Donald Trump has barely mentioned Obamacare in his race against Hillary Clinton, but should he choose to leverage the healthcare law in the second presidential debate Sunday, he would have some strong attack points.
President Obama’s Affordable Care Act has expanded coverage to millions of Americans, many of them for the first time, yet the law’s new insurance marketplaces are struggling under soaring prices and diminishing competition in many states.
Clinton never voted for the law, as it was passed after she left the Senate, and she says parts of it need to be improved. Yet she supports the law overall, giving Trump a political pathway to blame her for its more unpopular provisions and shortcomings.
Had just about any other Republican won the presidential nomination, namely Sens. Ted Cruz and Marco Rubio, they likely would be pounding Clinton daily over rising costs and insurance cancellations.
Obamacare may be more likely to come up Sunday night than during the first debate, as the debate will be conducted town hall-style with questions from viewers. And Trump may be more likely to talk about it, after his campaign manager Kellyanne Conway said last week she thinks it’s a ripe issue.
“In terms of healthcare, I think it’s a huge issue that’s been left on the table in these debates,” Conway said Wednesday on MSNBC’s “Morning Joe.”
Here are four ways Trump could attack Clinton on Obamacare:
1. Bill Clinton’s faux pas
When the former president referred to Obamacare as a “crazy system” early last week, Republicans pounced. The Republican National Committee is sending mailers to battleground states quoting Clinton’s comments and adding “Bill Clinton finally tells the truth … and it’s not going to help Hillary.”
Clinton wasn’t trying to label the entire healthcare law as crazy. Instead, he was raising concerns about a part of the measure that has troubled others as well — the ongoing affordability problems for people who need to buy marketplace plans but earn too much to qualify for subsidies.
“The people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies,” Clinton said.
But it could give Trump a prime opportunity to put Hillary on the defensive, if he tries to force her to explain her husband’s comments.
2. Obamacare premiums
Health insurance premiums had been rising for a long time, way before the healthcare law was ever passed. But some of the increases in the new marketplaces are unprecedented even for the health industry.
This week, Oklahoma announced plans will be an average of 75 percent more expensive next year. And in 15 states, average prices would rise by more than 30 percent, if insurers follow through with their proposals.
Some Republicans in key Senate races have been trying to blame their Democratic opponents for the sharp increases. If Trump tries to do the same with Clinton, it could be an effective line of attack.
3. Obamacare competition
There’s similarly bad marketplace news on the competition front. While just 4 percent of insurance rating areas had just one insurer this year, it could be as high as 36 percent in 2017, according to the firm Avalere.
Another 19 percent may have just two insurers, meaning that shoppers in more than half the rating areas will have an extremely limited number of choices. And some customers are struggling to find marketplace plans with provider networks that include their preferred doctors and hospitals.
4. Co-op failures
When the Affordable Care Act was passed in 2010, it set up 23 nonprofit health plans to provide additional competition in the marketplaces. But only six of these Consumer Oriented and Operated Health Plans, known as co-ops, are still operating, as the others folded due to massive financial shortfalls.
Most recently, Maryland announced that its co-op will be turned into a for-profit company to continue operating, leaving just five co-ops running as intended.
Republicans in Congress have used the widespread co-op failures as a major argument against the healthcare law, holding hearings on the subject and trying to highlight the federal tax dollars that were spent on them.
The subject of co-ops can be a little wonky, and Trump isn’t known for much discussion of policy details, but it could be another way for him to put Clinton in an uncomfortable position.
