If you are Paul Rugman or like minded, you measure it this way:
And let’s be clear: The reason this assault failed wasn’t that Donald Trump did a poor selling job, or that Mitch McConnell mishandled the legislative strategy. Obamacare survived because it has worked — because it brought about a dramatic reduction in the number of Americans without health insurance, and voters didn’t and don’t want to lose those gains.
You can’t argue with the facts, Obamacare did lower the number of uninsured. But that’s a little like saying government efforts to increase home ownership in the years before 2008 were a success.
You can’t measure success on one goal of a complex issue. Obamacare was also supposed to make health care affordable and improve quality. In other words, it was supposed to help all Americans and even today it’s presented in those terms.
Making something affordable by having others pay most or all of the cost, accomplishes nothing. If I can obtain a prescription with a $10 co-pay but my employer plan pays $200 is the Rx affordable; to who? Is it still affordable when the $200 goes to $250, but my co-pay is the same?
Obamacares troubles are exactly because of those subsidies; the need for them and because of adverse selection creating a higher cost enrollment pool of insured. And also because the political focus was on premiums while making little connection between health care spending and those premiums.