Donald Trump hasn't talked much about politics this election cycle, except for some vague claims that he'll bring back low unemployment and low inflation anyway, which, by the way, has already happened. (Unemployment has been at or below 4% for nearly two years. Thursday's consumer spending report showed the Federal Reserve's preferred core inflation gauge approaching its 2% target. The former president seems to devote most of his energy to the prospect of taking revenge on his political adversaries, whom he promises to "eradicate" like a "plague."
However, in recent days, Trump has declared that, if he returns to the White House, he will try once again to kill the Affordable Care Act (ACA), the reform that led to a significant decline in the number of uninsured Americans.
What is the reason for this new attack? "Obamacare sucks!" 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, 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 bullshit? Can we believe Trump's promise to deliver something much better?
On this last question, remember that Trump and his allies came very close to ending the ACA in 2017 and replacing it with their own plan, and the Congressional Budget Office conducted a detailed analysis of the legislation that nearly passed. The Bureau predicted that by 2026, under the Republican bill, 32 million people would have lost health insurance and premiums paid by those who buy their own insurance (rather than getting it through their companies) would have doubled.
There is, as far as I know, no reason to believe that Trump has come up with a better plan since then, or that a reanalysis of his project would be less depressing.
But while ending Obamacare would have dire consequences, how well has the ACA actually worked?
The main point in favor of Obamacare is simply the fact that the number of uninsured Americans dropped dramatically after the law went into effect. We are still a long way from the more or less universal coverage offered by all other advanced countries, and the health insurance that some Americans have is still inadequate, but the gap has narrowed a lot.
Now, Obamacare's success hasn't been exactly what its proponents had hoped for. Most of the original debate on reform focused on creating markets where individuals could buy their own insurance. And indeed, that "non-group" coverage has expanded, but most of the increase in coverage has been due to Medicaid expansion (which would be even greater if some red states, such as Texas and Florida, did not continue to refuse to accept federal funds to help their own residents).
Still, success is success, even if it hasn't been what you predicted. And I would argue that insurance marketplaces bring significant benefits that go beyond the number of people currently using them. Before Obamacare, Americans with pre-existing conditions who weren't lucky enough to get coverage through their companies were in dire straits: Insurers didn't cover them or charged them exorbitant premiums. I've known some people who stayed in jobs they hated because they had health issues and feared losing 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 security.
But what about the costs? Was Obamacare a fiscal disaster? Calculating the actual costs of the ACA is complicated, in part because the law, while offering extensive subsidies, also included many measures aimed at reducing health care costs. What I find surprising is that federal spending on health care since the passage of the ACA has grown much more slowly than virtually everyone anticipated.
For example, in its 2010 report on the long-term budget outlook, the Budget Office projected that spending on major health programmes in 2023 would be between 7.4% and 7.9% of gross domestic product. It now forecasts that figure to be just 5.8%. Predictions that Obamacare would lead to runaway spending have turned out to be completely wrong.
So why is Trump still hell-bent on ending a program that has improved many lives without blowing the budget? Much of it, no doubt, reflects the general hostility of the modern Republican Party to any program that helps less fortunate Americans.
But it's hard to resist the idea that there's also something personal at stake. In his rambling speeches, Trump often gives the impression of believing that Barack Obama is still the president. Regardless of whether Trump is really confused about it, the Affordable Care Act was Obama's greatest achievement. And everyone keeps calling the program Obamacare. Is Trump so vain and petty as to take health care away from millions of people simply to undo his predecessor's legacy? You tell me.
Paul Krugman is a Nobel laureate in economics. © The New York Times, 2023. Translation of News Clips.
Follow all the information from Economía y Negocios on Facebook and X, or in our weekly newsletter
Subscribe to continue reading
Read without limits
I'm already a subscriber