In an interview prior to the recent official opening of his presidential library, former President Barack Obama was asked to name his greatest accomplishment.

The first thing that came to mind was the Affordable Care Act (ACA).

As he put it, "For all the resistance from our political opposition, the Affordable Care Act has now helped 50, 60 million people, and continues to help people even though the current Congress has tried to weaken it and taken away some of the subsidies that were really helping a lot of working people."

The data tell a different story.

On a number of metrics — from the cost of coverage to the availability of high-quality care to the sustainability of public safety-net programs — our nation's healthcare system is in worse shape than it was before Obamacare became law.

Let's start with cost. Fewer than half of Americans can consistently afford access to quality care, according to a recent Gallup poll.

Obama seems to blame these affordability problems on the expiration of enhanced premium subsidies earlier this year.

That's an odd argument, given that those subsidies were not part of Obamacare. They were a temporary pandemic-era addition enacted more than a decade after the law's passage.

The fact is, premiums were soaring long before those subsidies appeared. According to the U.S. Department of Health and Human Services, average monthly premiums in states using the Healthcare.gov exchange more than doubled from $232 in 2013 to $476 in 2017. Last year, they hit $619 a month.

The cause can be found in Obamacare's design.

The law required insurers to cover a lengthy list of mandated essential health benefits, restricted their ability to price plans according to risk, and imposed other costly regulations on the individual market.

Insurers responded by raising premiums.

Rather than address the law's systemic flaws, Democrats have tried to paper over these price increases through ever-more generous tax-payer-funded subsidies — including the enhanced subsidies Obama mourns.

The law also introduced a number of distortions into the insurance market.

For instance, it created a taxpayer-financed bridge to early retirement by making it easier for Americans in their late 50s and early 60s to leave the workforce before becoming eligible for Medicare.

Obamacare initially included a temporary federal subsidy program for early retirees.

Once the exchanges opened, premium tax credits, guaranteed access to insurance, and caps on premiums for older enrollees essentially subsidized people for retiring early.

The Congressional Budget Office (CBO) warned years ago that Obamacare would lead some people to retire earlier than they otherwise would.

That prediction proved accurate. A study published by the National Bureau of Economic Research in 2020 found that the law reduced labor-force participation among 60- to 64-year-olds and shrank the near-elderly labor force by roughly 110,000 people between 2014 and 2018.

At a time of trillion-dollar deficits and mounting entitlement costs, subsidizing early retirement is a stunning misuse of taxpayer money.

Competition in the insurance market also suffered under the law.

Many insurers fled the exchanges after struggling to make the economics work.

A recent Government Accountability Office (GAO) report found that the median number of insurers participating in individual markets fell from 30 per state in 2011 to 10 in 2022.

The result is that a law that was supposed to improve patient choice ended up doing the opposite.

The law's Medicaid expansion generated a different set of problems. Obamacare expanded Medicaid eligibility to able-bodied adults earning up to 138% of the federal poverty level. To entice states to participate, Washington promised to cover 90% of the cost.

That's a much higher share than the federal government pays for Medicaid's legacy enrollees.

States responded to those incentives and enrolled able-bodied adults in droves. Roughly 20 million people are part of the Medicaid expansion population.

The Paragon Health Institute estimates that some 6.6 million of those people were ineligible enrollees in 2024, at a cost to federal taxpayers of nearly $37 billion.

Fifteen years after the Affordable Care Act's passage, our healthcare system is less affordable, less competitive, and less fiscally sustainable.

Yet many progressives see these shortcomings as an argument for even greater government control of healthcare. Obama himself endorsed single-payer healthcare before entering the White House.

Obamacare was a step in that direction.

Its record offers little reason to believe the next step would work any better.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Healthcare Policy at the Pacific Research Institute. Her latest book is "The World's Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It." Follow her on X @sallypipes. Read more Sally Pipes Insider articles — Click Here Now.