(Bloomberg View) — No issue has aroused more partisan passion over the past six years than the Affordable Care Act (ACA), the package created from the signing of the Patient Protection and Affordable Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA). Yet the law is playing only a secondary role in the U.S. elections.
Sure, Republican presidential candidates cater to their base by vowing to repeal and replace Obamacare, and on the Democratic side, Sen. Bernie Sanders of Vermont promises to replace it with a government-run universal coverage system.
But it doesn't dominate the dialogue and isn't a top priority on either side. Among the most embattled Senate Republican incumbents, the campaign websites of New Hampshire's Kelly Ayotte, Mark Kirk of Illinois or Ron Johnson of Wisconsin barely mention the ACA. An exception is Pat Toomey of Pennsylvania.
The explanation may be that for all its controversy and imperfections, the sweeping law has taken hold. "This is in the fabric of the nation," says Health and Human Services (HHS) Secretary Sylvia Mathews Burwell.
To be sure, the presidential election outcome will be a determinant of whether Obamacare is reshaped, bolstered or downsized.
But even some skeptics acknowledge that its numbers are rather impressive. About 20 million more Americans now have health insurance than before the law was enacted in 2010; in the last enrollment period on the health care exchanges, 12.7 million signed up, almost 40 percent were newcomers. The expansion of Medicaid for the poor is making a mark.
Millions of Americans with pre-existing conditions no longer can be denied coverage; kids can stay on their parents' plans until age 26, and health care inflation is the lowest in years.
Burwell, in an interview, noted that there are a lot of less-known successes, such as a sharp reduction in patient harm at hospitals. She acknowledges challenges, which she put in "three buckets": reforming the health-care delivery system to encourage quality, not quantity, of care; addressing a few places where markets still are broken such as Alaska, and making technical fixes to so the law works a little better.
Critics find more. Premiums have soared this year in a number of states. Congress, in a bipartisan move, postponed and is threatening to kill a few important provisions that could create budgetary and cost-control problems; 22 states where Republicans hold sway have refused the expansion of Medicaid coverage.
In the presidential campaign, the rhetoric still can get hot. Texas Sen. Ted Cruz says the ACA is "the biggest job-killer in this country. Millions of Americans have lost their jobs." Over all, from March 2010, when the law was enacted until today, the economy has added 13.7 million jobs.)
