Hillary Clinton hasn't spent much time talking about Obamacare on the campaign trail recently. But Bill Clinton has. And he thinks the law's insurance scheme amounts to a "crazy system" that doesn't serve small business owners and people who work long hours but make just a little bit too much money to qualify for federal aid.
At a rally in Michigan yesterday, Bill was blunt in describing his frustrations with the law's coverage mechanisms.
"So you've got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It's the craziest thing in the world," the former president said, according to CNN.
Describing the incentives the law creates for insurers to jack up health insurance rates, he said that, "It doesn't make sense. The insurance model doesn't work here."
Clinton also pointed out that the people hit hardest are those who make just enough money that they don't qualify for the law's most generous subsidies.
"The current system works fine if you're eligible for Medicaid, if you're a lower-income working person, if you're already on Medicare, or if you get enough subsidies on a modest income that you can afford your health care," he said. "But 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."
No, Bill Clinton hasn't suddenly turned into an opponent of Obamacare, or a critic of government involvement in health care policy. In his remarks, he also touted Hillary Clinton's still somewhat vague proposal to let more people buy into Medicare. He's not going to speak up in defense of the next GOP repeal vote.
But he was accurately describing some of the problems with the law, which provides health insurance subsidies for people making up to 400 percent of the poverty line, but provides an extra boost for lower-income individuals whose earnings fall below 250 percent of the poverty line.
Those at the lower end of the earnings spectrum have been relatively shielded from premium hikes that have occurred in the individual market under the law, yet people who earn just above those thresholds—and particularly those who earn just enough to get no subsidies at all—have been walloped by premium hikes over the past few years, and are set to get hit with significant increases going into 2017.
As The New York Times noted yesterday in a look at the law's ongoing troubles, "enrollment figures suggest that higher-income people who receive smaller subsidies or none at all have not seen insurance as such a bargain," and sign-ups have lagged as a result. According to a July report from the Commonwealth Fund, many people who don't get subsidies end up spending an outsized amount of their income on health coverage, and slightly more than half of those who get coverage under the law don't find their plans affordable.
As with Hillary Clinton's relative silence about the law, Bill Clinton's riff is plenty revealing.
He has always been unusually gifted at communicating, in clear and accessible language, not only how policy functions but what the lived experience of those who interact with a law or program is like. This is no exception. In typical fashion, he rather succinctly how the policy is designed and what its problems turned out to be, as well as the type of person who is most likely to experience those problems. (You might say he feels the pain of Obamacare.)
He's not lamely touting the law's virtues and successes while pretending that its problems don't exist, or trying to downplay them. He's digging into the frustrations that people have with the law, and explaining why it's working—or, in this case, not working—the way it is.
If Obamacare were an obvious success—one that not only worked but widely felt like it was working—you can bet that Bill Clinton would be singing its praises.
But he's not. Instead, he's focusing on its problems, making the case that it's a poorly thought out law that doesn't do a good job of serving many of the people it was supposed to help.
It's a pretty clear sign that Obamacare is broken, and that no matter who becomes president, the health care reform law will itself be in need of some serious reforms.