Accessibility statementSkip to main content Democracy Dies in Darkness Sign in Advertisement Democracy Dies in Darkness fact checkerAboutArchive fact checkerAboutArchive # Did Obamacare ‘massively’ increase the cost of health care? An attack by a Trump-friendly think tank misses the mark. 12 min Former Louisiana governor Bobby Jindal (R) in a screenshot from a video, “The Results Are In: Obamacare Has Failed,” released by America First Policy Institute (America First Policy Institute/(screen grab)) ![\\"\\"](\\" apps/imrs.php?src= authors/washpost/44f31222-8f22-4a07-b0eb-c77cbf11540a.png&h=196&w=196\\"/) Analysis by Glenn Kessler May 13, 2024 at 6:00 a.m. EDT “Obamacare was sold on a lie. It massively increased the cost of health care in America.” — former Louisiana governor Bobby Jindal (R), in a video for the America First Policy Institute, April 30 The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, was enacted nearly 15 years ago and has survived numerous attempts by Republicans to repeal or substantially dismantle it. Once viewed unfavorably by most Americans, Obamacare now wins favor with 59 percent of Americans, according to a February poll by KFF, a nonprofit health-policy organization. But Republicans haven’t given up. Former president Donald Trump, the presumptive 2024 GOP nominee, has promised to overhaul the law, saying on social media that “the cost of Obamacare is out of control, plus, it’s not good healthcare.” Advertisement Story continues below advertisement Now a Trump-aligned think tank, the America First Policy Institute, has issued a video that it is promoting heavily on social media. The video features former governor Jindal making a sustained attack on Obamacare, without providing many details about how it would be replaced. During Trump’s first presidency, the devil was in the details — Republicans had trouble crafting a law that didn’t cost millions of Americans their health coverage, increase insurance premiums or weaken protections for people with preexisting health conditions. ✅ Follow Fact-checking politicians Follow For this fact check, we are going to focus on two specific claims Jindal made about health-care costs — that because of Obamacare “premiums have increased 80 percent” and “total health-care cost for a family of four has increased by $12,000 a year.” These are repurposed talking points from previous GOP attacks on the law — which are highly misleading. ### The Facts It’s important to recall that the ACA was mainly aimed at helping to make health insurance affordable for people who buy it in the individual market — a relatively small percentage of the population. Advertisement Story continues below advertisement More than 80 percent of Americans who don’t get their health insurance from a public plan like Medicare, Medicaid or Veterans Affairs receive health coverage as part of their job perks, according to the Census Bureau. Still, the law imposed some requirements on employer-provided health plans, such as prohibiting annual and lifetime limits, capping out-of-pocket costs and covering preventive services at no cost to patients. It also required all employers with 50 or more people to provide health insurance. More broadly, the law also imposed substantial savings on Medicare, the old- age health program, by reducing payments to providers and encouraging greater efficiency. As for the individual market, before the Affordable Care Act, insurance companies could consider a person’s health status when determining premiums, sometimes making coverage unaffordable or even unavailable if a person was already sick with a problem that required expensive treatment. Even minor health problems could have led an insurance company to deny coverage. Advertisement Story continues below advertisement Instead, the ACA imposed two important concepts: guaranteed issue, which means insurance companies must sell insurance to anyone who wants to buy it, and community rating, which means that people who buy similar insurance and are the same age pay similar prices. The two together made insurance more affordable for people with serious diseases such as cancer. The ACA initially also required everyone to purchase health insurance or face a penalty, but that provision was later dropped. The net effect changed premiums at an individual level, with healthier, younger Americans being charged more. For instance, the law implemented an age band so that the amount an older individual pays would be no more than three times what a younger individual pays. But the theory was that costs would be spread through the system — and with more people receiving health coverage, the doubling in the cost of health-care premiums in the decade before the law was passed would begin to ease. Moreover, the law provided substantial subsidies for people who qualified based on income. For people who qualify based on income level, their premiums are rather low — about $100 a month after subsidies — and premiums have barely budged in the past five years, according to KFF. The percent of uninsured Americans has declined significantly in every state since implementation of the law, according a 2023 report by the health policy office of the Department of Health and Human Services. Advertisement Story continues below advertisement None of this is free. The Congressional Budget Office estimates that over the next decade, Obamacare subsidies will cost about $1 trillion; an additional $1.4 trillion will be spent on the ACA’s expansion of Medicaid. Provisions in the ACA that would have helped pay for these outlays were later repealed or rolled back. For reference, the Treasury also will lose more than $5.3 trillion because employer-provided health insurance is tax-free, the CBO says. With that background in mind, let’s look at the America First Institute video. Jindal, in the video, accuses Obamacare of creating an “affordability crisis” for families. Before he introduces the numbers, he rolls some clips of Obama appearing to promise that health-care premiums would decline: “Families will save on their premiums … cut the average family’s premium … lower your premiums … reducing premiums … work to lower your premiums.” All but one of these clips is from Obama’s 2008 campaign, when he was pitching a plan different from the one he enacted as president. Advertisement Story continues below advertisement Obama, when campaigning for president in 2008, did misleadingly say that his plan would reduce premiums for families by $2,500. Obama’s pledge came with a large asterisk, as explained in an Obama campaign memo: Despite his rhetoric, he was not saying premiums would fall by $2,500, but that health-care costs per family would be that much lower than anticipated. In other words, if overall costs — not just premiums — were expected to rise by $5,000 by the end of his first term, they would only rise by $2,500. That nuance often was lost in his campaign statements, and he was called out by fact-checkers at the time for making unrealistic assumptions. Obama was generally clearer as president. The one clip shown by Jindal from Obama’s presidency leaves out a reference to “bending the cost curve.” Indeed, once Obama became president, the health-care proposal he advocated as a candidate was significantly changed, even to the point of imposing the requirement to buy insurance that he had so criticized when his main Democratic campaign rival, Hillary Clinton, promoted it. But the White House more or less stuck to the idea that costs would not rise as quickly as previously estimated — except that the pledge was downgraded to $2,000 in lower costs by 2019. Many of the most significant provisions of the ACA did not take effect until 2014, midway through Obama’s second term, though the Medicare cuts happened immediately. Advertisement Story continues below advertisement Over the years, Republicans have compared Obama’s pledge with the increase in annual family premiums for employer-provided plans, as calculated by KFF, even though, as we said, the ACA largely was aimed at the individual insurance market. Jindal follows that same playbook. He says “premiums have increased 80 percent.” Then he cites another survey to make a separate statement about costs — “total health care cost for a family of four has increased by $12,000 a year.” Let’s examine each of these claims in turn. Even though much of the law was not implemented until 2014, health policy analysts tend to use 2010 as the dividing line before and after the law, as does Jindal. So we will follow that convention. Jindal’s claim of an 80 percent increase in premiums comes from KFF’s annual Employer Health Benefits Survey, which estimates annual premiums for family coverage for workers who received health insurance from their employer. In 2023, the numbers came from a survey of 2,133 randomly selected nonfederal public and private employers with three or more workers. The employers generally paid a substantial amount of the premium. In 2010, according to KFF, family coverage cost $13,770 and in 2023 it was $23,968 — an increase of 74 percent over 13 years. Advertisement Story continues below advertisement Here’s how the increase in premiums breaks down in five-year periods, with the exception of the three years since 2020. * 2000-2005: 69 percent increase * 2005-2010: 27 percent increase * 2010-2015: 27 percent increase * 2015-2020: 22 percent increase * 2020-2023: 11 percent increase. In other words, the cost curve has been slowly bending. In fact, while premiums previously rose at a faster rate than inflation, they now lag inflation. Matthew Fielder, former chief economist for the Council of Economic Advisers and now a health policy analyst at the Brookings Institution, calculated for The Fact Checker the annual rate increase in premiums after adjusting for inflation. * 2000-2010: 5.7 percent increase * 2010-2020: 2.8 percent increase * 2020-2023: 1.1 percent decrease “Broadly, the post-ACA period has continued to see relatively slow premium growth in historical terms,” Fielder said. For his other statistic, Jindal refers to a different survey, the Milliman Medical Index, which attempts to project all out-of-pocket costs, not just premiums, using a proprietary method that examines claims data and negotiated fees. He says health costs for a family of four have risen $12,000. The Milliman index, which has changed its methodology over time, shows costs were about $18,000 in 2010 and $31,000 in 2023. Advertisement Story continues below advertisement The Milliman index only goes back to 2005, so here’s the five-year breakdown since then. It also shows health costs are growing at a slower pace since the law was enacted. * 2005-2010: 48 percent increase * 2010-2015: 36 percent increase * 2015-2020: 16 percent increase * 2020-2023: 8 percent increase Put another way, if total costs had continued on the same pre-ACA path, they would now be about $60,000 — or double the current level. Whether the ACA has much to do with slowing the growth in health-care costs is debatable. Obama may have just been lucky. “Most of the decline in premium growth is attributable to factors other than the ACA,” said Fielder, who served under Obama. “One point in favor of that view is that premium growth had slowed a decent amount even before 2010. That said, I do think that spillovers from the ACA’s Medicare provisions have made some contribution, mainly by reducing the prices that private insurers pay providers. Certainly, there’s little reason to believe that the ACA increased growth in employer premiums.” Larry Levitt, KFF’s executive vice president for health policy, agrees that the law was just one of many factors for a reduced increase in health costs. “The ACA reduced growth in Medicare payments to hospitals, which may have had a spillover effect in the private sector,” he said. “The ACA also encouraged growth in accountable care arrangements [where doctors work together to manage a patient’s health], which has likely had some effect on costs.” But he said there were many other reasons, such as “the lingering effects of the Great Recession, slower growth of high-cost medical technologies, greater use of electronic medical records, and lower health-care use during the pandemic.” He added that in the individual market, “ACA’s premium subsidies have dramatically reduced the cost of health insurance for people who buy their own coverage.” When we presented our findings to America First, Jindal was unpersuaded. “Contrary to Obama’s broken promises, premiums have continued to increase every year. These premium increases have been devastating to the financial well-being of Americans,” Jindal said in a statement provided by America First, which was echoed in a thread he posted on social media. “President Obama said the purpose of the ACA was to lower the cost of health care. He did not lower costs, but instead merely shifted costs to taxpayers. When an enrollee qualifies for subsidies, the cost of their health coverage does not disappear. Because the ACA failed, and health care costs have continued to increase, the financial burden of health care on taxpayers has continued to increase. … These are costs that will be paid for by current taxpayers and by future taxpayers who will be paying higher interest rates on our debt.” ### The Pinocchio Test Jindal is relying on an old rhetorical trick — taking numbers out of context and then assigning all of the fault for a rise in prices to Obamacare. Health insurance costs have risen, but at a slower pace since the law was implemented. That’s what Obama suggested would happen, though he certainly oversold the potential impact rhetorically when campaigning in 2008. In any case, health analysts agree that Obamacare’s role in slowing the growth in premium costs is a relatively minor one. But just as you can’t fully credit the law for reducing prices, neither can you blame it for “massively” increasing prices. The law’s biggest success has been its intended main purpose — reducing the number of Americans without health insurance. Jindal earns Three Pinocchios. ### Three Pinocchios (About our rating scale) Send us facts to check by filling out this form Sign up for The Fact Checker weekly newsletter The Fact Checker is a verified signatory to the International Fact-Checking Network code of principles Share Comments ![\\"\\"](\\"/dr/resources/images/generic-newsletter-signup.png\\") ![\\"\\"](\\"/dr/resources/images/generic-newsletter-signup.png\\") Sign up Advertisement Advertisement live updatespolitics![\\"\\"](\\" apps/imrs.php?src= washpost.s3.amazonaws.com/public/BN557ZUEYJA2JICXKM44OUHO5E.jpg&w=767\\")1:35 AM #### What swing-state voters are saying about the Vance-Walz VP debate 12:29 AMHow Walz and Vance have prepared for tonight’s debate Advertisement Advertisement washingtonpost.com © 1996-2024 The Washington Post * washingtonpost.com * © 1996-2024 The Washington Post
Because of Obamacare healthinsurance premiums have increased 80 percent