Last night’s presidential debate featured an extended back and forth between Donald Trump and Hillary Clinton about Obamacare. And what is showed was that no one really likes it—and no one has a plan to fix it.
The exchange started when the candidates were asked about the law by an undecided voter who asked about the health law. “Premiums have gone up. Deductibles have gone up. Copays have gone up. Prescriptions have gone up and the coverage has gone down.” Obamacare, he said, was “not affordable.”
Hillary Clinton responded first. After caveating that she would not repeal the law, she said, “I’m going to fix it. Because I agree with you. Premiums have gotten too high. Copay, deductibles, prescription drug costs.”
It’s more than a little telling that this is how the candidate who is ostensibly the pro-Obamacare candidate is responding to voter concerns about the law: by agreeing with their criticisms, and agreeing that it’s not working.
In the same response, Clinton also defended parts of the law—including its rules restricting insurance companies from denying coverage based on preexisting conditions, and said she had “laid out a series of options we can try”—try!—”to get those costs down.”
But at no point did she make even a cursory attempt to explain what those options were. And her first response, after rejecting the option of full repeal, was to make many of the same critiques of the law that its opponents have been making for years.
Clinton, who has recently avoided talking much about Obamacare on the campaign trail, isn’t really defending Obamacare. She’s defending selected provisions of the law—while gesturing to supposed fixes that she does not describe.
Donald Trump, meanwhile, said that he would repeal and replace the law with—well, he hasn’t quite figured that out yet. “We have to repeal it. And replace it. With something absolutely much less expensive. And something that works.” That’s…not really a plan.
Trump did go on to offer one kinda-sorta policy idea, arguing that, “We have to get rid of the lines around the state. Artificial lines, where we stop insurance companies from coming in and competing because they want and President Obama and whoever was working on it, they want to leave those lines because that gives the insurance companies essentially monopolies. We want competition.”
This description is incoherent enough that I’m not entirely sure Trump himself knows precisely what he’s talking about. The “lines around the states” bit is just a catchphrase that he resorts to whenever he’s talking about the health law, as he did throughout the GOP primary debates earlier this year. In one telling instance, he went back and forth with Sen. Marco Rubio, who pressed him to explain what he meant when he said he wanted to get rid of the lines around the states, and he couldn’t elaborate. Trump’s ignorance about policy is so deep that it extends to his own policy proposals, which means that even if he happens to stumble upon a good policy idea, he can’t be trusted to implement it effectively.
As it happens, Trump does appear to have stumbled on an idea that is not half bad. Being charitable, it seems as if he is saying that individuals should be allowed to buy health insurance across state lines. Alone, this is far from sufficient to fix the health care system’s problems. But it might help reduce the cost of health insurance by letting people buy from states where insurers are subject to fewer expensive coverage mandates. In theory, those who live in states with lots of mandates, and expensive coverage to match, could buy from states with fewer mandates, making insurance more flexible and more affordable.
This is where Trump’s deep disdain for policy expertise becomes a factor. In the health care reform plan that Trump released earlier this year, he proposed allowing the purchase of health insurance across state lines “as long as the plan purchased complies with state requirements.”
In other words, Trump would require that insurers comply with insurance mandates in the states where the coverage is being sold—defeating the entire purpose of allowing insurance to be sold across state lines. Trump’s garbled explanation of his one policy idea strongly suggests he doesn’t understand what he’s talking about; his written-out proposal proves it.
As with much of the debate, the exchange was both infuriating and revealing. The state of the Obamacare debate in the presidential race is a pretty decent gauge of the state of the Obamacare debate nationally: No one really likes the law as it is—and no one has a plan to fix it.