A look at transcripts of Clinton stump speeches since she kicked off the general election campaign on Labor Day finds the Democratic candidate almost never talks about Obamacare. She doesn’t promise to expand it. She doesn’t promise to protect it. She doesn’t extol its benefits. She just doesn’t mention it.

There’s no doubt Obamacare is in trouble. Enrollment in the exchanges has fallen far short of projections. The purchasers of policies have turned out to be older, and in need of more care, than expected. Major insurers are pulling out of the exchanges altogether. Premiums are going up. Deductibles are skyrocketing, meaning many are left to pay most of their healthcare costs themselves.

Two issue briefs published today by The Commonwealth Fund and authored by several RAND Corporation economists (led by Christine Eibner) will be noted by casual readers for their presumably “scientific” conclusions that (1) a set of Clinton proposals will increase the number of insured Americans by over 9 million and decrease average spending by up to 33% for those with moderately low incomes; and (2) a sketchy set of Trump policy stances would increase the number of uninsured individuals by 16 million to 25 million relative to the current-law ACA baseline and disproportionately affect low-income individuals and those in poor health.

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The bitter, long-running fight over ObamaCare’s individual and employer mandates is all over but the shouting.

The problems plaguing the ObamaCare exchanges as enrollment lags, premiums spike and insurers from Aetna to UnitedHealth head for the exits have reached a critical stage, even as the penalties are about to spike for far too many millions of people who get a bad deal from the law. This year, 8 million people paid the individual mandate penalty — not too far from the 10.6 million who had coverage via the exchanges at the end of June. The status quo won’t survive the inevitable political backlash, nor should it. ObamaCare is like a car with a bad muffler: It can keep traveling down the road, even as everyone it passes begs the driver to pull over and get it serviced.

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While health care has not been central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.

Hillary Clinton and Donald Trump have laid out different approaches to addressing these and other health care issues. Central among these is their position on the future of the ACA. Hillary Clinton would maintain the ACA, and many of her policy proposals would build on provisions already in place. Donald Trump, in contrast, would fully repeal the ACA, and although his policy proposals and positions do not offer a full replacement plan, they do reflect an approach based on free market principles.

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Several RAND Corporation health economists have offered very rough estimates of the coverage and cost effects of the hazy health policy proposals by the two major presidential candidates, Hillary Clinton and Donald Trump. In choosing to fill Trump’s policy vacuum with their own void of limited health policy modeling, the RAND researchers conclude that Trump’s proposals would increase the number of uninsured individuals within a range of 16 to 25 million individuals (relative to current-law ACA arrangements), with disproportionate losses suffered by those with low incomes or in poor health. However, Trump doesn’t spend much more taxpayer money to achieve these results, and his plans in health policy would increase the federal deficit by somewhere between $0.5 billion to $41 billion.

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A liberal attempt to revive the public option is opening old wounds between the Democratic Party’s liberal and moderate wings. Thirty-three mostly-liberal Democrats, including all the Senate leadership, have signed onto a nonbinding Senate resolution to add the public option to Obamacare. But missing from the list are vice-presidential nominee, Sen. Tim Kaine and a half-dozen other moderates who face reelection in 2018. Kaine’s absence is especially striking since Hillary Clinton embraces the public option.

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In the event of a victory by Donald Trump in November, political analysis will take on a forensic cast. How did establishment politics — first in the GOP primaries, then in a national electorate — come to die?

Privately, Democrats would regret their selection of one of the most joyless, least visionary presidential candidates in recent memory. Publicly, they would blame trends that incubated within the Republican coalition, particularly a nativism incited by conservative media and carried by a candidate — alternately cynical and frightening — who is unbound by truth, consistency or decency.

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Republican presidential nominee Donald Trump said that as president he would use Medicaid to cover poor people who can’t afford private health insurance, and make birth control available without a prescription.

The comments appeared to differ both with what some Republicans have proposed in the past, and — in the case of Medicaid — aspects of Trump’s own policy proposals on his website. Republicans generally opposed the expansion of Medicaid to higher income levels under Obamacare, for example.

Speaking on “The Dr. Oz Show,” Trump said Medicaid, the joint federal-state program for the poor, should be used to help provide health coverage for those who can’t afford to buy plans from private health insurers. The show was taped Wednesday and aired Thursday.

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What happens to Obamacare after its namesake leaves the White House? The Affordable Care Act (ACA) has faced fierce opposition from congressional Republicans and many GOP-led state governments, survived unexpected legal challenges, and overcome a disastrous rollout of healthcare.gov. Through it all, ACA supporters could count on President Barack Obama to defend the law. But come January 20, 2017, that will change. If Donald Trump becomes president and Republicans maintain congressional majorities, the GOP could seek to repeal major ACA provisions, though Trump’s health care agenda is uncertain.

With the hourglass running out for his administration, President Barack Obama’s health care law is struggling in many parts of the country. Double-digit premium increases and exits by big-name insurers have caused some to wonder whether “Obamacare” will go down as a failed experiment.

If Democrat Hillary Clinton wins the White House, expect her to mount a rescue effort. But how much Clinton could do depends on finding willing partners in Congress and among Republican governors, a real political challenge.

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