Did Obamacare ‘massively’ increase the cost of health care?

An attack by a Trump-friendly think tank misses the mark.

“Obamacare was sold on a lie. It massively increased the cost of health care in America.”

— former Louisiana Gov. Bobby Jindal (R), in a video for 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.”

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.

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 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.

None of this is free. The Congressional Budget Office estimates that over the next decade, Obamacare subsidies will cost about $1 trillion; another $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.

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.

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.

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.

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. Jindal earns Three Pinocchios.

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