Bill Clinton Calls For Allowing People At Subsidy Cutoff To Buy In To Medicare Or Medicaid At An Affordable Rate

Bill Clinton: “Figure Out An Affordable Rate” To “Let People Buy In To Medicare Or Medicaid.” From the October 3 Hillary Clinton campaign rally in Flint, Michigan:

Now the next thing is, we got to figure out now what to do on health care. Her opponent said, ‘Oh, just repeal it all. The market will take care of it.’ That didn’t work out very well for us, did it? We wound up with the most expensive system in the world and we insured the smallest percentage of people. On the other hand, 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.

But the people that are getting killed in this deal are small businesspeople and individuals who make just a little too much to get any of these subsidies. Why? Because they’re not organized, they don’t have any bargaining power with insurance companies, and they’re getting whacked. So you’ve got this crazy system where all of a sudden, 25 million more people have health care and then the people that 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 so here’s the simplest thing ― you raise your hands, you think about it ― here’s the simplest thing: figure out an affordable rate and let people use that ― something that won’t undermine your quality of life, won’t interfere with your ability to make expenses, won’t interfere with your ability to save money for your kid’s college education. And let people buy in to Medicare or Medicaid.

Here’s why: you can let people buy in for just a little bit because unlike where you are now, if you were on the other side of this, if you were an insurer, you’d say, ‘Gosh, I only got 2,000 people in this little pool. Eighty percent of insurance costs every year come from 20 percent of the people. If I get unlucky in the pool, I’ll lose money.’ So they overcharge you just to make sure, and on good years, they just make a whopping profit from the people who are least able to pay it.

It doesn’t make any sense. The insurance model doesn’t work here; it’s not like life insurance, it’s not like casualties, it’s not like predicting flooding. It doesn’t work. So Hillary believes we should simply let people who are above the line for getting these subsidies have access to affordable entry into the Medicare and Medicaid programs. They’ll all be covered, it will not hurt the program, we will not lose a lot of money. And we ought to do it. [Transcript of former President Bill Clinton speaking at a Hillary Clinton for President rally in Flint, Michigan, 10/3/15, via The Huffington Post]

Trump Campaign Claims Bill Clinton “Absolutely Trashed” “Crazy” Obamacare

Donald Trump: Bill Clinton “Absolutely Trashed President Obama’s Signature Legislation.” At an October 4 campaign rally, Republican presidential nominee Donald Trump said former President Bill Clinton of “absolutely trashed President Obama’s signature legislation.” Trump claimed that Clinton “was also reiterating what he has said throughout his campaign,” doubling down that he would repeal and replace Obamacare. From an October 4 Los Angeles Times article:

“He absolutely trashed President Obama’s signature legislation,” Trump told thousands of supporters in Prescott Valley, a desert town 90 minutes north of Phoenix. “I’ll bet he went through hell last night. Can you imagine? Can you imagine? Can you imagine what he went through after making that statement? He went through hell.

“Honestly, there have been many nights when he has gone through hell with Hillary Clinton,” Trump added, continuing his recent line of attacks on the Clintons' marriage. "I want to thank him honestly for being honest.”

Trump said that Bill Clinton was also reiterating what he has said throughout his campaign. Trump repeated his pledge that he would, on his first day as president, ask Congress to send him a bill to repeal and replace Obamacare. [Los Angeles Times, 10/4/16]

Trump: “Wow, Did You Just Hear Bill Clinton’s Statement On How Bad ObamaCare Is. Hillary Not Happy. As I Have Been Saying, REPEAL AND REPLACE!”

Wow, did you just hear Bill Clinton's statement on how bad ObamaCare is. Hillary not happy. As I have been saying, REPEAL AND REPLACE!

— Donald J. Trump (@realDonaldTrump) October 4, 2016

[Twitter, 10/4/16]

Mike Pence: “Even President Bill Clinton Calls Obamacare A Crazy Plan.” During the October 4 vice presidential debate, Republican vice presidential nominee Mike Pence asserted, “Even President Bill Clinton calls Obamacare a crazy plan.” Pence continued, criticizing Democratic presidential running mates Hillary Clinton and Tim Kaine’s plan “to build on Obamacare.” [FoxNews.com, 10/4/16]

Media Outlets Explain Trump Took Clinton’s Comments Out Of Context

NY Mag: Trump’s Characterization Of Bill Clinton’s Comments Lack Context That Shows He Supports Keeping And Enhancing ACA, Not Repealing It. New York magazine’s Eric Levitz debunked the Trump campaign’s characterization of Clinton’s remarks as “Democrats ... coming to realize just what bad public policy ObamaCare really is,” explaining that “when you look at Clinton’s quote in context, you see that this is not what he realized at all.” Levitz wrote that “Before Clinton started talking about the people our ‘crazy system’ is failing, he made it clear that said system is still better than the one Obama inherited, which Donald Trump would have us return to,” and thus “was advocating for Hillary Clinton’s proposed reforms to the ACA, not for the law’s repeal.” From the October 4 New York magazine article:

It sounds like Bill Clinton is auditioning for a GOP attack ad.

[...]

“With premiums continuing to skyrocket, state insurance markets collapsing and businesses struggling to comply with its job-killing mandates, even Democrats like Bill Clinton are coming to realize just what bad public policy ObamaCare really is,” Trump spokesperson Jason Miller wrote in a statement.

But, as the Huffington Post notes, when you look at Clinton’s quote in context, you see that this is not what he realized at all.

Before Clinton started talking about the people our “crazy system” is failing, he made it clear that said system is still better than the one Obama inherited, which Donald Trump would have us return to[.]

[...]

Thus, the former president was advocating for Hillary Clinton’s proposed reforms to the ACA, not for the law’s repeal.

“Hillary believes we should simply let people who are above the line for getting these subsidies have access to affordable entry into the Medicare and Medicaid programs,” Clinton went on to say. “They’ll all be covered, it will not hurt the program, we will not lose a lot of money. And we ought to do it.”

In a separate speech in Pontiac Monday, Bill made his view of Obamacare more explicit, saying, “I think [Obama’s] health care bill has been a remarkable success for 25 million people, and for getting rid of pre-existing conditions, and the problems with it show why the president was right to recommend a public option in the first place.” [New York, 10/4/16]

Bill Clinton Acknowledged A Central Problem Other Democrats Have Also Acknowledged

Huff. Post: Bill Clinton’s Accurate Assessment Of The ACA “Mirrors Hillary Clinton’s And Obama’s Own.” Huffington Post’s Jeffrey Young explained that focusing on Clinton’s “craziest thing in the world” quotation “doesn’t fully portray Bill Clinton’s argument for keeping the Affordable Care Act …  and enhancing it with policies proposed by Hillary Clinton’s campaign.” Young noted that “Clinton accurately described the status quo as one where people who get health coverage from government programs like Medicare and Medicaid, and people who are eligible for subsidies under the Affordable Care Act, are well-covered ― but where people who earn too much for financial assistance can face high premiums.” From the October 4 Huffington Post article:

A CNN report published Tuesday begins this way:

Bill Clinton criticized President Barack Obama’s signature policy reform while on the stump for his wife, Democratic presidential nominee Hillary Clinton, calling Obamacare “the craziest thing in the world.”

That quotation, while accurate, doesn’t fully portray Bill Clinton’s argument for keeping the Affordable Care Act ― which has extended health coverage to 20 million people and cut the uninsured rate to a historic low ― and enhancing it with policies proposed by Hillary Clinton’s campaign.

Bill Clinton accurately described the status quo as one where people who get health coverage from government programs like Medicare and Medicaid, and people who are eligible for subsidies under the Affordable Care Act, are well-covered ― but where people who earn too much for financial assistance can face high premiums.

[...]

Despite its characterization in the CNN report, Bill Clinton’s assessment of the health care system and the Affordable Care Act mirrors Hillary Clinton’s and Obama’s own. [The Huffington Post, 10/4/16]

Modern Health Care: Bill Clinton’s Comments “Were More Or Less Consistent” With Hillary Clinton’s Proposals To Enhance The ACA.  A blog post on ModernHealthCare.com explained that Clinton’s comments “were more or less consistent with [Democratic presidential nominee Hillary Clinton’s] proposals to offer additional tax credits for healthcare costs and establish out-of-pocket spending caps for prescription drugs.” University of Chicago health policy expert Harold Pollack explained that “Hillary Clinton's proposals to expand the ACA's premium subsidies to more Americans, allow a public health plan option and let people over 50 voluntarily buy in to Medicare would help solve the affordability problems” Bill Clinton mentioned. [ModernHealthCare.com, 10/4/16]

The Atlantic: “Both Obama And Clinton Are Referring To The Same Central Challenge The Affordable Care Act Now Faces.” The Atlantic’s Russell Berman wrote that Bill Clinton’s comments “are not that far off the message that Obama and Hillary Clinton have been sending.” Berman noted that they “are referring to the same central challenge” in that “not enough young, healthy people have signed up for insurance” under Obamacare. Berman expanded on the fuller context of Clinton’s comments, which included “a description of Hillary Clinton’s plan to fix it.” From the October 4 article:

Yet when read in full, Clinton’s comments are not that far off the message that Obama and Hillary Clinton have been sending about the law for several months. No, Obama surely wouldn’t want anyone, let alone a former president, to call his signature domestic policy achievement “crazy.” But in an interview with New York Magazine’s Jonathan Chait, the president said that while he believed the law had been “a huge success,” it also had “real problems.”

Both Obama and Clinton are referring to the same central challenge the Affordable Care Act now faces. Not enough young, healthy people have signed up for insurance under the law’s exchanges, leading to higher premiums for those who are enrolled and prompting insurers to withdraw from the exchanges in many states.

“The current system,” the former president said while campaigning in Flint, Michigan, “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 healthcare.”

But the people that are getting killed in this deal are small businesspeople and individuals who make just a little too much to get any of these subsidies. Why? Because they're not organized, they don't have any bargaining power with insurance companies, and they're getting whacked. So you've got this crazy system where all of a sudden, 25 million more people have healthcare and then the people that 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.

Speaking a day earlier in Pontiac, Michigan, Clinton offered a similar analysis, only it sounded more favorable to the law because he prefaced his critique by saying Obamacare had been “a remarkable success” for the 25 million who have gained health insurance.

And in both appearances, Clinton immediately followed his diagnosis of what ails Obamacare with a description of Hillary Clinton’s plan to fix it. “Hillary believes we should simply let people who are above the line for getting these subsidies have access to affordable entry into the Medicare and Medicaid programs,” Bill Clinton said. “They’ll all be covered, it will not hurt the program, we will not lose a lot of money. And we ought to do it.” [The Atlantic, 10/4/16]

Slate: Clinton Was “Was Making A Sound Point About The Flaws Of The ACA, As It Currently Exists, That Many Liberal Policy Types Essentially Agree With.” Slate’s Jordan Weissman examined former President Clinton’s healthcare comments and concluded that former President Clinton was making a criticism “many liberal policy types,” including President Obama, “essentially agree with,” that the Affordable Care Act “has not worked out as well for healthy Americans with somewhat higher incomes, who receive less generous subsidies” than the poor and sick the law has significantly helped:

The thing about all of this is that Clinton's comments weren't necessarily wrong. Exaggerated and bizarrely delivered in a way that seemed custom-designed for a Republican attack ad? Definitely. But broadly speaking, he was making a sound point about the flaws of the ACA, as it currently exists, that many liberal policy types essentially agree with.

[...]

It seems that Clinton got carried away making a point that even Obamacare's ardent supporters have begun to accept: While the law has done an excellent job expanding insurance coverage among the poor and sick, it has not worked out as well for healthy Americans with somewhat higher incomes, who receive less generous subsidies to buy private coverage. It is not a coincidence that enrollment rates on the insurance exchanges created by the law seem to be much lower for middle-class families, who have to pay more for their coverage, than for low-income households whose premiums are by and large covered by the feds. And if you don't qualify for subsidies at all because your household earns more than 400 percent of the poverty line—$97,000 for a family of four in 2016—Obamacare might feel like a bit of a rip-off, especially if your premiums and out-of-pocket costs have been rising. Frankly, it is kind of crazy that after a once-in-a-generation reform, our health insurance system still contains a giant hole that it lets middle- and upper-middle-class families fall through. Fixing the law through more generous subsidies, or creating options like the Medicare buy-in, could help that. [Slate, 10/4/16]

Bill Clinton’s “Current System” Remark Referred To The Broader Healthcare System, Not Specifically Obamacare

Vox: It Was “Pretty Clear” Clinton Talked “More Broadly About The American Health Care System, And The Patchwork Of Insurance Programs.” Vox’s Sarah Kliff explained that the former president's remarks about a “crazy” health care system were, in full context, “describing Obamacare as one chunk of a nonsensical ‘current system’” hampered by “the patchwork of insurance programs” Americans have to navigate. Kliff concluded that our health care system “was [confusing] before Obamacare passed, and it still is afterward”:

First things first: Clinton did remark that the “current system” we have for health care is ”the craziest thing in the world.”

Watching the remarks, it seems pretty clear to me that Clinton is talking more broadly about the American health care system, and the patchwork of insurance programs that cover most citizens.

[...]

At least to me, it seems that Clinton is describing Obamacare as one chunk of a nonsensical “current system.” And I think most Democrats — most Americans, really — would agree with this assessment of how health insurance works in the United States.

Obama, after all, wasn’t starting from scratch when he began pursuing health reform. There wasn’t a politically viable path to ending employer-sponsored insurance and moving to a simpler system. So Obama ended up pushing a patch that would make a Byzantine system work better — but certainly didn’t make a crazy system sane.

We have a health care system where access to coverage depends on where you live, where you work, how old you are, and how much you earn. When any of those variables change — you get older, move states, switch jobs — you switch to a new type of coverage with its own co-payments, doctor networks, and paperwork. You can’t really compare any of the different programs because they’re all structured so differently. And most of them offer very little transparency about how much health care will actually cost you after you sign up.

So, in a nutshell, yes! Our current system is confusing and complex — it was before Obamacare passed, and it still is afterward. [Vox, 10/4/16]