Story highlights
Clinton and Trump to inherit intractable health care issue
Clinton would try to fix Obamacare, Trump wants to repeal and replace
President Barack Obama leaves the White House in 12 weeks, but the law that bears his name will polarize politics long after he’s gone.
Big price hikes to Affordable Care Act premiums announced this week mean that Obama’s proudest legislative achievement will fail to resolve the decades-old controversy surrounding the government’s role in managing the cost of and access to health care.
It will fall to the next administration whether to fix Obamacare’s shortcomings – including rising premiums and deductibles, slowing enrollment growth and the increasing number of insurers pulling out of the ACA marketplaces – or to trash the system and start again. Neither Hillary Clinton nor Donald Trump have laid out a detailed plan for how they would revise or replace the law or how they would navigate the toxic politics that surface in Washington whenever health care is on the agenda.
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Trump has proven better at condemning Obamacare – his stump speech includes vows to repeal and replace it – than saying how he would tackle the crisis over access and cost. He hasn’t made health reform a centerpiece of his campaign.
“My first day in office, I’m going to ask Congress to put a bill on my desk getting rid of this disastrous law and replacing it with reforms that expand choice, freedom and affordability,” Trump said Tuesday in Florida. “Hillary Clinton wants to double down on Obamacare and make it even worse. She wants to put the government totally in charge of your health care.”
Still, Clinton has been far more up front about what she would try to accomplish.
“The President and I have talked about it,” Clinton told WHCQ Radio in Florida on Tuesday. “We’re going to get copays and premiums and deductibles down. We’re going to tackle prescription drug costs. And we can do that without ripping away the insurance that people now have.”
Clinton’s campaign said she would increase competition among insurers to improve choices for Obamacare customers, including a public option, and would take on pharmaceutical companies over rising drug prices and provide tax relief for out of pocket expenses. Her plan also includes incentives for states to expand Medicaid. Plans previously published by her campaign include pledges to tackle diseases like Alzheimer’s and autism, substance abuse and Zika and aims to improve public and rural health infrastructure.
Political minefield
The former first lady and New York senator has been working in the political minefield of health care for decades – dating back to her failed effort during her husband’s administration in the 1990s.
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But her broad knowledge of possible approaches will not help her solve the fundamental political problem surrounding Obamacare: any legislative fix to the law will require some level of support from Congress. And unless she is able to whip up a Democratic wave sufficient to claim back the GOP-dominated House, the political fight over rescuing Obamacare will be fierce.
Republicans in the House who have voted over 50 times to repeal the law aren’t likely to line up to save it. And even some Democratic senators from red states up for re-election in a brutal 2018 mid-term election slate may shy away from tough votes to prolong the law.
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Trump does have a position paper on the issue, in which he promises to repeal the individual mandate, modify laws that prohibit the sale of health insurance across state lines and allow people to deduct insurance premiums from their tax returns.
Trump would promote individual Health Savings Accounts with tax free contributions and would allow patients access to imported drugs from overseas to bring down prices.
But he offers few insights into how he would take on and defeat the huge vested health care interests that are a powerful influence on Washington politics or how he would overcome resistance to some aspects of his plans from his own party.
Rep. Chris Collins, a New York Republican, told CNN’s Wolf Blitzer Tuesday that he believes Trump would adopt the health care plan drawn up by House Speaker Paul Ryan’s Republican conference.
“It is my understanding that Mr. Trump has seen that plan and what he is talking about … is in fact a better way, a replacement plan,” Collins said.
2016 fallout
The Obamacare price hikes – the government said Monday premiums for the benchmark plan are set to rise an average of 22% next year – are a surprise twist in the final stretch of a campaign that had seemed to settle down in recent days. Trump was quick to seize on the issue, suggesting he believes it’s something he can use to throw Clinton, who is leading most polls, on the defense.
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“It’s blowing up all over the country,” Trump told reporters Tuesday at his golf resort in Doral, Florida, vowing to repeal and replace Obamacare with something less expensive.
The rising premiums could also provide a boost for Republican Senate candidates who are struggling to overcome opposition to Trump in their states. The National Republican Senatorial Committee released a video of Katie McGinty, a Pennsylvania Democrat who is locked in a tight race with incumbent Republican Pat Toomey, in which she said Democrats should be “proud of” Obamacare.
“Is Shady Katie still proud of Obamacare?” the NRSC released asked.
Iowa Republican Party chairman Jeff Kaufmann said in a statement that Democrat Patty Judge, who is seeking to unseat GOP Sen. Chuck Grassley, “cheers and hollers for the Obamacare disaster.”
That is a message likely to be adopted in other Senate races that could decide control of the chamber, including Sen. Kelly Ayotte’s uphill re-election battle in New Hampshire and Sen. Richard Burr’s tough fight in North Carolina.
Higher premium hikes in states such as Florida – a vital battleground where Clinton and Trump campaigned on Tuesday – and Colorado could also shape the political narrative in the run-up to election day.
And Clinton’s push into Arizona, a red state that Democrats believe they can pluck from Trump on Election Day, is now facing a new obstacle following news that Obamacare premiums could rise 116%.
But there is no guarantee Obamacare’s new problems will necessarily be a slam dunk for Republicans. A CNN/ORC poll published Monday showed that health care was only the fifth most important issue motivating voters this year, behind other concerns including the economy, immigration, foreign policy and terrorism.
Another factor that could diminish the impact of the latest Obamacare travails is the unconventional nature of this election, which at this late stage seems to be turning far more on Trump’s personality and temperament than a detailed discussion of policy issues.
Perhaps the biggest hurdle to Obamacare’s latest woes swaying the election is the tight calendar – the election is just 13 days away. Millions of voters have already made up their mind about Trump and Clinton and cast early ballots.
Former White House press secretary Jay Carney, who spent long hours defending Obamacare from the briefing room, admitted the law was not as popular as the president would like it to be. But he said voters would give Clinton credit for trying to repair it.
“Is it something …. that’s going to change the election? No, it’s not,” Carney said on CNN’s “New Day” on Tuesday. “Remember, the opportunity Republicans had to use Obamacare against the Democrats and win the White House was in 2012. Mitt Romney, a far more credible candidate for president of the United States from the Republican Party, you know, beat us hard over the head with Obamacare.”
“And guess what,” Carney continued. “The American people re-elected President Obama.”