So roughly six months after the disastrous roll-out of the Obamacare exchanges that lost the Democrats all the public goodwill that the Republicans practically gave them after their government-shutdown temper-tantrum, it seems like the law's mostly picked up. After the issues with the site caused the sign-up projections to be revised down from 7 to 6 million, Obamacare went and [url=http://acasignups.net/graph]hit 7 million exchange sign-ups anyway[/url]. The policy pretty much met its exchange sign-up targets. Are all of those plans paid for? No, but you can see on that graph that even discounting all of the plans that [i]might[/i] not be paid for, exchange signups easily hit 7 million a few days into April, now totalling about 7.24 million. But, ok, maybe all of those people just had their insurance cancelled anyway, so this isn't actually reducing the number of uninsured people. Is that the case? [url=http://hrms.urban.org/quicktakes/changeInUninsurance.html]Um, no.[/url] While the Medicaid expansion that a number of petulant state Republicans rejected (Not even on ideological grounds, but purely out of tribalism) was one of the biggest sources of a reduction in uninsured Americans, levels of uninsured people has still markedly decreased, representing about 5.4 million Americans being moved onto insurance who previously had none. Those were just early estimates, though - the more recent and accurate [url=http://www.rand.org/blog/2014/04/survey-estimates-net-gain-of-9-3-million-american-adults.html]RAND survey[/url] has estimated that it's more like a gain of insurance for 9.3 million Americans to mid-March, which isn't even including the massive surge in exchange enrolments in the latter half of the month. And that's just in the first year - as Obamacare gets older, and the individual mandate ramps up to a more significant level, we should be expecting that figure to become bigger and bigger. Now let's look at the structure of Obamacare: all of the specific health industry reforms aside, the insurance side of Obamacare relies on [url=http://talkingpointsmemo.com/dc/republicans-new-obamacare-reality-no-repeal-without-replace]three essential pieces of the policy[/url]: community-wide rating, subsidies for low-middle income households and the individual mandate. The community-wide rating is the only real way to make market-based health insurance affordable for those with pre-existing conditions, by absorbing them into a wider risk pool. The down-side to that is that it distorts the market, providing a disincentive to those -without- those pre-existing conditions to get health insurance, even though those are the people that the law relies on to keep premiums affordable by keeping the overall community health risk down. This is where the individual mandate comes in: by providing a financial incentive to have health insurance, you're essentially counteracting this disincentive. Without this, insurance costs would spiral and you'd be unable to make insuring those people who most need insurance actually practical. Of course, then you run into the issue of putting a financial burden on people who can barely afford the insurance in the first place, and that's why there are generous subsidies given to lower and middle income households to help compensate for the financial cost of insurance and make it more affordable. If you're paying significantly more for your insurance, now, chances are that you're either pretty well off, financially, or were on a plan so scant it barely provided a thing. But where does the money for these subsidies come from? Well, from things like the individual mandate. Overall, with all of the aspects of Obamacare that are involved, the Congressional Budget Office has always predicted that Obamacare wouldn't just be revenue neutral, but would, overall, create a modest decrease in the deficit. And in the latest [url=http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/14/lower-premiums-yes-really-drive-down-obamacares-expected-costs-cbo-says/]from the CBO[/url] it seems as though the costs of those subsidies will actually be significantly less than originally expected, thanks to lower premiums. Of course, all of that isn't to say that Obamacare can't be criticised, of course it can, but if you want to extend insurance coverage and aim for universal health insurance (and that's something both the Democratic and the Republican party agree on, I should add) you can't do any [i]less[/i] than Obamacare does. A market based policy with an individual mandate is very much a conservative approach to universal health care (There's a reason Obama kept talking about 'Romneycare' back in 2012 and that people outside of America often identify Obama as a centre-right politician), and there's a lot more that can be done to provide health care more equitably and universally, but without moving to government-funded health care, there isn't a lot of room for improvement. Obamacare is, overall, a functional, positive move on health care reform which is essentially the result of left leaning Democrats deciding to compromise and take the policy Republicans had always said they'd supported and actually making something happen with it. For all of the talk about Washington being unproductive and constantly bickering, this is a really good example of one side of politics deciding to meet the other half-way, and the Republican side throwing a four year long hissy fit about it.