Obamacare has increased enrollment in its health care exchanges to more than 11 million, and the conservative response to the law’s demonstrable success at carrying out its goals has been fascinating to behold. Measured by volume, the right-wing backlash has diminished severely, as great roaring waves of furious anger have given way to irregular ripples of discontent. But measured by its content, very little has changed. Conservatives are talking much less than they used to about Obamacare, but they are saying more or less the same things, treating the law as a costly and obvious failure. What’s most striking is how oblivious most of them remain not only to measures of the law’s success, but even to the broad parameters of its objectives.
To take a typical example, here is Stephen Moore, chief economist at the Heritage Foundation, making his case, such as it is, that Obamacare has failed to meet its cost targets. Perhaps the most revealing aspect of Moore’s column is the fact that, five years after its passage, the chief economist of the most influential conservative think tank in the United States lacks even a passing familiarity with its fiscal objectives.
Obamacare has two fiscal goals. The first is to pay for its expanded coverage with a combination of spending cuts and higher taxes, so that the net effect is to reduce the deficit. The second, and more ambitious, goal is to change the incentives of the health-care system to gradually bring down health-care inflation (a goal health-care wonks have called “bending the curve”). Moore’s column, which I am excerpting in its entirety, makes clear he does not understand either target. Moore begins by defining Obamacare’s goal as reducing the deficit:
If there were a contest for the biggest lie in Washington over the past 30 years, it would be hard to compete with President Obama's boast that he would put 30 million more Americans on Medicaid and Obamacare subsidies, and this would reduce the budget deficit. That's got to be right up there with President Clinton declaring, "I did not have sexual relations with that woman."A new Congressional Budget Office report has blown the lid off the Obama whopper fib.
Keep in mind what Moore is claiming here. Obama promised that the ACA would reduce the deficit, and according to Moore, the Congressional Budget Office has a new report showing this promise was false. If true, this would be enormous news. In fact, no such finding exists. CBO originally estimated that Obamacare would reduce the deficit. It correspondinglyestimated for the next several years that repealing the law would increase the deficit. CBO stopped issuing cost estimates of the overall law. It did, however, report that its estimate of the law’s gross costs — the spending on coverage — has been falling, rather than rising. Indeed, the federal government is now projected to spend less on health care than it was projected to spend before Obamacare was passed:
So, no, there is no CBO report proving that Obamacare increased the deficit, as we shall see when Moore describes what he read:
The Congressional Budget Office reports that through the first four months of fiscal 2015, federal spending is rising at an 8.2 percent clip. Most components of spending are relatively flat and national defense outlays — the most important function of government — are falling. Still, one area accounts for almost the entire budget blowout: Obamacare.Medicaid spending is up a stratospheric 23 percent so far this year thanks to massive new enrollments. In addition, the $7 billion in Obamacare "exchange subsidies" so far this year brings the rise in costs of the "Affordable" Care Act to nearly 30 percent. In one year. And in an era of almost no inflation. Obamacare has turned out to be, just as feared, the largest expansion of government since the Great Society.
Notice the switch here? Moore began his column by claiming that the CBO has proven that it’s a “lie” that Obamacare would reduce the deficit. But the data he provides does not remotely prove this. It merely shows that federal spending on Medicaid and exchange subsidies — that is, Obamacare — is up in 2015. That is completely different than saying Obamacare has increased the deficit. Indeed, the design of Obamacare all along was to spend money to cover the uninsured, and to cover the cost of this new spending with a combination of spending cuts and higher taxes. There is nothing in Moore’s column to indicate he even understands this.
Instead he proceeds to switch his accusation yet again to claim that Obamacare has led to “higher health costs”:
This stampede of rising health costs was so predictable that most budget experts acknowledged — even liberals, privately — costs would spike when the new health law insurance subsidies kicked in. It had to happen. How could we possibly put tens of millions more Americans on Medicaid and other taxpayer assistance and also save money at the same time? It was a laughable claim that Team Obama somehow reiterated time and again — and they even managed to keep a straight face.And this is a president who lectures Republicans in Congress about "simple math."
Moore’s argument is so incoherent that it is hard to follow, but let me try to explain. Higher health costs is not the same thing as higher federal spending on health care. Health-care costs is how much we pay for our treatments (which happens to be much more than what people in other countries pay).