Democratic lies sold it, Republican lies soiled it, and most Americans don't like it. On the fifth anniversary of Obamacare, the Affordable Care Act stands as an ugly reflection of today's political culture: partisan, short-sighted, and flawed—and yet, better than the alternatives.
Signed into law by President Obama on March 23, 2010, the law established minimum standards for health insurance; created market "exchanges" for people and small businesses to buy polices; expanded Medicaid and provided subsidies to low-income Americans; and required everybody to be insured or pay a penalty.
About 16.4 million adults gained health insurance under the ACA, according to the Obama administration. Health care spending slowed: The new system is expected to cost $139 billion less than projected in 2010. Flush with new business, the health care industry defied warnings about a "government takeover" and is in good condition.
Much can still go wrong. First, the law has not been fully implemented by the administration, which has a lousy record of managing government systems, particularly the details of Obamacare. You might recall the missed deadlines and busted ACA website.
Second, the Supreme Court case King v. Burwell, the product of sloppy legislative work among Democrats, could jeopardize tax credits and subsidies in the 36 states with a federal marketplace. Without those benefits, premiums would skyrocket and the insurance market faces a "death spiral."
None of this fully explains why a plurality of Americans continue to oppose the law. While dissent has slightly faded, at no point in the past five years have more people favored Obamacare than opposed it.
My theory for the enduring stigma: A lack of trust.
Neither the White House nor the GOP congressional leadership dealt honestly with each other during the 2009 negotiations, which broke down and led to a Democratic-only bill. A law of this magnitude almost never succeeds without buy-in from both parties.
Even worse, after surrendering to gridlock, Democratic and Republican leaders distorted the pros and cons of the default Obama plan.
The president promised people that if they liked their doctors and insurance plans, they could keep them. He knew that couldn't be true for everybody. So did his staff. But it was an election year.
Obamacare adviser Jonathan Gruber famously admitted that the law never would have passed if the administration had been honest about the fact that the penalty for noncompliance with the mandate was actually a tax. "And, basically, call it 'the stupidity of the American voter,' or whatever, but basically that was really, really critical to getting the thing to pass," Gruber said.
Obama didn't trust the country enough to talk openly about a more fundamental truth: Obamacare redistributes wealth. Insuring millions of Americans who can't afford it means taking money from some subgroups of Americans and giving it to others. It is simple math, complicated politics.
Obama worried that Republicans would call him a socialist so he tip-toed around the elephant in the room. Rather than asking Americans to sacrifice for the greater good—appealing to the nation's better angels—Obama let most voters believe that transforming one-fifth of the U.S. economy would be virtually painless.
Rather than lead, he pandered. And guess what: Republicans called him a socialist anyhow.
But at least Democrats at some point stopped lying. The GOP deception continues to do this day. Despite mounds of evidence to the contrary, Republicans leaders still call Obamacare a "jobs killer."
The law did not add to the budget deficit (it has actually gone down, though for reasons not related to the ACA). It did not destroy the health care or insurance industries. While many people are paying more (remember, "Obamacare redistributes wealth"), a wholesale jump in premiums never occurred.
And yet, these and other unsubstantiated claims are accepted as fact by most GOP voters. Untruths and outright lies are embedded in the stump speeches of Republicans presidential candidates, like tumors on the body politic.
This is what happens when there is a leadership deficit in Washington. Five years ago, Obama signed a bill that has helped 16 million Americans get health insurance. But a nation of 300 million is even more deeply divided and less trusting of government than it was on the law's first day.
Which is why Obamacare may not see a sixth anniversary. Not if the Supreme Court rules against the Obama administration and throws health care reform back to the White House and Congress, a polarized, short-sighted. and flawed group of so-called leaders who are more likely to blame each other than to work together. The ACA is far from perfect, but 16 million newly insured people is better than that grim alternative.
This article is from the archive of our partner National Journal.