In 2010, during the signing of the Affordable Care Act (ACA), also known as Obamacare, Joe Biden, then Vice President of the United States, was caught on an open microphone telling President Barack Obama that the law was “a big one “Law” is a thing.” Okay, actually he said another word in the middle. In any case, Biden was right. One of his greatest unsung achievements – it's amazing how many Americans consider him an unusually productive president who didn't do much – is that Biden has made Obamacare an even bigger deal, so much so that it improves the lives of millions of Americans.
As you may have noticed, Biden has been putting up some good numbers lately. Economic growth continues apace despite widespread recession predictions, while unemployment remains near its lowest level in 50 years. Inflation, particularly by the Fed's preferred measure, has fallen closer to the central bank's target. And the stock market continues to record new highs.
Oh, murders are down sharply, and overall violent crime may be at its lowest level in 50 years.
Biden deserves a political reward for this good news, considering that Donald Trump and many in his party have predicted economic and social catastrophe if he were elected, and that Republicans generally continue to talk as if there is such a thing United States high inflation. and uncontrolled crime. (Trump, of course, called the good employment numbers a hoax. Wait until he hears about the drop in crime.)
What's less clear is how much of the good news on these fronts can be attributed to Biden's policies. Presidents definitely don't control the stock market. In general, they have less influence on the economy than many believe; I would give Biden some credit for the strength of the economy, due in part to his spending policies, but the rapid decline in inflation in 2023 is mostly a reflection of a country trying to emerge from the ongoing disruptions caused by the Covid pandemic. The same applies to the decline in violent crime.
However, there is one area where presidents wield great influence: healthcare. Obamacare led to huge improvements in health insurance coverage when it took full effect in 2014. Trump tried to repeal Obamacare in 2017 but failed, and the backlash to that attempt helped Democrats gain control of the House of Representatives the following year. But Trump was able to partially undermine the program, for example by cutting funding for “navigators” who help people enroll.
This erosion has now finally been eliminated. The Biden administration just announced that 21 million people have signed up for the ACA's health insurance marketplaces, up from about 12 million on the eve of the pandemic. The United States does not yet have the universal coverage common in other wealthy countries, but some states such as Massachusetts and New York have come close.
And that progress, unlike other good things, is entirely thanks to Biden, who has restored help for people seeking health insurance and improved a key aspect of the system. The Obamacare system is not easy. Many of the health economists I know would have wanted something like Medicare for All if it had been politically feasible. But that wasn't the case and still isn't, so in its place we have a kind of Rube Goldberg machine, a collection of gadgets designed to expand access to health care through minimal change to existing regulations. A central part of the system are those markets where insurers are prohibited from discriminating against people with pre-existing conditions and where buyers receive subsidies to help them pay premiums.
It's not an ideal mechanism, but much better than nothing. However, markets were initially underfunded: aid was too low, so many people still had problems paying insurance premiums, and there was also a limit, as aid was only available to people living below 400% of the poverty line.
Biden largely addressed these issues as part of the Inflation Reduction Act of 2022, reducing maximum premium payments (net of subsidies) and eliminating the 400% cap. The result is that health insurance coverage is significantly cheaper, particularly for middle-income Americans who previously earned too much to qualify for welfare. Hence the increase in registrations in the market.
I don't know if health care will be a major issue in the 2024 election. But it should be.
Biden has made health care more accessible and affordable for millions of Americans.
However, if Trump wins, he will try again to end Obamacare; He has already said it, and it is very likely that he will succeed this time. He promises to replace it with something “much better.” I guess that depends on your definition of “better”: In 2017, the Congressional Budget Office estimated that Trump’s health care plan would increase the number of uninsured by 32 million within a decade; this value would probably be higher today.
So another reminder of how much is at stake this year.
Paul Krugman He is a Nobel Prize winner in economics.
© The New York Times, 2024
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