Biden’s Health Care Moves

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Good morning. Biden’s health care moves underscore how little Trump did to sabotage Obamacare.

Obamacare endured a grueling first decade of existence. Its launch was famously clunky. It was unpopular in its early years. It narrowly escaped repeal at both the Supreme Court and in Congress.

But the law — passed in 2010 and more formally known as the Affordable Care Act — has survived. It’s more than survived, in fact. It now stands as a monument to a particular theory of progressive lawmaking: When the government enacts a new benefit that makes life easier for millions of people, the program tends to endure. That describes universal high school, Social Security, Medicare, Medicaid and now Obamacare.

President Biden yesterday signed a package of executive actions on health care, and many experts described them as steps to undo Donald Trump’s attempted sabotage of the law. Which they are. But the modest scope of the actions is also a reminder of how little progress Trump made in undermining the law.

The number of Americans without health insurance did rise during the Trump presidency, because of his attempts to diminish the law. His administration did little to advertise Obamacare policies and weakened some of its provisions, like protections for people with certain medical conditions. But this increase in the number of uninsured reversed only a small portion of the decline caused by Obamacare.

Even after Trump, an additional 20 million or so Americans have health insurance today largely because of Obamacare. Others have better benefits — like maternity care and addiction treatment — or face lower costs.

What Biden did yesterday

Biden’s orders still matter, because Trump’s actions mattered.

Biden will try to strengthen protections for people with medical conditions. He will also create a new three-month sign-up period for Obamacare, starting next month, aimed partly at people who lost their jobs during the pandemic. The most recent sign-up period was in the fall.

Perhaps most significant, the Biden administration plans to promote the sign-up period heavily, through advertisements, email and other outreach, according to my colleague Margot Sanger-Katz, who’s been covering Obamacare for most of its existence. “Biden’s people think the Trump people bungled the regular enrollment period,” Margot told me.

By the end of Trump’s presidency, the uninsured rate probably rose close to 10 percent, from 8.6 percent in the Obama administration’s final year. Through executive action, Biden may be able to reduce it to about 8 percent over the next four years, according to my reporting.

The bigger question is whether Biden can persuade Congress to pass a new law that would go further than Obamacare did, by making coverage less expensive for more people. Otherwise, at least 25 million Americans are likely to remain uninsured.

“There are still millions of poor, uninsured Americans in states that didn’t expand Medicaid,” Margot says, “and millions of middle-class Americans who find Obamacare insurance unaffordable.”

The big picture: “The Affordable Care Act is a highly flawed, distressingly compromised, woefully incomplete attempt to establish a basic right that already exists … in every other developed nation,” Jonathan Cohn, another longtime health care journalist, writes in “The Ten Year War,” a forthcoming book. “It is also the most ambitious and significant piece of domestic legislation to pass in half a century.”

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ARTS AND IDEAS

How to fix the Oscars

The first Academy Awards ceremony, on May 16, 1929, was 15 minutes long and resembled a corporate banquet. Over the years, the ceremony turned into the hourslong spectacle that you’ve probably watched at some point. Now some critics and Hollywood people are urging new changes.

Some could even take effect this year. The ceremony has been postponed until late April because of the pandemic.

A.O. Scott, a film critic at The Times, made the case for completely revamping the ceremony. Among his suggestions: expanding the awards categories to create separate prizes for genres like comedy, horror and action, which are typically not considered prestige cinema and are shut out from awards.

He also recommends treating “Parasite,” last year’s best-picture winner, “not as an outlier but as a harbinger.” It was the first film not in the English language to win that award, and it “fulfilled the Oscar ideal” — a well-crafted movie with something to say that stands the test of time — better than any mainstream Hollywood production in decades, he writes. So why not remove the best international feature category and make best picture an explicitly international category? Another idea: broadening the awards voting pool by expanding academy membership for more geographical, generational and cultural diversity.

Others have more immediate suggestions. During the pandemic, the actors nominated for awards should stay home and participate remotely, Peter Mehlman, a former “Seinfeld” writer, told The Times. “Don’t you think accepting an Oscar on a couch with dogs and kids might just humanize these people?” he said.

Oscars buzz: Here are the films The Times’s critics and writers would nominate for best picture, including “The Forty-Year-Old Version,” “Sound of Metal” and “Minari.”

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Take THE news quiz

Which top government jobs have still never been held by a woman? What did Anthony Fauci endure over the past year? And what’s going on in the above photo? Take this week’s News Quiz, and see how well you do compared with other Times readers.