In 2010, during the signing of the Affordable Care Act (also known as Obamacare), then-Vice President Joe Biden told President Barack Obama on the microphone that the bill was a “big deal.” Caught. Yes, there was actually another word in the middle. Biden was right anyway.
And one of President Biden's lesser-known accomplishments—it's surprising how many Americans believe that an extraordinarily productive president hasn't done much at all—is that President Biden's Obamacare is making bigger policies and improving the lives of millions of Americans.
As you may have noticed, as many Americans seem to have finally realized, Biden has been doing pretty well lately. Economic growth remains on track, defying widespread predictions of a recession, while unemployment is near a 50-year low. Inflation is moving closer to the Fed's target, especially when using the Fed's recommended metrics. The stock market continues to set new highs.
Oh, and murders are plummeting, and overall violent crime could reach yet another 50-year low.
Donald Trump and many in his party predict economic and social disaster if Biden is elected, and Republicans in general still speak as if America is suffering from high inflation and rampant crime. Given that, Biden probably deserves some political reward for this good news. . (Of course, Trump dismisses the positive employment numbers as fake. Just wait until you hear about the drop in crime.)
It's less clear how much of the good news on these fronts is due to Biden's policies. The president doesn't control the stock market. In general, they have a smaller impact on the economy than many believe. I would like to give Mr. Biden some credit for the strength of the economy, and while that is in part due to his spending policies, the rapid elimination of inflation in 2023 is largely due to the nation's ability to overcome the coronavirus pandemic. This reflects the country's efforts to emerge from the prolonged disruption caused by the pandemic. Perhaps the same is true for the surge in violent crime.
But one area where the president will make major changes is health care. Obamacare was passed, although it really should be called Pelosicare because Nancy Pelosi (no matter what Trump thinks, she is not the same person as Nikki Haley) played a key role in getting it passed. At that time, the scope of medical insurance coverage expanded significantly. It was fully implemented in 2014.
Trump's failed attempt to repeal Obamacare in 2017 led to a backlash that gave Democrats control of the House of Representatives the following year. Nevertheless, Mr. Trump was able to cause some erosion in the program, for example by cutting funding to “navigators” that help people register.
That erosion has now been definitively reversed. The Biden administration just announced that 21 million people have enrolled in insurance through the ACA health insurance marketplaces, up from about 12 million on the eve of the pandemic. The United States has yet to achieve the universal health care standard of other wealthy countries, but some states, such as Massachusetts and New York, are getting closer.
And unlike some other good things, this gain was entirely due to Biden, who restored aid to people seeking health care and strengthened key aspects of the system.
Obamacare is not simple. Many health economists I know would want a system like Medicare for All if it were politically feasible. But it wasn't, and it wasn't, so what we have instead is a kind of Rube Goldberg device, a way to increase access to health care with minimal disruption to existing arrangements. It is a combination of gadgets designed to expand access. These markets, where insurance companies are prohibited from discriminating against people with pre-existing conditions and buyers receive subsidies to help pay premiums, are a key part of the system.
This isn't an ideal mechanism, but it's much better than doing nothing. However, there was originally a lack of funds in the market. Many people still struggle to pay their premiums because the subsidy is too low, and the subsidy has also been discontinued, making it only available to individuals up to his 400% of the poverty line.
As part of the Inflation Control Act of 2022, Biden largely solved these problems by lowering the cap on premium payments (net of subsidies) and eliminating the 400% cliff. As a result, health insurance coverage will become much more affordable, especially for middle-income Americans who previously earned too much to qualify for subsidies. As a result, registrations on the marketplace are rapidly increasing.
It is unclear whether healthcare will become a major issue in the 2024 election. But it should be.
Biden has made health insurance more accessible and affordable for millions of Americans.
But if Trump wins, he will try again to repeal Obamacare. He's said the same thing before, so he's very likely to succeed this time. He promises to replace it with something “much better.” I guess this depends on your definition of “better”. In 2017, the Congressional Budget Office estimated that President Trump's health care plan would increase the number of uninsured people by 32 million people within 10 years. Today the number is probably much higher.
So let me remind you once again how much is at stake this year.