By Peter Sullivan - 10-25-16 06:00 AM EDT
Democrats are increasingly acknowledging that the Affordable Care Act has an affordability problem.
Former President Bill Clinton said recently that people who are ineligible to get subsidies to buy ObamaCare insurance are "getting killed."
Minnesota Gov. Mark Dayton said this month that "the reality is the Affordable Care Act is no longer affordable to increasing numbers of people."
Even President Obama said in a speech last week that "there are going to be people who are hurt by premium increases."
Every one of these Democrats made the argument that ObamaCare is working well for most people, and that the problem of rising premiums is specifically focused on a minority of consumers who earn too much money to qualify for federal subsidies.
Clinton said the system "works fine" for people who get subsidies under the law to help them afford coverage, while Dayton said that "the law is working" for most enrollees and that those negatively affected amount to about 2 percent of Minnesotans, with individual coverage.
Yet the problems with the law are leaving Democrats exposed to GOP attacks.
Republicans have been beating the drum about higher premium increases this year, which are on average about 25 percent for a benchmark plan, the administration said Monday.
Donald Trump seized on some of the admissions by Democrats at a rally in Cleveland on Saturday.
"Just this month, the Democratic governor of Minnesota admitted the reality is the Affordable Care Act, he said, is no longer affordable," Trump said. "He said that. And you probably saw last week, Bill Clinton called ObamaCare 'the craziest thing in the world.'"
Democrats point out that 85 percent of ObamaCare enrollees receive financial help under the law and that it cushions people by increasing along with any premium increases. (People are eligible for assistance under the health law if they make below about $47,000 for an individual.)
But it is the other 15 percent, about 1.6 million people, who do not receive financial help, where Democrats admit there is a problem. There are also about 7 million people with individual coverage outside of the law's marketplaces who are fully exposed to premium increases.
Democratic presidential nominee Hillary Clinton has fought back by saying that by repealing ObamaCare, Republicans would be taking away coverage for the 20 million people who gained insurance under the law. And repealing ObamaCare would do away with protections like preventing insurance companies from denying people coverage because they are sick, which meant that in the past, some people could not get coverage at any price.
Democrats also note that those facing premium hikes are a small slice of the population. About 150 million Americans are largely unaffected because they get insurance through their jobs, and in fact premium growth is slowing down in this market.
ObamaCare enrollment is about 10 million people, and only about 1.6 million of those consumers are facing the premium hikes.
Still, Clinton at the second presidential debate noted the problem.
"I'm going to fix it, because I agree with you," Clinton told a questioner who complained of rising health costs under ObamaCare. "Premiums have gotten too high."
Both Clinton and Obama have proposed increasing the financial assistance available under ObamaCare so that it could be available to people who do not currently qualify.
Clinton, for example, wants to provide a new tax credit of up to $5,000 to help people pay for premium costs as well as out of pocket costs like deductibles, which can also be a major problem under ObamaCare.
But those proposals would require congressional action, and Republicans remain firmly opposed to spending more money on the healthcare law.
The administration points out that ObamaCare premiums started out about 15 percent below projections, in the first year, which Democrats praised at the time.
"It turns out, lo and behold, actually, the prices came in lower than we expected - lower than I predicted," Obama said in 2013. "That's how well competition and choice work."
But now, administration officials say they wish insurers had set their premiums higher and more accurately to begin with, so they wouldn't have to hike them so much now.
"Would we all have preferred to be 10 percent higher say from the start with more gradual increases?" Andy Slavitt, head of the Centers for Medicare and Medicaid Services, said this month. "Of course. You bet we would."
But he pointed to the financial assistance as protecting people from the hikes. The administration said Monday that about three quarters of ObamaCare enrollees can find a plan for $75 a month or less, once the subsidies are factored in.
With Democrats increasingly calling for increasing that financial assistance, Bob Kocher, who was a White House adviser on health reform during the drafting of the health law, said that financial constraints prevented Democrats from making the subsidies more generous to begin with.
He noted that the law had to be fully paid for with either tax increases or Medicare cuts, which limited the amount of money for subsidies.
"There weren't any more publicly acceptable cuts that I'm aware of that we could have taken," Kocher said. If they had been able to somehow find more acceptable savings, he said, "I would have loved to apply it to subsidies."
More broadly, he also called for reforms to make the healthcare system more efficient and bring down costs for everyone.
Across the system, and not just in ObamaCare, he said, "affordability is an enormous problem."