Republicans have waged their seven-year war against Obamacare on behalf of a remarkably small number of aggrieved Americans.
President Donald Trump spoke for his party last fall as he ripped the Affordable Care Act for pushing rates "through the sky." As Republicans crafted a replacement this spring, he promised "much lower premiums and deductibles."
In reality, just a tiny fraction of Americans — disproportionately young, male, healthy and middle-to-high income — has seen costs sharply increase because of Obamacare. Liberal and conservative experts alike place the number well below 10 million people — 3 percent or less of the population.
Twice that number – disproportionately poorer and less healthy people — gained insurance under Obamacare. Many received immense medical and financial benefits.
True to their anti-government ethos, Republicans disdain Obamacare on tax-and-spending grounds. But ideological complaints that its mandates inhibit freedom never achieved broad resonance. Attacks on its "job-killing" effects faded amid uninterrupted private sector employment gains since it passed.
That left out-of-pocket costs through premiums and deductibles the most potent GOP weapon – even though premiums and deductibles for most Americans were little changed by Obamacare.
In fact, Obamacare's principal impact on the bulk of the population has been political noise.
More than 90 percent of those with health insurance before Obamacare got it from employers or the government, mainly Medicare and Medicaid; their coverage didn't fundamentally change.
"The basic circumstances of their health insurance, the general level of premiums, access to care was basically unaffected," said Joseph Antos, a health care expert at the conservative American Enterprise Institute.
Premiums for employer-provided coverage increased by an annual average of 3.1 percent from 2010 and 2016 – less than they increased in the decade before Obamacare.