Donald Trump, desperate for a winning political issue in the final two weeks of the presidential race, mounted a new offensive Tuesday, tying Hillary Clinton to sharp premium increases that will hit some Americans covered under the Affordable Care Act, the signature program of her closest ally, President Barack Obama.
“It’s over for Obamacare,” Trump declared on Monday night at a rally in Tampa.
On Tuesday morning in Miami, he proclaimed that “this election is going to be about Obamacare.” And he said “Obamacare is just blowing up” — a message his advisers said he would hammer at two rallies and in interviews through the day.
The Department of Health and Human Services reported Monday that premiums for midlevel health plans on the health law’s federal insurance exchange would rise by an average of 25 percent, but in some cities and states, premium increases will be considerably higher. Trump asserted that rates would go up “60, 70, 80 percent” — apparently referring to exorbitant jumps in select markets.
Those increase, however, will be cushioned for most people on the exchanges by generous government subsidies that will rise with the premiums.
The higher premiums pose an 11th-hour test for both Trump and Clinton in a campaign that, since starting in the spring of 2015, has not revolved around policy issues to any great extent. Trump has repeatedly struggled to prosecute a political case against Clinton in a sustained way, most notably failing to focus this summer on the scathing FBI report on her State Department email.
Whether he can make Clinton pay a political price for supporting the Affordable Care Act, and more broadly for championing Obama’s presidency, will reveal his ability to turn a policy issue into a political weapon at this late stage of the race.
For Clinton, the problems with the Affordable Care Act could force a reckoning that she had hoped to avoid. As a candidate, she has linked herself more closely to Obama than any nominee has done with a sitting president in modern times, defending his economic record and praising him for pushing the health law through a sharply divided Congress. Republicans had hoped that their nominee would force Clinton to own the health care law, politically speaking, or at least be forced to defend it, but she has mostly skated past its flaws in cost and coverage.
In fact, parts of the health law are politically popular. The United States has the lowest percentage of uninsured citizens in its history. Because of the Affordable Care Act, insurers cannot deny coverage for a pre-existing medical condition and cannot cap lifetime coverage. Children can remain on their parents’ policies until age 26.
Clinton wants to improve the law, she says, by increasing the subsidies that help cover premium amounts and by allowing more Americans to get government help. She also wants to add a government-run insurance option, which she says would increase competition and choice in the marketplaces created under the health law. And she has proposed allowing people younger than 65 to buy in to Medicare.
A Clinton campaign aide, Jennifer Palmieri, talking to reporters aboard the Clinton campaign plane, did not shy from the topic.
“The choice in the election is: Are you going to repeal the Affordable Care Act, kick 20 million people off of insurance, go back to putting health insurers in control of whether or not pre-existing conditions are covered?” she said. “Or are you going to improve upon it?”
Trump says he wants to repeal the health law and take more of a free-market approach. He would reduce federal regulation and coverage requirements so insurance would cost — and cover — less. He would not require Americans to have health insurance, as the Affordable Care Act does.
“By failing to denounce it, Hillary Clinton owns it,” Kellyanne Conway, Trump’s campaign manager, said of the health care act in an interview on Tuesday. “She is in an impossible spot: extol and expand the features of a program that millions of Americans see as having reduced quality, choice and access, or lurch leftward to embrace a Sen. Sanders type single payer plan in the hopes of embracing Sanders voters.”
That political attack will not necessarily resonate.
While the problems in the individual insurance market are real, they affect only a small fraction of Americans. In 2015, 49 percent of Americans got health insurance through a job, 34 percent got it through Medicare or Medicaid, and 7 percent got it through the individual market, according to the Kaiser Family Foundation, a nonpartisan research group. Of the 10.5 million Americans who get health insurance through the Affordable Care Act marketplaces, about 85 percent of them receive income-based subsidies to defray the cost.
That leaves 7 million people buying insurance on their own without subsidies, either because their income is too high or they are not aware of the option — a significant number but not a huge voting base.
Still, some Republicans said on Tuesday that the premium rises were an unexpected political gift. “It needs to be the principal message — you can’t dilute the attack by all the other stuff Trump talks about everyday,” said Ed Rollins, a veteran Republican strategist. “The hour is late and the time is short.”
Trump has already stumbled in that effort. Speaking to scores of his own workers at his Miami golf course Tuesday, he said that “all of my employees are having a tremendous problem with Obamacare” — suggesting that his company does not provide health insurance or else misunderstanding the health law. Moments later he said of his employees, “They’re not worried about their health care because we take great care of people.”
After finishing, Trump left it to the resort’s general manager to talk to reporters about the confusion and confirm that only a few employees may be insured through the Affordable Care Act.
Steve Elmendorf, a Democratic strategist and lobbyist, argued that Obama’s job approval rating was strong enough — 54 percent, according to the latest Gallup tracking poll data — that Clinton did not need to rethink her dual strategy of championing his leadership and proposing changes to the health law.
“Trump has shown no ability to ride any substantive issue with any consistency, and Obama’s numbers are going up, not down,” Elmendorf said.
Elaine C. Kamarck, director of the Center for Effective Public Management at the Brookings Institution, said that Clinton stood a chance of brokering a deal to fix the health care program if elected president, and that she was skeptical Trump could get much traction on the issue.
Kamarck, a domestic policy adviser in Bill Clinton’s White House, said the problems with the health law had been apparent for some time. Neither the law’s subsidies nor its penalties for those who refuse to buy insurance have persuaded enough young, healthy people to go into the insurance marketplaces it created. That has left a pool of customers in some parts of the country that is too sick and too small.
Because so many marketplace customers have needed expensive medical care, some insurers have spent more on claims than they have earned in premiums. And the federal government’s strategies for protecting insurance companies from large losses have not been as effective as hoped.
While benchmark premiums are going up an average of 25 percent, rates are set to increase much more in some places.
For a 27-year-old in Phoenix, the average monthly premium for a benchmark plan will rise next year by 145 percent, to $417 from $170, according to the Department of Health and Human Services. But subsidy amounts will keep pace with rate increases, so people who qualify for assistance may not face nearly that much of a price hike.
Another reason for the volatility in the marketplaces is political. The Obama administration, blocked by Republican opponents in Congress, has paid out only a fraction of the $2.5 billion it owes insurers under a provision of the health law that was supposed to protect them from unexpectedly large losses during their first few years in the marketplaces. Several insurers cited the minimal payments as one of the main reasons they raised rates or abandoned the marketplaces.
On Tuesday, Republicans zeroed in on the Phoenix rate increase to press their case in the new battleground of Arizona.
“I can’t imagine Arizona voting for Democrats,” said Hugh Hewitt, the conservative talk show host, said during an interview with Trump’s running mate, Gov. Mike Pence of Indiana.
“Yeah, it really is incredible,” Pence said. “Isn’t it amazing that you had Barack Obama a week ago literally celebrating the launch of Obamacare, and then we find out from his own HHS in the last 24 hours that premiums are going to go up 25 percent across the board?”