In 2010, during the signing of the Affordable Care Act (ACA), also known as Obamacare, Joe Biden, vice president of the United States at the time, was caught on an open microphone telling President Barack Obama that the law was “a great thing.” Okay, actually he said another word in the middle. In any case, Biden was right. One of his greatest unsung accomplishments—it's amazing how many Americans believe he is an unusually productive president who hasn't done much—is that Biden has turned the Obamacare into an even bigger thing, such that it is improving the lives of millions of Americans.
As you may have noticed, Biden has been putting up some good numbers lately. He economic growth continues apace, defying widespread recession predictions, while unemployment remains near its lowest level in 50 years. Inflation, especially using the Fed's preferred gauge, has fallen closer to the central bank's target. And the stock market continues to record new highs.
Oh, murders have plummeted, and violent crime overall may hit its lowest level in 50 years.
Biden deserves some political reward for this good news, considering that Donald Trump and many in his party predicted an economic and social disaster if he was elected, and that Republicans, in general, continue to talk as if there was high inflation in the United States. and uncontrolled crime. (Trump, of course, has been calling out the good employment numbers as bogus. 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 do not 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, which has been driven in part by his spending policies, but the rapid disinflation of 2023 is mainly a reflection of a country trying to work its way out of the persistent disruptions that caused the covid pandemic. The same can be said for the decline in violent crimes.
However, there is one area in which presidents do exercise great influence: healthcare. He Obamacare led to vast improvements in health insurance coverage when it went into full effect in 2014. Trump attempted to repeal the Obamacare in 2017, but failed, and the reaction to that attempt helped Democrats take control of the House of Representatives the following year. Trump, however, was able to partially erode the program, for example by cutting funding for “navigators” who help people enroll.
This erosion has now been definitively corrected. The Biden Administration just announced that 21 million people have signed up for coverage through 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 this progress, unlike other good things happening, is entirely due to Biden, who restored help to people seeking health coverage and improved a key aspect of the system. The system of Obamacare It's not simple. Many of the health economists I know would have preferred something like Medicare for All, if it had been politically feasible. But it wasn't and still isn't, so what we have in its place is a kind of Rube Goldberg machine, a hodgepodge of gadgets designed to expand access to healthcare by minimally altering existing arrangements. Those markets, where insurers are prohibited from discriminating against people with pre-existing conditions and buyers receive subsidies to help them pay premiums, are a key part of the system.
It's not an ideal mechanism, but it's much better than nothing. At first, however, the markets were under-resourced: aid was too low, so many people still had problems paying insurance premiums, and there was also a limit, since aid was only available to people that were below 400% of the poverty line.
Biden, as part of the Inflation Reduction Act of 2022, largely resolved these problems, reducing maximum premium payments (net of subsidies) and eliminating the 400% cap. The result is that health insurance coverage is considerably more affordable, especially for middle-income Americans who previously earned too much to qualify for aid. Hence the increase in registrations in the market.
I don't know if healthcare will be an important issue in the 2024 elections. But it should be.
Biden has made health coverage more accessible and affordable for millions of Americans.
However, if Trump wins, he will try again to end the Obamacare; she has already said it, and it is very possible that this time she will succeed. She 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 Trump's health plan would increase the number of uninsured by 32 million over a decade; that figure would probably be higher today.
So, one more reminder of how much is at stake this year.
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