An Obamacare Checkup

A little over a year since the nationwide enrollment of theAffordable Care Act, or Obamacare, began, experts and health consumers are reviewing the experience. It’s a kind of annual checkup, with millions of Americans palpating and probing the health of health care, poring over statistics, listening to tales of woe, and gazing upward anxiously from time to time to see if the sky is falling.

Thus far, the experience has not been catastrophic; the patient has not died from the operation, but he is still hooked up to various tubes and machines, and not out of danger yet.

We haven’t forgotten October 1, 2013, when the unmitigated disaster of HealthCare.Gov seemed to herald the materialization of every anti-Obamacare I-told-you-so and more. Although the enrollment nightmare is over, the phenomenal cost in time and money and the hardships caused to millions of applicants should be in the future histories of the program.

Hopefully, something will be learned from it. The price tag — about $800 million in all — was appalling, even if the software had worked, which it didn’t. HHS secretary Kathleen Sebelius did the honorable thing by resigning, and Canadian contractor CGI Federal was replaced by QSSI, owned by health insurer UnitedHealth.

But the broom didn’t sweep so clean. CGI and other at-fault contractors didn’t give back any of that money. In addition, former QSSI vice president Andrew Slavitt was appointed No. 2 in the program, despite his own culpability in the initial dysfunctions.

What about the bottom line? Has there been an improvement in health care that would justify all the expense and tumult?

Like everything else about Affordable Care, there is no simple answer.

Gallup reported in July that the uninsured rate for adult Americans of 13.4 percent was the lowest it had recorded since it began measuring the rate in 2008. The percentage of Americans without health coverage dropped 7 points over the past 11 months. That translates into over 15 million more people with insurance. That’s significant.

But it will take further analysis to determine just how significant. Because, among other things, the government uses a narrow definition of what constitutes an insured person. If you had insurance at any time during the year, the Census Bureau now considers you insured. Someone who was covered for a month or two, but lost a job and is no longer covered, would still appear insured via the Census formula. And some 15 percent of the population remains uninsured.

The rate of growth in health-care costs has reportedly slowed.The Kaiser Family Foundation reported last month that the average change in premiums for benchmark silver tier plans will be a reduction next year compared to 2014.

A CBS-New York Times survey found that nearly half of respondents described basic medical care as entailing financial hardship, up 10 points from a year ago. Premiums, deductibles, co-payments or other out-of-pocket expenses have gone up. Even those with good coverage were often hit hard by emergency room fees and prescription drug costs. A short ambulance ride or a few stitches could cost thousands of dollars.

While the Affordable Care Act mandates the coverage of certain screening services at no cost to patients, any subsequent treatment means money out of pocket. As a result, many people with coverage are avoiding medical treatment because they fear they can’t afford the potential bills.

So, while the Affordable Care Act has not been a total catastrophe, those with complaints about the new state of health care in America cannot be dismissed or downplayed. The new reality is far from utopian. Millions remain uninsured, and those with insurance continue to be heavily burdened by the phenomenal costs of medical care.

So far, the direst predictions — of skyrocketing health costs and a shipwrecked economy — did not come true. For example, the warnings that employers would stop hiring because of having to bear more of the cost of health coverage as of now turned out to be largely unfounded.

The sky has not yet fallen. But it is too early to tell what the precise ramifications of Obamacare will be.