Ever since her primary campaign, Hillary Clinton has toed a careful and consistent line on Obamacare. On the one hand, she’s praised the health-reform law, which has expanded health coverage to millions of Americans, “as one of the great accomplishments of the Obama Administration” and “of the Democratic party going back to Harry Truman.” On the other, she’s promised to fix the legislation’s noticeable flaws, in part by creating publicly sponsored insurance plans or allowing Americans to buy their way into Medicare. In short: Obamacare is good—now let’s make it even better. This is not an especially hard political script to follow.
Except, apparently, for her husband. During a campaign appearance on Monday in Michigan, Bill Clinton unleashed a riff about the Affordable Care Act in which he argued the law had left us with a “crazy system” that was hurting small businesses and middle-class Americans. His larger point was that his wife’s reforms were urgently needed. But that’s been mostly lost in headlines about Bill going nuclear on President Obama’s signature legislative achievement, even after his attempts Tuesday to dial back the comments. It was one of those not infrequent moments this election cycle where you kind of had to wonder: Is Bill trying to throw this race?
The thing about all of this is that Clinton’s comments weren’t necessarily wrong. Exaggerated and bizarrely delivered in a way that seemed custom-designed for a Republican attack ad? Definitely. But broadly speaking, he was making a sound point about the flaws of the ACA, as it currently exists, that many liberal policy types essentially agree with. Here are his full comments, for context:
We gotta figure out what to do now on health care. Her opponent said oh just repeal it all the market will take care of it. That didn’t work out very well for us, did it? We wound up with the most expensive system in the world and insured the smallest percentage of people. On the other hand, the current system works fine if you’re eligible for Medicaid, if you’re a lower-income working person, if you’re already on Medicare, or if you get enough subsidies on a modest income that you can afford your health care. But the people who are getting killed in this deal are small business people and who make just a little bit too much to get any of these subsidies. Why? Because they’re not organized. They don’t have any bargaining power with insurance companies. And they’re getting whacked. So you’ve got this crazy system where all of a sudden 25 million more people have health care, and then the people out there bustin’ it sometimes 60 hours a week end up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.
So here’s the simplest thing. Figure out an affordable rate and let people use that, something that won’t undermine your quality of life, won’t interfere with your ability to make expenses, wont’ interfere with your ability to save for your kids’ college education, and let people buy into Medicare or Medicaid.
It seems that Clinton got carried away making a point that even Obamacare’s ardent supporters have begun to accept: While the law has done an excellent job expanding insurance coverage among the poor and sick, it has not worked out as well for healthy Americans with somewhat higher incomes, who receive less generous subsidies to buy private coverage. It is not a coincidence that enrollment rates on the insurance exchanges created by the law seem to be much lower for middle-class families, who have to pay more for their coverage, than for low-income households whose premiums are by and large covered by the feds. And if you don’t qualify for subsidies at all because your household earns more than 400 percent of the poverty line—$97,000 for a family of four in 2016—Obamacare might feel like a bit of a rip-off, especially if your premiums and out-of-pocket costs have been rising. Frankly, it is kind of crazy that after a once-in-a-generation reform, our health insurance system still contains a giant hole that it lets middle- and upper-middle-class families fall through. Fixing the law through more generous subsidies, or creating options like the Medicare buy-in, could help that.
It’s just Clinton’s framing that’s so politically bizarre. Instead of taking a cue from his wife, who stresses that she wants to advance reforms or do the work that has yet to be done, he pretty much echoes standard GOP talking points by going on about people who have ended up “with their premiums doubled and their coverage cut in half.” Suffice to say, it is not actually clear how many of those individuals exist—there’s a bit of a debate about whether or how much Obamacare has actually driven up average premiums—but they’re almost certainly not the norm. They’re the anecdotes that Fox News likes to trot out.
Anyway, it might be time for the Clinton campaign to rethink that whole explainer in chief thing.