Is obama care working
Executive summary
The Affordable Care Act (Obamacare) still insures millions and preserved key protections like coverage for pre-existing conditions, but its short-term outlook is fragile: enhanced premium tax credits that helped about 22 million marketplace enrollees could expire after 2025, threatening big premium spikes and causing surveys to show roughly one-quarter of enrollees would consider going without coverage if subsidies end or costs double [1] [2]. States and insurers are already reacting—enrollment in some marketplaces has dropped as much as 33% amid uncertainty, and carriers are signaling plan reductions or rate changes if subsidies lapse [3] [1].
1. Big-picture: Obamacare’s achievements and the baseline facts
Obamacare expanded access through Medicaid expansion in many states and created marketplaces where roughly 24 million people buy plans; most marketplace enrollees (about 22 million) received premium tax credits in 2025, illustrating how dependent the system is on federal subsidies to keep coverage affordable [1]. The law also enshrines consumer protections—like coverage for pre-existing conditions—that remain politically and legally salient, and some lawmakers emphasize preserving those elements even while debating cost fixes [4].
2. The immediate problem: Enhanced subsidies are set to expire
The enhanced premium tax credits enacted during the COVID era are scheduled to expire at the end of 2025 unless Congress acts; analysts and insurers warn that expiration will raise average premiums and out-of-pocket costs for many enrollees—examples include households going from $0 to hundreds more per year in premiums depending on income [1]. Insurers and state marketplaces are already adjusting plans and signaling potential rate changes tied to the subsidy cliff [3] [1].
3. Real-world signals: enrollment swings and consumer anxiety
States reporting enrollment show mixed signals: California’s Covered California reported enrollment down about 33% from last year, Pennsylvania reported a 12% drop in new enrollees and higher churn among current customers, and anecdotal reports show consumers canceling assistance appointments while they await a congressional decision [3]. Polling by KFF and Reuters finds roughly one in four marketplace enrollees say they would go without coverage in 2026 if subsidies are not extended and premiums double, underscoring how price-sensitive many enrollees are [5] [2].
4. Insurers and markets: retreating from riskier markets
Major insurers—UnitedHealthcare, Centene, and Cigna—have indicated they would scale back offerings or adjust rates in “less favorable markets” if the federal help evaporates, which could reduce choice and competition in some regions and further pressure prices for remaining enrollees [3]. Industry and state officials frame these moves as responses to regulatory and fiscal uncertainty rather than intrinsic failures of the exchange model [3].
5. Political cross-currents and alternative proposals
Congress is divided: Democrats largely push to extend or make permanent enhanced subsidies to avoid sticker shock, while many Republicans oppose extensions and promote alternative reforms—some proposals claim to preserve exchanges and pre-existing condition protections while reshaping subsidies and account-based approaches [6] [4]. This partisan impasse has left open enrollment and consumer behavior in flux and given rise to op-eds and think pieces arguing both that Obamacare is broken or that it must be preserved [7] [8] [9].
6. What “working” means today: coverage vs. cost
If “working” is measured by the number of people covered and protected against pre-existing condition exclusions, the ACA continues to function and insure millions [1] [4]. If “working” is measured by affordability and stability without extraordinary subsidies, current reporting shows severe stress: expiration of enhanced credits would materially raise premiums and out-of-pocket caps, prompting enrollment declines and insurer retrenchment [1] [5] [3].
7. Limitations in available reporting and unanswered questions
Available sources document enrollment shifts, insurer statements, polling on likely behavior, and the policy cliff at year-end; they do not provide a single, definitive quantitative projection of nationwide premium increases under every legislative scenario, nor do they settle longer-term effects on health outcomes or federal budgets beyond cited analyses [1] [2]. For granular impacts in any given county or for specific populations, state-by-state filings and actuarial work not included in these sources would be needed.
8. Bottom line for readers and voters
The ACA remains a functioning framework that protects many consumers, but its near-term performance depends heavily on whether Congress extends enhanced subsidies. Without legislative action, reporting from Reuters, CNBC, The New York Times and others finds concrete signs—rising premiums, enrollment drops, insurer pullbacks, and consumer willingness to drop coverage—that affordability will deteriorate sharply [3] [1] [5] [2].