The ACA turns five today, and it is still a big Biden deal. The uninsurance rate has cratered, the growth rate of medical costs are now down to the level of general economic growth, and quality in the system is improving as Medicare has successfully begun to attach penalties for being ineffective. These are all BBDs.
Right now, HHS estimates roughly 16.4 million more people have health insurance today than they did on on 3/23/2010. This is an undercount as it neglects trend changes. Before PPACA was signed, the trend was for more people to become uninsured every year. If PPACa was not passed, we’re probably looking at 18 to 20 million more people without health insurance in that counterfactual universe compared to ours.
Is PPACA perfect? Hell no. Is it a whole lot better than the pre-exisiting condition? Hell yes. Is it vastly superior to the Republican alternative of nothing but high income tax credits and race to the bottom deregulation, hell yes.
So our job is to understand why PPACA matters, defend it from the neo-feudalists and reactionaries, and figure out how to make it better. But is still is a Big Biden Deal.