If Trump succeeds in essentially turning out the midterm electorate in a presidential year — whiter, older, angrier — the main motivating issue may be the restriction of immigration. But the general atmosphere of contempt for government that helps Trump — of disdain for the weakness and incompetence of the political class — is due to the Affordable Care Act.

More than six years after becoming law, the proudest accomplishment of the Obama years is a political burden for Democrats. A recent Gallup poll found that a majority of Americans disapprove of Obamacare. The larger concern for Clinton and her party comes deeper in the numbers. Only 18 percent of Americans believe the Affordable Care Act has helped their families; 80 percent say it is has hurt or had no effect. A higher proportion of Americans believe the federal government was behind the 9/11 attacks than believe it has helped them through Obamacare.

The Affordable Care Act has come to embody and summarize declining trust in political institutions. The law was passed in a partisan march, without a single Republican vote. The system’s federal website was launched with a series of glitches and failures that still make “healthcare.gov” a byword for public incompetence in the computer age. Only 17 state-based exchanges (16 states and the District of Columbia) were created. Of that number, four (Hawaii, New Mexico, Nevada and Oregon) have failed, and Kentucky’s will be dismantled/shuttered next year. According to a recent report by the House Energy and Commerce Committee, the Oregon exchange received $305 million in federal funds but never created a functional website or enrolled a single person in private insurance online.