One of the assets Hillary Clinton has at her disposal as the 2016 campaign hits the home stretch is that she's supported by a fairly popular incumbent president. Granted, most politicians are popular compared to Clinton and Donald Trump, but President Obama's popularity — at or above 50 percent in 17 of the last 20 weeks of Gallup surveys — means that she can position herself as his heir in a way that appeals to enough people to make up a majority of voters.
But there's a risk to that strategy. Obama's signature accomplishment, the Affordable Care Act (better known as Obamacare), is having the roughest year of its existence. Expectations that coverage prices will increase substantially in 2017 and a new report from the Kaiser Family Foundation showing that the number of plans available to enrollees has fallen in much of the country are just the latest pieces of bad news for the ACA. There's a link between the price increases and the number of insurers, of course, but the drop in options is also a function of big-name insurers, like Aetna, declining to participate in the program. (Aetna's withdrawal is not without its own political element.)
The Kaiser Family Foundation made maps comparing the number of plans available in each county next year (per its estimates) with the state of health-care options this year. Gray counties are places with three or more plan options. The red county on the 2017 map is Pinal County, Ariz., where KFF estimates no insurers are currently planning to participate in the exchange.
It's hard to predict how this might affect users. Cost increases are ameliorated by the government's subsidizing of exchange plans in many cases, and not everyone who needs coverage will rush to enroll in a new plan before Election Day. But if we compare the drop in the number of insurers in states (using a calculus explained below) with how close the voting was in those states in 2012, there's a cluster of changes in states where polling suggests a close race between Trump and Clinton.
Included in the states with big changes are Georgia, Arizona and North Carolina — three states where the race is still relatively close and which Donald Trump very much needs to hold. (Utah actually improved its coverage, according to KFF's data, but only slightly. It is shown as zero above.) There's not a close correlation between states that were close four years ago and the change in coverage, mind you, but the problem is more widespread in states that were closer.
There won't be a lot of people who vote on the issue of declining Obamacare insurers specifically. It will be fewer than the number who will be directly frustrated by that decline. But the perception of a program that is struggling in particular states may have a broader effect. Clinton's hope to leverage Obama's successes on behalf of her own candidacy may take a hit, though, if his signature accomplishment presents itself to voters as something of a frustration.
How I calculated the change in insurers: KFF provides state data on the number and percentage of counties covered by one, two or three-or-more insurers in 2016 and 2017. The number on the second graph above is an attempt to quantify the extent of the change between the two years, by multiplying the percent of counties in each category in 2016 by one, two or three (depending on the category) and then subtracting the same calculation for 2017. If 100 percent of the counties in a state were covered by three-or-more insurers but next year half will be covered by two and half by one, the resulting change would be 150. If, instead, a quarter of the counties went to one insurer, the change would be 50. Not perfect, but it works for the purposes above.
