Sure, Obamacare has helped more Americans get insurance. But the cost of premiums is way, way up, and going higher still. The poor — in some ways — get more, but the middle class is paying much more for less.

Some people love it, others can’t stand it. That’s the Affordable Care Act in a nutshell.

Five-and-a-half years after it squeaked through Congress without a single Republican vote in either the House or Senate, the law is a study in duality, but a supremely expensive study. And lately, some Republicans lawmakers are warning that without a serious strategy to defeat it, the law just might be around forever.

One View: Too Costly to Bear
President Barack Obama’s signature domestic policy achievement is far from an achievement to Brad McClain of Fairhope, Alabama.

Not so long ago, McClain, 62, an interdenominational Christian pastor, had one of the best insurance plans on the market with Blue Cross Blue Shield. The plan covered him, his wife Shannon, also 62, and a teenage son and daughter, all for $800 per month, with a $200 deductible.

Blue Cross wanted to raise McClain’s premiums to $2,000 per month.

He liked the plan so much he stuck with it for seven years. Then came the Affordable Care Act — and there went McClain’s premier coverage. In late 2013 and early 2014, as the ACA was entering the health care marketplace, Blue Cross wanted to raise McClain’s premiums to $2,000 per month. Even the company’s cheapest plan suddenly cost $1,200 per month with a $12,000 deductible.

Signing up for the ACA wasn’t an option. That estimate was even higher, and McClain’s income wasn’t low enough to qualify for the law’s subsidies. So after crunching the numbers, McClain and his wife simply went without insurance altogether, ultimately paying the penalty for noncompliance with the ACA and gambling that the family wouldn’t have any catastrophic accidents or illnesses.

More than a year later, he still hasn’t settled on a private insurance plan, and he isn’t happy about his experience.

“Even with paying (the ACA penalty), we still came out ahead, so fortunately it worked out for us,” McClain told LifeZette. “We had some small incidents, but nothing major over the past year. Look, I know there’s a lot that had to be reformed, but I don’t think this particular approach works well. We just find ourselves in a really challenging situation.”

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Another View: Worth the Higher Costs
For somebody looking for “middle America,” McCarty qualifies — literally. McCarty lives near Plato, Missouri, a small town of just over 100 people that the 2010 U.S. Census lists as the population center of the United States. A 63-year-old self-employed painter, McCarty and his wife Liz, 62, were among the millions of Americans initially frustrated by the ACA’s well-documented website problems.

Then the couple saw their premiums for a mid-level plan jump from $20 per month with a $1,000 deductible in 2014 to a $300 monthly premium with an $8,000 deductible this year.

After crunching the Obamacare numbers, McClain and his wife simply went without insurance altogether.

However, McCarty had both of his knees replaced in successful surgeries funded by the ACA, and it turns out the increase in his bills was due to an incorrect estimate of his annual investment income.

By far, he said the ACA has proven a better deal than the private insurance market, where his research had shown the couple’s health care would have cost $16,000 a year in premiums — with a $20,000 deductible. McCarty blames the media for the perception that the law is a failure, saying his own experience has shown just the opposite.

“Even with the increase, it has still worked well,” McCarty said. “This is considered a Southern, Republican state and most people here are against Obama, so because of that the Affordable Care Act is considered evil. That’s just the way it rolls. But it’s been terrific for me, an unbelievable success. It’s just that (the media) never ask people like me.”

Bad News, Good News
The ACA has been in practice just a year-and-a-half, after uninsured Americans were given a deadline of spring 2014 to either sign up through its procedures or find coverage somewhere else.

One clear result of the law so far: More Americans are insured, either under the ACA or not. This past April, the polling firm Gallup said the percentage of uninsured Americans has dropped from 18 percent in the third quarter of 2013 — shortly before the law went into effect — to 11.9 percent in the first three months of this year.

Premiums are rising both for enrollees in the ACA and those who are outside the program. That trend seems likely to continue into 2016.

Nearly 12 million Americans have signed up for the ACA this year, up from 8.1 million in last year’s enrollment period. The bad news: Premiums are rising both for enrollees in the ACA and those who are outside the program. That trend seems likely to continue into 2016.

Last month, the federal Centers for Medicare and Medicaid Services released proposed rate increases from insurers of at least 10 percent for next year, both inside and outside of the exchanges created by the ACA. The numbers are only proposals and won’t be finalized by states until October.

Despite the attention-grabbing proposed rate increases for 2016, CMS said it has been told by insurers that most Americans can expect to see rate increases of below 10 percent — and actuarial filings reflect that. Also, the proposed increases vary widely with the plan and the state. UnitedHealthcare, for example, has requested rate hikes as low as 1.2 percent in some states and as high as 18 percent in others.

Some firms in some states want to raise rates much higher, in some cases by up to 60 percent in just one year. In Tennessee, for example — where Obama made a personal appearance this month to plug the program — rate hikes range from 11 percent for some plans by UnitedHealthcare to nearly 47 percent by Time Insurance Co. Other insurers sit somewhere in the middle. Blue Cross Blue Shield wants to hike rates by more than 36 percent, for instance.

But More Bad News is Coming
Many analysts explain that proposed rate hikes is the natural result of more patients pursuing preventive care — regular doctor visits, medical tests and prescription medicine.

Kev Coleman, director of research and data for HealthPocket Inc., a California-based firm that helps consumers compare various health care plans, said the increases should be no surprise. Many consumers who signed up for the ACA for its first year in 2014 saw their costs rise because the industry as a whole saw Americans with expensive, pre-existing conditions — who were often denied care prior to the ACA — join the marketplace. Secondly, he noted the new law required insurers to expand benefits.

“So the first big driver is a sicker risk pool, and then you have benefits being expanded,” Coleman said. “So you’re going to have to raise rates. There’s no two ways about it.”

“As people are finding out, we’re hearing from them,” Sen. John McCain told LifeZette. “We’ve certainly seen an increase in calls and just a sense of shock and surprise about the (rate) increases.”

Rates for 2016 are especially noteworthy, Coleman said. Insurers for the first time have had a full year’s worth of claims data to analyze how patients are using the new law. At the same time, the size of the insured pool in ACA exchanges has jumped from 6.7 million a year ago to 11.7 million people today.

“That’s why the rates this year are so important,” Coleman said. “We now know who’s going to be in the risk pool and how they’re going to use the care.”

Will Obamacare Survive?
In the Senate, which was the stage of the dramatic Christmas Eve vote in 2009 that approved the ACA, Republicans say they are getting an earful from constituents over rate increases. Republican Sen. John McCain of Arizona, who was Obama’s 2008 presidential opponent, is among those who call it “sticker shock.”

“As people are finding out, we’re hearing from them,” McCain told LifeZette. “We’ve certainly seen an increase in calls and just a sense of shock and surprise about the increases.”

But Democrats say they have heard just the opposite. Sen. Jeanne Shaheen of New Hampshire, for example, said the ACA has helped increase competition in New Hampshire, therefore keeping costs low for consumers.

In Maryland, Sen. Ben Cardin said he hasn’t heard an outcry either. “To the contrary — there’s been much less noise than I’ve heard in the past,” Cardin said. “There’s always people who are concerned about premiums, but it’s been at a lower threshold. I normally hear when there’s a spike in complaints about something, but there hasn’t been.”

Another worry among Republicans: The law may eventually succeed by simply surviving.

Elsewhere, many in the GOP say they finally may be out of ideas to unravel the Affordable Care Act, especially now that the U.S. Supreme Court has twice upheld its constitutionality. A handful of legislative devices remain, such as repealing the law’s 2.3 percent excise tax on medical devices, but most Republican lawmakers believe little concrete can be done unless Obama is succeeded by a Republican president.

Another worry among Republicans: The law may eventually succeed by simply surviving.

“It’s five years on now, and there’s been two Supreme Court [decisions],” said Sen. Richard Shelby, R-Ala., who chairs the Senate Banking Committee. “It might become part of our fabric. You don’t know, do you?”

When More Means Less
Still, many on the right remain fervently unconvinced the law is working and say the marketplace as a whole continues to be damaged. A report by the National Center for Public Policy Research, a conservative think tank, noted that insurers in 37 states plus the District of Columbia are seeking double-digit rate increases for 231 different plans for 2016 — up from 121 plans in 2015.

The uphill trend gets worse with the higher requests. Insurers sought increases above 20 percent for 21 plans and hikes of more than 30 percent for nine plans in 2015, said the NCPPR report. For 2016 there are 126 plan requests above 20 percent and 61 requests exceeding 30 percent. Also, for the first time, for 2016 insurers want to raise rates by more than 40 percent on 26 different policies and by more than 50 percent on a total of 12 policies.

The accompanying federal subsidies mean Americans with even slightly higher incomes are paying more for less coverage.

Others, meanwhile, are noting a paradoxical trend by which middle-class Americans are getting less and less from the new law.

Doug Badger, senior health care policy adviser to former President George W. Bush from 2002 to 2005, argued that as premiums have risen under the ACA, coverage has shrunk for middle-class Americans.

Badger said that while the law has attracted those with lower incomes, the accompanying federal subsidies mean Americans with even slightly higher incomes are paying more for less coverage.

“That reality is because of the way the subsidies are structured, which are not just premium subsidies but also cost-sharing subsidies,” Badger said. “The more you pay, the less you get.”

Badger points to a March study by the Washington-based health care research firm Avalere that discovered that 76 percent of lower-income households with incomes below 150 percent of the federal poverty level, or $17,655, have signed up for an ACA plan, compared to only 2 percent of previously uninsured Americans with higher incomes of 400 percent or more of the federal poverty level, or $47,080.

A 25-year-old healthy person who only earns about $15,000 a year may pay $25 a month for coverage that will pick up an average of 94 percent of their medical costs, Badger said. But someone earning $35,000 a year could easily find himself paying much more for a policy that covers only an average of 70 percent of his costs.

“When you think about it in combination with other, lower-income programs like food stamps, like the earned income tax credit, like housing assistance and so forth, you’re creating huge disincentives for people to work and earn more, because they’re getting very, very lavish benefits when they limit their work activity,” Badger said. “The more they earn, the less generous those benefits become. It really amounts to punishing the middle class, not rewarding its work efforts.”

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