“It’s worth remembering what Republicans said would happen before the A.C.A. went online: that it would fail to reduce the number of uninsured, that it would blow a giant hole in the budget, that it would lead to a “death spiral” of rising premiums and declining enrollment.
What actually happened was a dramatic fall in the uninsured, especially in those states that expanded Medicaid. The budget costs of expanding Medicaid and subsidizing other insurance have been significant, but estimates for 2019 suggest that these costs will be around $115 billion — much less than half the revenue lost due to the Trump tax cut.
What about that death spiral? Premiums on the health exchanges established by the A.C.A. initially came in much lower than expected, then rose sharply when the people signing up for those exchanges turned out to be fewer and sicker than insurers had hoped. But the markets have now stabilized, with only modest premium increases for 2019 and insurers returning to the exchanges.
And while the exchanges are covering fewer people than projected, Medicaid is covering more than expected, so that overall gains in coverage have been surprisingly on target. In early 2014, the Congressional Budget Office projected that under the A.C.A., by 2018 there would be 29 million uninsured U.S. residents. The actual number is … 29 million.”