Donald Trump hasn’t talked much about politics this election cycle, aside from a few vague claims that he will somehow bring back low unemployment and low inflation, which, by the way, has already happened. (Unemployment has been at 4% or lower for nearly two years. Thursday’s consumer spending report showed the Federal Reserve’s preferred gauge of core inflation is nearing its 2% target.) The former president seems to have the most energy to take revenge on his political opponents, whom he wants to “exterminate” like a “plague.”
However, Trump has said in recent days that when he returns to the White House, he will again try to end the Affordable Care Act (ACA), the reform that has led to a significant decline in the number of Americans without health insurance.
What is the reason for this new attack? “Obamacare is shit!” declared the former and possibly future president. For those offended by the language, these are Trump’s own words, and I think I owe it to my readers to report what he actually said and not sanitize it. Trump also promised to offer “much better health care,” without giving specific details.
So let’s talk about the essentials. Is Obamacare really nonsense? Can we believe Trump’s promise to deliver something much better?
On this final question, keep in mind that in 2017, Trump and his allies came close to ending the ACA and replacing it with their own plan, and that the Congressional Budget Office conducted a detailed analysis of the nearly passed legislation. The bureau predicted that by 2026 under the Republican bill, 32 million people would have lost their health insurance and that premiums paid by those who buy their own insurance (rather than through their companies) would have doubled.
To my knowledge, there is no reason to believe that Trump has since come up with a better plan or that a new analysis of his project would be any less depressing.
But while ending Obamacare would have devastating consequences, the question is, to what extent did the ACA really work?
The main reason for Obamacare is simply the fact that the number of uninsured Americans fell dramatically after the law went into effect. We are still far from the more or less comprehensive coverage offered by all other developed countries, and some Americans’ health insurance remains inadequate, but the gap has narrowed significantly.
Now the success of Obamacare did not quite meet the expectations of its supporters. Most of the original reform debate focused on creating markets where individuals could purchase their own insurance. And indeed, this “non-group” coverage has expanded, but most of the increase in coverage is due to Medicaid expansion (which would be even larger if some red states like Texas and Florida didn’t continue to do so). refusing to accept federal funds to help their own residents).
Nevertheless, success is success, even if it wasn’t what was predicted. And I would argue that insurance markets offer important benefits that extend beyond the number of people who currently use them. Before Obamacare, Americans with pre-existing conditions who weren’t lucky enough to get coverage through their employers were in a dire situation: Insurance companies either didn’t cover them or charged them exorbitant premiums. I know some people who stayed in the jobs they hated because they had health problems and were afraid of losing their insurance. Insurers are now prohibited from discriminating based on medical history, and this, coupled with subsidies that keep premiums low, has given Americans much-needed reassurance.
But what about the costs? Was Obamacare a financial disaster? Calculating the true cost of the ACA is complicated, in part because while the law provided large subsidies, it also included many measures to reduce health care costs. What surprises me is that federal health care spending has increased much more slowly since the passage of the ACA than virtually everyone expected.
For example, in its 2010 Long-Term Fiscal Outlook Report, the Budget Office projected that spending on key health programs would be between 7.4% and 7.9% of gross domestic product in 2023. He now predicts that this figure will only be 5.8%. Predictions that Obamacare would lead to a huge increase in spending have proven completely wrong.
So why is Trump still determined to end a program that has improved the lives of many people without breaking the budget? Much of this undoubtedly reflects the modern Republican Party’s general hostility to any program that helps less fortunate Americans.
But it’s hard to resist the idea that there’s something personal at stake, too. In his rambling speeches, Trump often gives the impression that he believes Barack Obama is still president. Regardless of whether Trump is genuinely confused about it, the Affordable Care Act was Obama’s greatest achievement. And everyone keeps calling for the Obamacare program. Is Trump so vain and petty that he is depriving millions of people of health care just to tear down his predecessor’s legacy? You tell me.
Paul Krugman is a Nobel Prize winner in economics. © The New York Times, 2023. Translation from News Clips.
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