But others took exception to how well the ACA is working and in particular cited the costs to middle-class families, and whether it is actually containing spending.

Jonathan Skinner, a Dartmouth College economist, and co-author Amitabh Chandra of Harvard University, agreed with Obama’s contention that the law has succeeded in expanding coverage but noted that health care spending has begun to increase since 2014, according to a Washington Post article. If spending has dropped, they add, it may be because of a shift to high-deductible health plans which could cause people to limit their spending, particularly on more expensive medical procedures.


Stuart Butler, a researcher at the Brookings Institution and former official for the conservative think tank Heritage Foundation, wrote that “core parts of the ACA need to be reassessed and revised.” He notes that since the ACA was enacted Medicaid enrollment has increased more than anticipated.

“A cause of the disappointing trend in exchange enrollment and the strong Medicaid growth is that the premiums and out-of-pocket exposure make exchange plans unattractive to many U.S. residents. With subsidies focused on people with incomes near the poverty line, many middle class and modest-income households find they face substantial and uncertain costs if they enroll in exchange plans,” Butler wrote in his editorial. “For many households, the president’s promise of affordable coverage rings hollow and has not been realized.”

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