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Health check: Obamacare is gaining momentum. But there is far to go before the US President’s defining policy is a sure success

Such considerations are nothing compared with the tragedy that the failure of Obamacare would be for America

At last, the “Obamacare” insurance exchanges created to drag US healthcare into the 21st century are starting to do brisk-ish business. An encouraging 975,000 people signed up for health cover in December, taking the total to 1.1 million. It is not yet apparent if the young and healthy are signing up as fast as their older and sicker counterparts. Nor is it clear whether the most are paying for themselves or are claiming subsidies. What is undeniable, though, is that – after a rocky start – the roll-out of the Affordable Care Act is finally gaining momentum.

What a rocky start it was. The political background was highly toxic – indeed, Republican opposition was so strong that, even after the law was passed in 2010, the GOP made more than 40 attempts to throw it out (including a Supreme Court appeal and a 16-day shutdown of the federal government). The Obama administration might therefore have been expected to pay close attention to the practicalities, particularly given that the scheme relied on vast new IT systems of the kind which so often cause headaches. Yet when the system went live on 1 October there were so many glitches it all but ground to a halt, frustrating users in their millions.

Neither did the fiasco end there. Although the President had promised explicitly and repeatedly that satisfied insurance holders would not be affected –“if you like your healthcare plan, you’ll be able to keep your healthcare plan, period,” ran one famous assurance – when the time finally came, millions of Americans received letters cancelling their existing arrangements and requiring them to make new ones. Cue high-octane charges of deception and growing doubts even among Democrats.

All of which would be tricky in any event. In a second term grinding to a halt under the weight of Edward Snowden’s national security revelations and presidential indecision over chemical weapons in Syria (a vacuum swiftly filled by Moscow), the debacle was yet more damaging. Worse still, the Affordable Care Act is Mr Obama’s defining domestic policy. If the reform upon which so much has been staked runs into the sand, it will be difficult for even the president’s most ardent supporters to defend his record.

Such considerations are as nothing, however, compared with the tragedy that the failure of Obamacare would be for America. For millions of citizens of a country as rich as the US to be unable to afford to be ill is as incomprehensible as it is indefensible.

The recent headway is, then, to be welcomed – and not just by Obama supporters. There is still so much further to go, however. Only tomorrow, at the start of the new year, will those who enrolled find out whether they have the policies for which they signed up. Then there are the larger questions to consider; if the fines that start, for the uninsured, at the end of March are not sufficient to send the healthy to insurance exchanges, premiums will rocket – and public support will plummet. Meanwhile, government claims that the 7 million enrolments target is within reach are not wholly convincing.

With so many hurdles still to clear, it can only be hoped that the lessons of the past year have been learned. A shake-up of healthcare provision was always going to be a challenge. But the administration made it harder still.

Video: Obamacare - Calorie information to be displayed on vending machines