News headlines suggest this election is largely about sex and emails. These issues matter, they reflect on the character of the presidential rivals. But 48 hours on the campaign trail this week has convinced me that more substantive things are running through the minds of the voters. I had to encourage some Republicans at one Trump rally to talk about the FBI. But people need no encouragement to discuss Obamacare. And I’m hearing it mentioned among nonpolitical Americans in bars and cabs.
Open enrollment for the insurance exchanges began Tuesday and consumers who logged on were in for a shock: Monthly premiums are up by an average 25%. Why?
Even though the vast majority of those enrolled in Obamacare get a tax credit, which creates a subsidy to reduce how much they have to pay, the President’s signature health care reform offers a great example of his mixed record, of good intentions undermined by reality.
The number of uninsured in the United States is down, which is surely good. But government interference in the market has had consequences. Compelling everyone to buy a product raised demand. But Obamacare’s effect on insurers’ costs and profitability prompted a number of them to flee certain state markets, reducing supply for consumers. For instance, in many Arizona counties there’s only one insurer selling exchange plans for 2017. The premium for the benchmark plan has more than doubled across the state. In Oklahoma, for those not eligible for a subsidy, the premiums can go as high as 69%, and in Alaska, monthly premiums can reach $760.
Trump, as you can imagine, is making a big play out of this. I saw him speak about it in Philadelphia on Tuesday, in a speech that was scripted, direct and effective, although it left out some key details, including the subsidies. But even if there’s more nuance than the Republicans admit, the Obamacare mess does help Trump in three critical ways. First, it’s the kind of story of administrative failure that suggests the government doesn’t know what it’s doing and needs a new broom. Those with memories of the Obamacare website’s disastrous start will confirm that it’s become a byword for incompetence. An embarrassment.
Second, Obamacare’s implementation is a story of half-truths. Americans were told they could all keep their doctor or their plan. This turned out to be untrue.
Finally, when voters stop to think about Obamacare they are reflecting upon the President’s record.
For many Americans it’s a legacy of slow growth in the economy and in their wages — of only just keeping their heads above the water. Crucially, that’s a legacy Hillary Clinton has endorsed and promised to protect: She says she only wants to increase government’s role in health care, not reduce it.
Her strategy is part of the transactional relationship between the Obamas and the Clintons — couples who were never close and were even at loggerheads during the 2008 campaign. But thereafter they developed a political interdependence. The Clintons campaigned strongly for Obama in 2012; Obama is now touring the country to show his support for Clinton. And Clinton presumably hopes Obama’s charisma will rub off and attract minority voters. “Seriously,” she famously asked, “is there anyone more inspiring than Michelle Obama?” — a tacit admission that she is personally about as inspiring as the color beige.
A braver politician would not have tied herself to Obama’s wider legacy. Bernie Sanders said it was insufficiently radical; there was plenty of scope to say that Obamacare was a good idea but deeply flawed. Clinton, perhaps because she has been so closely aligned with health care reform her whole public life, has chosen to defend and expand it. That means she now owns it. And if the voters decide on balance that they don’t like it — which polls suggest is the case — then she’s in trouble.
If Obamacare ends up mattering, then maybe this election is more conventional than we think. The candidates offer standard partisan policies on health care: Democrats favor state regulation, Trump offers a free market approach by, say, allowing people to purchase health care across state lines. Moreover, a dynamic of people passing a verdict on an incumbent President by punishing his chosen successor is as old as the republic itself.
As the polls even up — and they are definitely getting closer — one explanation to entertain is that this election is at some level both typical and mundane. People are voting against the incumbent and for change. No one can deny the role that working-class anger and cultural reaction has played in Trump’s support. But it’s likely that for millions who vote for him, the decision is a rational one that they calculate is best for their family.
