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Observations Yankee Doodling

How will we know if Obamacare has “worked”?

BMJ 2014; 349 doi: (Published 10 November 2014) Cite this as: BMJ 2014;349:g6725
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, and associate editor, The BMJ
  1. dkamerow{at}

It depends on what you think it was intended to do

As the beginning of the second annual sign-up period for the US Affordable Care Act approaches, it is reasonable to ask whether or not the act, “Obamacare,” has been a success. As with most things, where you stand depends a lot on where you sit. Republicans commonly call Obamacare an utter failure, and Democrats defend it as increasingly successful. In reality, of course, it is way more complicated than that.

Take, for example, the experience of two family friends, both rather liberal Democrats. The first is in a family with a chronically ill adult. As a result, they had been paying huge monthly premiums for adequate coverage and found, to their delight, that they could dramatically reduce their monthly premiums under the Affordable Care Act. The second friend discovered that, contrary to promises that he could keep his insurance, his health plan was cancelled. His income level precluded subsidies, and the premiums for his new plan doubled. In both cases, the difference was thousands of dollars a year, but in opposite directions. Needless to say, the first family is …

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