WASHINGTON (AP) — President Barack Obama told insurers this week his health care overhaul has had some growing pains. But with premiums rising and marquee insurers bailing, could the real diagnosis be "failure to thrive?"
The medical term refers to when patients, often youngsters but also adults, fail to achieve or maintain proper weight. This is the fourth election cycle in which the Affordable Care Act has been in play, struggling for political traction and a healthy level of acceptance from a divided public.
"Progress has not been without challenges," Obama wrote insurers. "Most new enterprises have growing pains and opportunities for improvement." He asked for help with the fourth sign-up season, which starts Nov. 1.
Here's a look at key indicators for the health of "Obamacare," now and in the future:
UNINSURED: IN REMISSION, BUT NO FULL CURE
The uninsured rate is 8.6 percent, a historic low, according to the most up-to-date government numbers. That means at least 21 million fewer people uninsured since the law passed in 2010, reversing decades-long coverage losses. Experts credit the law for nearly all the progress.
That's to be expected when the government requires most people to have health insurance, provides tens of billions of dollars a year to subsidize premiums, and imposes fines on holdouts remaining uninsured. The law also bars insurers from turning away those in poor health.
The concern now is that so many remain uninsured — about 27 million people. Of those, the administration has estimated that nearly half would be eligible for private coverage through insurance markets like HealthCare.gov, where most consumers qualify for subsidies. More customers would help stabilize premiums.
Prognosis: Slower progress; risk of relapse.
COST: TEMPERATURE RISING
So far, the Affordable Care Act has actually cost taxpayers less than what nonpartisan congressional experts estimated when it passed. That's because fewer people than expected are covered, and also the average subsidy has been lower than originally projected.
But the story on costs looks different from the perspective of the 11 million customers in the law's insurance markets. Premiums in many communities are expected to go up significantly for 2017. Not a big worry, says the administration, because subsidies will also rise, shielding most consumers. Yet some may have to switch plans, or settle for a higher deductible.
Medicare chief Andy Slavitt, who oversees the health care law, says part of the problem is that insurers set their premiums too low and are now having to correct that. "Once these one-time effects kick in, our expectation is we will see a very normalized rate of growth," Slavitt said.
But if higher premiums cause some consumers to drop out, or turn off prospective customers, the remaining pool will be more expensive to cover. That could start a vicious cycle.
The cost of covering low-income beneficiaries through the law's Medicaid expansion also has increased faster than expected.
Prognosis: Frequent monitoring needed.
QUALITY AND CHOICE: STILL SEEN AS A PLUS
Sixty-eight percent of consumers who have a plan through the health law's marketplaces rate their overall coverage as excellent or good. A recent survey by the nonpartisan Kaiser Family Foundation also found high satisfaction with choice of hospitals and doctors, and with copays. But only about half were satisfied with their annual deductibles.
In a worrisome sign, the survey found fewer customers than in previous years saying that overall, their plans are a good value for what they pay. That has slipped below 50 percent.
So far, Obama's law seems to have helped with the financial health of many working families. Major government and private surveys have found fewer people struggling to pay medical bills, coinciding with the law's coverage expansion. Impacts on physical health will take more time to clearly discern.
A big test is looming next year. Insurers that have suffered steep financial losses are scaling back participation, and many consumers, particularly in small cities and rural areas, face reduced choice. That could have ripple effects on choice of medical providers.
POLITICAL ACCEPTANCE: TBD
Major legislation often has problems and unintended consequences, forcing Congress to retool.
With very few exceptions, political polarization has shut down that option for the 2010 health care law. Polls show that the public remains divided, and opponents have an edge in terms of intensity.
On the political right, the prevailing view remains that the whole law must be repealed. It's unclear if Republicans would be willing to leave millions of people uninsured to accomplish that.
On the left, the push is to expand the law by enriching subsidies and introducing a government-sponsored "public option" insurance plan.
Divided government has been able to bridge wide policy differences in the past, but partisanship has seldom been as heated.
Prognosis: Clearly, Obama's health care legacy is in the hands of his successor.