Joe Biden’s Projected DNC Speech – The Health Care Segment

Joe Biden will accept the nomination this evening as the Democratic candidate for the President of the United States. I have some thoughts on what he will and won’t say on health care. If this experiment goes well, I’ll do the same next week with President Trump.

Mr. Biden will overstate both his role in the Obama administration and the role of President Obama in passing the Affordable Care Act (ACA), which was largely the work and vision of Speaker Nancy Pelosi. He’ll characterize the law as a huge accomplishment, which he’ll tell you should put him way ahead of President Trump on health care issues. He will say that President Trump has no health care accomplishments, and that the president has only tried and failed to dismantle the ACA.

He’ll talk about what’s popular in the ACA, its bedrock principle being “protections for people with pre-existing conditions”, a phrase that originated after the law passed but polls well and is often conflated with the law. He’ll add that “Donald Trump wants to take those protections away”. He’ll cite that the law allows young adults to stay on their parents’ insurance until age 26 and how that’s a good thing, while at the same time admonishing President Trump for allowing escape options for other people without reasonable solutions in ACA markets.

ACA Markets 2017-2020

Joe Biden won’t mention that ACA markets have grown stronger since 2016. He will hide that more people have been helped and fewer have been hurt. He’ll try to portray a weakening marketplace without a like-minded leader at the helm.

He will not acknowledge the condition of ACA markets in 2016 when he left government service. He might mention that the uninsured rate has increased and ACA enrollment is down since President Trump assumed office. Even our friends at Mother Jones will fact-check him here, “It’s tempting to conclude that the culprit for this is Donald Trump’s efforts to sabotage Obamacare, but the declines began in 2016, when Obama was still in office, and have continued pretty steadily since then.”

He will not acknowledge the lower net premiums that have caused more lower-income people to enroll in 2018 and 2019, even with removal of the individual mandate penalty. He won’t mention that insurers began returning to improved marketplaces in 2019 after a three-year exodus. He won’t mention that premiums have somehow remained flat going on three years while all his friends predicted spiraling increases. He will offer no words that indicate that he understands that the market has improved or that he comprehend anything that has happened in ACA markets since he left the Vice-Presidency. He will present some vague notion of ACA markets being deliberately harmed, and struggle to support such claim with facts.

ACA Lawsuit

Mr. Biden will reference the legal case on ACA constitutionality before the Supreme Court, but he will neglect to mention the plaintiffs, their harm, and their requested remedy. He will cast a dispersion that the court case is a single-handed effort by President Trump and follows a continued relentless pattern of the president to overturn the ACA. Mr. Biden will not mention that the administration has no influence over the court case. He will not acknowledge that it is the role of Congress to clean up sticky constitutional issues and this is usually speedily handled without unnecessary drama; a complicit media will not call out Congress either. Joe Biden won’t mention that Congress needs to act and either save the ACA or let it fall with the essential mandate, and that it is irresponsible for Congress to allow the Supreme Court to render this decision. Mr. Biden will try and persuade Americans to believe that the president rather than Congress can stop the court case, and he’ll meaninglessly say that “the president is in court right now” for effect.

Despite the fact that the Trump administration has consistently argued that any adverse ACA ruling be stayed to allow a smooth market transition, Mr. Biden will falsely imply that the administration is arguing for an injunction, and he will use salacious language like “the president is trying to rip health care away from millions in the middle of a pandemic” to paint that lie. He will say the president is “heartless” and that his legal position is unconscionable, at the same time he knows the president’s consequential policies do not align with inconsequential legal positions.

Coronavirus

Joe Biden will say the coronavirus is not Donald Trump’s fault, but that the president “squandered” opportunities and “didn’t listen to experts”, and he’ll want you to believe things would be back to normal had he been president, adding “it didn’t have to be this way”. He’ll add something about millions of Americans at risk of losing their health care during a public health crisis, and how he would be sure everyone has coverage coming out of it.

He will say that the coronavirus disproportionately impacts communities of color. Without saying it directly, he will imply that President Trump lacks empathy for those communities.

Legislative Proposals

He will talk vaguely about legislation, mostly about making coverage more affordable (which he won’t define) and he won’t discuss the financial value of insurance. He’ll say that a public option is “the best way to lower costs and cover everyone” but he will not provide any substantive context.

He will speak more abstractly than substantively about his legislation and weave in identity politics, noting that he will “defend the rights of all Americans to have access to quality, affordable health care, free from discrimination.” He will say something about “restoring outreach”, with the implication the market that is less than half its expected size only because people simply have not heard of Obamcare (or do not realize their tax credit eligibility).

Continuing to avoid substance, he will contrast his plans with President Trump who “continues to do everything he can to dismantle the ACA”. Again, he will avoid Trump’s record of sustaining and strengthening markets, and making the law both more tolerable and more popular.

He’ll suggest the ACA is in danger and say he will “protect and build on the ACA to ensure everyone gets the care they need”. This will sound awfully similar to ACA promises, which provided unbalanced tax credits but didn’t ensure care. He will talk about now being the right time to take the step toward universal coverage. Kamala will tell him to add “meet the moment” for good measure, and he will. He will talk about the ACA as a huge accomplishment, but say there is “more work to be done”. He will not reference Senator Tom Harkin’s “starter home” analogy, but he’ll say something to that effect to downplay the original Obama/Biden grand ACA expectations. He will repeat how he wants to “build on the ACA” and not tear it down. He will use the meaningless words “Medicare-like public option” to talk about how he is going to "build on the ACA". His “public option” plan is not the Platinum Public Option; it is either a lionfish option or more likely an unnecessary cannibalization of ACA markets, but 'Medicare-like' will play well with people who have a positive view of Medicare, perhaps liking its nonrestrictive nature and being unaware of its out-of-pocket costs.

 He won’t talk about his plan to calibrate premium subsidies on “more generous” gold plans rather than silver. He won’t discuss that gold plans are only “more generous” in states that have not yet responded to President Trump’s ACA makeover and are not complying with ACA’s rules. He won’t mention that Colorado is formally taking such action through legislation, but he will be dismissive of President Trump doing the same thing through an executive order, and say that it’s not needed as “Obamacare already does that”.

He will say something about lowering the Medicare eligibility age to 60. He will not mention how that will reduce ACA market enrollment and cause ACA premiums to increase.  He will not discuss why creating alternative options for the demographic that the ACA works best for is the right course; he won't discuss that this is a electoral ploy and not a beneficial market maneuver. At the same time he advocates alternative options for people with ACA solutions, he will say that President Trump’s escape options for people without ACA solutions “undermine Obamacare”.

.He will summarize his policy goals with something opaque and without any real substance, and try to connect it to why you should vote for him, because “your life depends on it”.

Bringing the RINOs and Progressives Together

Mr. Biden will reject John McCain’s claim that this his July 2017 vote was a protest against the process, and instead he will say that “my friend John McCain crossed the aisle because he cared more about his country than his party”.

He will say something about disagreeing with Bernie Sanders on policy details, but that he and Bernie are on the same team and want the same thing, for people to have health insurance coverage, and Donald Trump just wants to take it away. He won’t tell you that President Trump has championed similar private markets with tax credit incentives, and primarily opposed the ACA’s individual mandate, as did President Obama. He won’t acknowledge President Trump’s policy, but will repeat the bizarre claim that “President Trump wants to take health care away”.

While Mr. Biden will mention some policy substance, his message will primarily be intended to make you believe he cares more about you than President Trump, and that’s somehow more important and effective that policy implications. Given the state of ACA market improvement since 2016, he really has no other winning opportunity. His message will be that he will lead an activist administration and ignore my advice to first better understand successes and challenges before unknowingly disrupting improving markets. He will want you to believe that doing something is always better than doing nothing, and that letting Trump’s makeover complete on its own is not an option. He may later shift on policy here, but you won’t hear about it tonight.

He won’t convince you that he has a mastery of policy substance and he won’t try, but he may convince you that his mind is still sharp enough for the job, and that you should trust him anyway because he wants what is right for you more than the other guy. That’s usually good enough for the television audience and the policy wonks can make the real sausage later. My larger concern is I have read his campaign website with a focus on the three ACA adjustment pillars of premium subsidies, Medicare eligibility age, and a public option proposal. I am not convinced that he has anyone on his team who understands ACA mechanics, and that is much more problematic than the “Ol’ Uncle Joe cares about you” speech we are about to hear.