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Wednesday, December 7, 2016

WASHINGTON — Will it take the repeal of the Affordable Care Act or its evisceration by the Supreme Court for us to appreciate what it’s actually done?

Critics of the ACA are so insistent on pointing to the problems it has encountered — erroneous tax information to 800,000 taxpayers is the latest — that it was especially enlightening on Friday to talk with Sylvia Mathews Burwell, the secretary of Health and Human Services.

You might think of her as a wonk with a heart. She refers to her agency as the “Department of the Kitchen Table” because the issues it deals with, from health care to food safety to the problems facing elderly parents, are the sorts that we discuss at breakfast or dinner.

What does Obamacare mean at many of those kitchen tables? Because of the law, at least 10 million fewer Americans are uninsured — and that’s a conservative number. The drop in the nation’s uninsured rate is the largest since the early 1970s, when Medicaid was still taking hold and both Medicare and Medicaid were expanded to cover people with disabilities.

These aren’t just government numbers. Here is what Gallup said in January: “The uninsured rate has dropped 4.2 percentage points since the Affordable Care Act’s requirement for Americans to have health insurance went into effect one year ago.”

Gallup might have mentioned not just the mandate but also the financial help many Americans have received to buy coverage under the ACA. Some more numbers: 87 percent of the people who signed up on the exchanges qualified for subsidies, and the average assistance to each was $268 per month. Perhaps some out there would rather not have government help people buy health insurance, but this seems to me a good and decent use of our tax money.

True, the administration messed up at the start of the program and will have to rectify this tax problem. Still, in this year’s enrollment period, its target was 9.1 million, and 11.4 million signed up. Again, Burwell doesn’t want to oversell: Some of those signing up will fall by the wayside before they complete the process and pay for insurance. But past experience suggests the final number will still surpass the target.

We don’t talk about it much, but by closing the “doughnut hole” in the Medicare drug program, thus providing more help, the law has saved 8.2 million seniors over $11 billion since 2010. That comes to $1,407 per beneficiary. How many elderly Americans want that to go away? This is something else that “repealing Obamacare” would mean.

Are you a budget hawk? The slowdown in Medicare cost inflation between 2009 and 2012 saved the government $116.4 billion. Burwell is way too careful a wonk to claim that all this was caused by the health care law, but largely good things have happened — including, by the way, to employment — since it passed. Its critics predicted all sorts of catastrophes. They were wrong.

Oh, yes, and between the Medicaid expansion and the children’s health insurance program, 10 million people gained coverage. And that’s with two of the states with the largest number of uninsured, Texas and Florida, staying out of the ACA expansion.

Roughly 3 million young adults have received coverage courtesy of the law’s provision that allows them to stay on their parents’ plans until age 26. And Americans no longer have to worry that they won’t be able to get insurance because of pre-existing conditions.

I am sorry to burden you with all these numbers, but the arguments you usually hear about the law are remarkably fact-free. As Burwell says, they typically focus on a single word — that would be “Obamacare” — not what the law does.

Burwell would love to work with Republicans to make the law better. More could be done, she says, to ensure that people now getting coverage also receive the care they need. Both parties could team up to improve “the quality of the care and the value of the dollar we pay.” And we could ease the income “cliffs,” the points where people become ineligible for government help.

But it’s lots more fun for opponents of Obamacare to scream “socialism” and make scary and groundless predictions.

I hope that when the Supreme Court deals with the frivolous lawsuit concocted to wreck the law, the justices think about all the people they would hurt — badly — if they destroyed it. The Repeal Obamacare crowd might usefully think a little more about them, too.

E.J. Dionne’s email address is [email protected] Twitter: @EJDionne.

Photo: SEIU International via Flickr