Considering its disastrous rollout, it's amazing that as of March 31, seven million people have enrolled in the Affordable Care Act's new insurance marketplaces. But that number doesn't accurately depict the impact ACA has had on the uninsured and the underinsured.

According to a review of state and federal enrollment reports, surveys and interviews with insurance executives and government officials conducted by Rand Corp. and given to the Los Angeles Times, at least 4.5 million previously uninsured adults have signed up for state Medicaid programs and about nine million people, many of them previously uninsured, have bought health plans directly from insurers, instead of using the marketplaces

And according to national health insurance surveys from the federal Centers for Disease Control and Prevention, another three million young adults have gained coverage through a provision of the law that enables dependent children to remain on their parents' health plans until they turn 26.

Charles Gaba, who has been tabulating the numbers for acasignups.net, contends the actual number is somewhere between 14.6 and 22.1 million people.


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"The bottom line is this: No matter how you slice it, this is a ton of people receiving decent healthcare coverage who either a) didn't have anything before or b) can no longer be dropped, denied or bankrupted by coverage that was scattershot, piecemeal or shoddy," wrote Gaba.

That's the largest expansion in health coverage in 50 years, noted Noam Levey for the Los Angeles Times.

"The Affordable Care Act still faces major challenges, particularly the risk of premium hikes next year that could drive away newly insured customers. But the increased coverage so far amounts to substantial progress toward one of the law's principal goals and is the most significant expansion since the creation of Medicare and Medicaid in 1965."

As those numbers are being tallied up, Republicans are not sitting idly by.

Wisconsin's Rep. Paul Ryan has introduced a Fiscal Year 2015 budget that calls for repealing ACA and asks Congress to "pursue patient-centered health-care reforms that actually bring down the cost of care by empowering consumers."

According to Think Progress: "In a possible preview of the GOP's election-year rhetoric, this year, Ryan warns -- in almost apocalyptic terms -- that the law ‘will undermine the private insurance' and ‘the competitive forces of the marketplace.' He even argues that it would ‘eventually lead to a single-payer system.'"

Think Progress notes that while Ryan goes to great lengths to criticize the ACA's "government mandates" and the supposed decision to leave "health- care decisions into the hands of bureaucrats," he praises this very same kind of government-control elsewhere in the budget.

"For instance, in discussing his plan to allow future retirees the choice of private insurance through his 'premium support' proposal, Ryan promises that 'the Medicare program and its benefits will remain as they are, without change.' For future retirees, Ryan proposes an Obamacare-like exchange that will feature private insurers providing Medicare-like plans. However, Ryan tasks the government with policing the plans private insurers offer 'to avoid cherry-picking, and to ensure that Medicare's sickest and highest-cost beneficiaries receive coverage.' Just four pages earlier, Ryan criticizes such government intervention in the exchanges."

House Republicans have already voted 51 times to repeal ACA and on March 30, House Speaker John Boehner said they weren't giving up the fight.

"House Republicans will continue to work to repeal this law and protect families and small businesses from its harmful consequences," he said. "We will also continue our work to replace this fundamentally-flawed law with patient-centered solutions focused on lowering health care costs and protecting jobs."

It's a sure bet if Republicans take the Senate in November the repeal effort will take on a new earnestness, as the Democrats will be in no position to thwart House-approved repeal measures. But it's doubtful any repeal bill approved by Congress will have the votes necessary to overcome a veto by the president.

Levey writes that even if Republicans control both houses of Congress following the November elections, "The millions of newly insured also create a politically important constituency that may complicate any future Republican repeal efforts."

Michael Hiltzik, also writing for the Los Angeles Times, took a look at Texas Sen. Ted Cruz's Facebook page, where he asked people for their opinions on Obamacare.

Hiltzik notes the response Cruz got was not what he expected.

"It's probably fair to say that he didn't expect the tsunami of "YES" votes that have shown up on the page among the 47,000 that Facebook says have been posted. The general tenor of remarks is that the Affordable Care Act is a good thing, that Cruz should get out of its way already and that, if anything, he should be working to improve it, not overturn it."

Ron Fournier, writing for the National Journal, notes while Democrats are in danger of losing the Senate due to Obamacare and the propaganda war its critics have waged against it, Republicans aren't immune from backlash.

"Will Republicans pay a price for blocking Medicaid expansion in states?"

Whether you believe the number affected is seven million or more than 22 million, the fact is ACA has changed the way Americans view health insurance. If that's good or bad has yet to be determined.

As Fournier notes "a flawed ACA is the best approach that a divided and dysfunctional Washington could produce at the time ..."

We at the Reformer have advocated for a single-payer system and grudgingly accepted Obamacare as the best thing Democrats could get through a divided Congress.

"For Obamacare to be a durable reform, the ACA needs political and policy input from Republicans," writes Fournier. "Democrats need to be willing to cede some control, and Republicans need to responsibly accept it. That's not going to happen any time soon. Not when ‘fix it' is an empty election-year slogan for the Democratic Party, and when governing from Washington is impossible for the GOP."

We'll be interested in seeing whether the GOP's repeal Obamacare efforts are nothing but rhetoric to rile up their base and insure they secure control of Congress and if they do take control whether they will actually push ahead with those efforts. We're not so sure overturning something that has positively affected up to 22 million people is a wise campaign strategy, but the Republicans and their big money puppet masters have proven adept at getting people to vote against their own best interests.

In the next few months, Democrats need to run toward ACA and not away from it, and they need to defend it as the best plan possible given the intractability of the GOP and its hatred of America's first black president. Show some spine Democrats. We think you've got one, but we need to see the proof.