On the fifth anniversary of Obamacare, after the botched website rollout, the infamous broken promise about keeping your health care plan if you like it, the staggering midterm election losses for Democrats and persistent doubts among consumers, President Obama had a proud message for his critics Wednesday: I told you so.
“This law is saving money for families and for businesses,” Mr. Obama told invited guests at an Obamacare celebration at the White House. “This law is also saving lives. It’s working, despite countless attempts to repeal, undermine, defund and defame this law.”
After five years of defending the centerpiece of what likely will become his legacy, the president couldn’t resist taunting Republicans who have been fighting the federal entitlement program at every turn. He said 16 million more Americans have gained health care coverage as a result.
“We have been promised a lot of things in these past five years that didn’t turn out to be the case: death panels, doom, a serious alternative from Republicans in Congress,” Mr. Obama said. “It’s not the fiscal disaster critics warned about for five years.”
But more Americans still disapprove of Obamacare than those who favor it, 43 percent to 41 percent, although the gap between those camps has narrowed to its closest margin in over two years, according to a Kaiser Family Foundation poll released this week.
Republicans said Mr. Obama’s boasts can’t cover the law’s shortcomings.
“No matter how much President Obama spins his unpopular health care law so Hillary Clinton can run for his third term, middle-class Americans are still being saddled with higher premiums, higher taxes, fewer work hours, and canceled plans,” said Republican National Committee spokesman Michael Short.
Analysts say another legacy of Obamacare is how the law, enacted without a single Republican vote, has cast a partisan shadow over the rest of Mr. Obama’s presidency and his dealings with Congress. Democrats lost badly in the midterm elections of 2010 and 2014, in part because of a public backlash over the law’s passage and later over its botched website launch and consumers’ lost coverage.
Ever since Republicans gained control of the House in 2011, they have waged dozens of legislative efforts to repeal part or all of the law. Some analysts say the creation of Obamacare may have permanently damaged relations between the White House and congressional Republicans in a way that prevented deals on immigration reform and other potential compromise issues.
“He used every ounce of political capital to pass Obamacare. It is for him, even to this day, what his legacy will be, so he needs this desperately to succeed,” said Brandon Rottinghaus, a political science professor at the University of Houston who has written on presidential leadership. “It has expanded this political friction between President Obama and Congress once Republicans took over both houses. The president, on the negative side, has birthed a major movement which has made it its mission to take him and the Democratic Party down. He has worsened relations between the branches. He has invited a narrative of imperial overreach,” all because of Obamacare.
For Mr. Obama, the political consequences were both immediate and long-term. In the aftermath of Obamacare’s passage in 2010, the tea party rose to prominence, propelling Republicans to victory and giving the GOP control of the House.
“This has really become very personal,” said Joe Antos, an analyst on federal health care policy at the conservative-leaning American Enterprise Institute. “Obama has been defensive all along. It’s been personal because of the way the Democrats in Congress and in the White House ran their campaign. It was a bare-knuckled, no-holds-barred wrestling match with all the big actors in the health sector.”
Rep. John Fleming, Louisiana Republican, said the health care overhaul is one of several instances in which the White House decided to go it alone. He also cited the president’s deportation amnesty and political targeting by the IRS.
“These are egregious things that just show bad faith and really destroy relationships,” he said.
But he said he does think the health care debate set a political sea change into motion.
“The reason why the huge [House] Democrat majority has shrunk to a small Democratic minority, and the Democrats have lost the Senate, is one thing: Obamacare,” he said. “We don’t talk about that, but the truth is that’s really why this is happening.”
Obamacare is facing another challenge at the Supreme Court, which will decide this summer on a challenge brought by Republican-backed plaintiffs to invalidate the law’s insurance subsidies in 34 states that didn’t set up their own exchanges. If that happens, more than 7 million people likely will lose their coverage.
Several of the states that would be affected by an anti-Obamacare ruling are critical to next year’s presidential race. One of the battlegrounds is Florida, home to likely Republican candidates Marco Rubio and Jeb Bush.
Allan Lichtman, a political historian at American University, said Obamacare has been “a chief point of contention with the Congress.”
“But the truth is, he’s been in contention with Republicans in Congress on almost every issue,” Mr. Lichtman said. “Republicans and Democrats can find almost nothing to agree on these days.”
Only three lawmakers attended the Obamacare celebration at the White House: Democratic Reps. Kathy Castor of Florida, Ron Kind of Wisconsin and Jim McDermott of Washington state. The attendance served as a reminder of how incumbent Democrats ran from Obamacare, and from Mr. Obama himself, on the campaign trail last year.
“Obama is far more effective in defending the law and proclaiming what the law has done than the cowardly Democrats were, especially in 2014, trying to run away from Obamacare and run away from President Obama,” Mr. Lichtman said. “You can’t do that. It doesn’t work.”
The administration said this month that a net 16 million Americans had gained health coverage since Obamacare’s key provisions took root, including Medicaid expansion, state-based health care exchanges and allowing young adults to stay on their parents’ plans. A total of 28 states have adopted the Medicaid expansion, with most Republican governors opposing it.
But a study released Thursday found that the exchanges have been unable to attract Americans with moderate incomes, even though the government provides subsidies to people making up to 400 percent of the federal poverty level.
States using the federal HealthCare.gov portal enrolled 76 percent of eligible residents with incomes from 100 to 150 percent of the poverty level, yet participation “declined dramatically as incomes increase and subsidies decrease,” according to Avalere Health, a Washington-based consultancy.
The same states were able to enroll only 16 percent of eligible residents who earned 301 percent to 400 percent of the poverty level.
“People receiving more generous subsidies are expected to enroll in the exchanges at higher rates. However, participation levels decline as incomes increase, even among individuals who would be eligible for both premium subsidies and cost-sharing reductions,” said Elizabeth Carpenter, a director at Avalere.
As this president prepares to leave Washington and even long after his successor moves into the Oval Office, the effects of Obamacare still will be felt, analysts say.
Despite the administration’s insistence that the political battle over the law was won in 2012 — when Mr. Obama defeated Republican Mitt Romney, who campaigned extensively on repealing the law — the reality appears much different.
“There was a sense that in 2012 this had been adjudicated — according to Obama and others, this battle has been won, the war has been won. I think that’s wrong,” Mr. Rottinghaus said, adding that Obamacare, when it is written about decades from now, may be viewed as even more divisive between the parties than entitlement programs such as Social Security and Medicare.
“None of them had the legs this one has in terms of creating that partisan distance,” Mr. Rottinghaus said.
⦁ Tom Howell Jr. contributed to this report.