Fewer people are skipping doctor’s visits to save money

The Affordable Care Act (or “Obamacare,” if you like) has many provisions, but by and large it raises taxes on the rich to subsidize health insurance for people in the bottom third of the income distribution. Under the circumstances, it’s not that puzzling that conservatives want to get rid of it.

Update: Watch interview with President Obama on the future of Obamacare

At the same time, saying that the main reason to repeal the law is in order to deliver a six-figure tax cut to millionaires is a weak argument politically. So repeal proponents often seize on very real ways in which the law’s benefits fall short, to try to make the case that somehow the ACA system is actually worse than nothing for the people who are in it. Paul Ryan, for example, says Obamacare has “failed the American people, and things are only getting worse.”

But while it’s certainly true that if you are in the top one percent of the income distribution you are paying higher taxes thanks to the ACA, a new study from the Commonwealth Fund shows that the law is succeeding in its core goal of providing people with access to health care. It looks at a number of different indicators across all 51 states (they are counting DC as a state for these purposes) and shows how many saw improvement versus stasis versus worsening.

Two key points about this.

One is that a couple of these things measure actual health care utilization. That’s important because many people have been disappointed by the high deductibles that often come with Affordable Care Act plans, and say the insurance the law offers is “too expensive to use.” Obviously people would be better-off with more generous insurance, but we’re seeing here that even with existing ACA plans many fewer people skipping needed care.

The other is that the dental care line at the bottom offers a useful comparison. The ACA didn’t do anything to expand access to dental coverage, so the trend here gives us a sense of what might have happened without it. And the news is mostly bad. Even though the economy improved between 2012 and 2014, rising costs and stingier state governments meant that we saw an overall worsening of access to dental care even as access to medical care improved.