It is way too early to tell how the Affordable Care Act (ACA) is going to shake-out. Neither Republican doom-saying nor Democrat triumphalism seems warranted at this moment. There are signs of gains that need to be consolidated and issues that may need to be addressed.

During the first year of the ACA the uninsured rate fell by thirty percent/10 million people.[1] That means that seventy percent/20 million people of the previously un-insured are still un-insured. Between 2002 and 2012 a rising number of Americans told Commonwealth Fund pollsters that medical bills caused them financial troubles.[2] Medical debt became one of the leading causes of people filing for bankruptcy. Many people (43 percent in 2012) decided against seeking some sort of medical care because of the cost. The Affordable Care Act intended to address this problem as one part of its effort to make health care more broadly available. The number of Americans reporting trouble with medical debt peaked at 41 percent in 2012. Then the number began to fall, hitting 35 percent in 2014. The number of those who did not seek medical care because of cost also fell to 36 percent. So, is the glass full, half-full, or empty?

The big problem is health-care costs and, thus, health-insurance costs.

Between 2003 and 2013, insurance premiums rose faster than did median incomes.[3] Between 2003 and 2010 insurance premiums rose by an average of 5.1 percent per year. In thirty-seven states the total employer + employees contributions equaled at least 20 percent of median income. Thus employers’ labor costs also rose. From 2011 to 2013, the pace of increases slowed, but continued to rise at a rate of 4.1 percent. By 2013 the average insurance premium had reached a national average of $16,000. Employers started looking for a way to limit the rise in their labor costs.

What they have hit on, in many cases, is shifting the cost to employees. In 2003, 52 percent of workers had employment-provided insurance with a deductible. By 2013 the number had risen to 81 percent. Furthermore, the deductibles have also risen by an average of 146 percent. They now average $1,000 per person in most states. According to a Commonwealth Fund study, the out-of-pocket costs for employees (insurance premiums + deductibles) rose from 5.3 percent of median household income in 2003 to 9.6 percent in 2013.

On the one hand, according to one report, 58 percent of Americans polled want ObamaCare repealed.[4] Why? Job-creation and wage increases have both been lagging for several years. This has left people feeling like the Great Recession never ended. Perhaps the shifting of medical costs to their consumers makes people feel like ObamaCare never happened.[5]

On the other hand, although health-care costs have risen more slowly since passage of the ACA, most economists—as opposed to political spokesmen—attribute this to the recession. They are likely to start back upward as the economy recovers. This will increase the pressure on employees for out-of-pocket expenses and premiums.

In short, we’re not yet done with health insurance reform. Maybe we’ll get it all the way right the next time.

[1] “Obamacare: Why, in Year Two, it’s still so unpopular,” The Week, 16 January 2015, p. 6.

[2] Margot Sanger-Katz, “Distress Appears to Ease Over Cost of Health Care,” NYT, 15 January 2015.

[3] Tara Siegel Bernard, “Health Premiums Rise More Slowly, but Workers Shoulder More of Cost,” NYT, 8 January 2015.

[4] “Obamacare: Why, in Year Two, it’s still so unpopular,” The Week, 16 January 2015, p. 6.

[5] However, it is possible that what they don’t like is Obama, rather than the Care. People often disapprove of a President in his lame-duck years.