Trump ben­e­fits from ills of Oba­macare

Cecil Whig - - FRONT PAGE - Michael Ger­son

— In the event of a vic­tory by Don­ald Trump in Novem­ber, po­lit­i­cal anal­y­sis will take on a foren­sic cast. How did es­tab­lish­ment pol­i­tics — first in the GOP pri­maries, then in a na­tional elec­torate — come to die?

Pri­vately, Democrats would re­gret their se­lec­tion of one of the most joy­less, least vi­sion­ary pres­i­den­tial can­di­dates of re­cent mem­ory. Pub­licly, they would blame trends that in­cu­bated within the Repub­li­can coali­tion, par­tic­u­larly a na­tivism in­cited by con­ser­va­tive me­dia and car­ried by a can­di­date — al­ter­nately cyn­i­cal and fright­en­ing — who is un­bound by truth, con­sis­tency or de­cency.

And, by God, they would be right in much of this critique. But this is re­ally only ad­e­quate to ex­plain how Trump seized a pow­er­ful plu­ral­ity of Repub­li­can pri­mary vot­ers. Stip­u­lat­ing a Trump vic­tory, Democrats could not dis­miss the win­ning coali­tion as an ocean of de­plorables. If Hil­lary Clin­ton loses, it will be be­cause she was the re­sume can­di­date in an anti-es­tab­lish­ment wave elec­tion. It will be be­cause she ar­gued that Amer­ica, with in­cre­men­tal corrections, is on the right track set by Barack Obama, while more than 60 per­cent of Amer­i­cans be­lieve the coun­try is off course, and have thought so for years.

If Trump suc­ceeds in es­sen­tially turn­ing out the midterm elec­torate in a pres­i­den­tial year — whiter, older, an­grier — the main, mo­ti­vat­ing is­sue may be the re­stric­tion of im­mi­gra­tion. But the gen­eral at­mos­phere of con­tempt for govern­ment that helps Trump — of dis­dain for the weak­ness and in­com­pe­tence of the po­lit­i­cal class — is due to the Af­ford­able Care Act.

More than six years after be­com­ing law, the proud­est ac­com­plish­ment of the Obama years is a po­lit­i­cal bur­den for Democrats. A re­cent Gallup poll found that a ma­jor­ity of Amer­i­cans dis­ap­prove of Oba­macare. The deeper con­cern for Clin­ton and her party comes deeper in the num­bers. Only 18 per­cent of Amer­i­cans be­lieve the Af­ford­able Care Act has helped their fam­i­lies; 80 per­cent say it is has hurt or had no ef­fect. A higher pro­por­tion of Amer­i­cans be­lieve the fed­eral govern­ment was be­hind the 9/11 at­tacks than be­lieve it has helped them through Oba­macare.

The Af­ford­able Care Act has come to em­body and sum­ma­rize de­clin­ing trust in po­lit­i­cal in­sti­tu­tions. The law was passed in a par­ti­san march, with­out a sin­gle Repub­li­can vote. The sys­tem’s


fed­eral web­site was launched with a se­ries of glitches and fail­ures that still make “health­” a by­word for pub­lic in­com­pe­tence in the com­puter age. Only 17 state-based ex­changes (16 states and the District of Columbia) were cre­ated. Of that num­ber, four (Hawaii, New Mex­ico, Ne­vada and Ore­gon) have failed, and Ken­tucky’s will be dis­man­tled/shut­tered next year. Ac­cord­ing to a re­cent re­port by the House En­ergy and Com­merce Com­mit­tee, the Ore­gon ex­change re­ceived $305 mil­lion in fed­eral funds but never cre­ated a func­tional web­site or en­rolled a sin­gle per­son in pri­vate in­sur­ance on­line.

Pre­mium costs in the ex­changes in­creased about 12 per­cent na­tion­wide from 2015 to 2016. Cur­rent rates are now be­ing fi­nal­ized, but it looks like the in­crease from 2016 to 2017 will be dou­ble that. “This sug­gests that the sys­tem is not find­ing its bal­ance or ap­proach­ing sta­bil­ity but ac­tu­ally get­ting more un­sta­ble,” says Yuval Levin of Na­tional Af­fairs. “Peo­ple just aren’t find­ing the in­sur­ance of­fer­ings in the ex­changes at­trac­tive, and the law leaves in­sur­ers very few op­tions for im­prov­ing them. The in­sur­ers are in­creas­ingly flee­ing — a third of coun­ties in the U.S. will have only one option in the ex­changes next year. And there isn’t much the ad­min­is­tra­tion can do about it.”

Be­cause of a poi­soned leg­isla­tive at­mos­phere, there is no prospect of leg­isla­tive fixes to an un­sta­ble and per­haps un­sus­tain­able sys­tem of health ex­changes. So Pres­i­dent Obama is left to call a “Mil­len­nial Out­reach and En­gage­ment Sum­mit” later this month, urg­ing the kids to buy health in­sur­ance and right Oba­macare’s list­ing de­mo­graphic ship. It is less a so­lu­tion than a con­ces­sion of help­less­ness.

Trump calls at­ten­tion to these fail­ures, while of­fer­ing (as usual) an ap­par­ently ran­dom col­lec­tion of half-baked poli­cies and base­less pledges (“ev­ery­body’s got to be cov­ered”) as an al­ter­na­tive. There is no rea­son to trust Trump on the health is­sue; but there is plenty of rea­son to dis­trust Demo­cratic lead­er­ship. No is­sue — none — has gone fur­ther to con­vey the im­pres­sion of pub­lic in­com­pe­tence that feeds Trump­ism.

If Trump wins, there will be a host of rea­sons, but one will be this dra­matic fail­ure of lib­eral gov­er­nance.

Michael Ger­son is a syn­di­cated colum­nist. Con­tact him at michael­ger­son@wash­

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