The successes or failures of the Affordable Care Act seem to have no real bearing on the political debate surrounding the law. We know this to be true, of course, because if the efficacy of the law made a real-world difference, the debate would already be over

The number of Americans struggling to pay medical bills fell last year for the first time in nearly a decade – the latest sign that Obamacare is making health care more affordable. Sixty-four million people, or approximately 35 percent of the U.S. population, said they had trouble paying bills or were stuck paying off medical debt in the past year, according to a new survey by the Commonwealth Fund released on Thursday. That was down from 75 million people, or 41 percent of the population, in 2012.

Since Commonwealth started conducting this research a decade ago, the percentage of Americans in financial distress due to medical bills was steadily increasing every year. Then the Affordable Care Act became law and conditions improved.

The lead author of the research, Sara Collins, the lead author, said in a press release, “These declines are remarkable and unprecedented in the survey’s more than decade-long history. They indicate that the Affordable Care Act is beginning to help people afford the health care they need.”

Making matters slightly worse for ACA opponents, the same research found “for the first time since 2003, there has been a decline in the number of people putting off health care because of the cost.”

In other words, conservative critics of “Obamacare” screamed relentlessly about the prospect of health care “rationing” if the ACA became law. It turns out, they had it backwards .

On the right, I imagine some may be thinking, “OK, the rationing we predicted hasn’t happened, and Americans are facing less financial distress over health care costs, but what about all the bad news?”

For the most part, the Republican response to these developments is to play make believe and pretend the successes don’t exist.