policy itself, and as the New York Times reported yesterday, the law is working as designed, even during a deadly pandemic.

The Affordable Care Act gave states the option to cover poor residents through Medicaid, and it offered tax credits to help low- and middle-income Americans buy health insurance. Since the coronavirus pandemic set off job losses this spring, enrollment in both programs has been growing.... State Medicaid enrollment, according to one report, had an 11 percent increase between February and September in the 36 states that have released data. Another paper, from Manatt Health, shows those gains concentrated in states that have participated in the health law's Medicaid expansion, with an enrollment growth rate of 22.2 percent between February and November.

The Times' report added that Obamacare sign-ups, while heartening to those eager to see more American families with health security, would likely have been even higher still "if not for Trump administration moves that included slashing the A.C.A.'s advertising budget and declining to have an additional sign-up period when the pandemic hit."

In other words, Republican efforts to undermine their own country's health care system had an effect, and probably kept some from getting coverage, but the Affordable Care Act continued to work well anyway.

To a very real extent, 2020 served as a test for the ACA and the existing system. In recent decades, when there's an economic downturn in the United States, the number of Americans without health insurance goes up considerably.

In 2020, however, the United States saw an economic catastrophe, driven by a public-health crisis, and the nation's uninsured rate -- which started inching higher after Donald Trump took office -- remain largely unchanged.

Now all Americans need is for Republican-appointed Supreme Court justices to ignore GOP calls to destroy the nation's health care system in its entirety, an explicit goal for Trump who chose a third of the members of the current high court.