Americans are beginning to realize that under the Patient Protection and Affordable Care Act, many people will in fact not be able to keep their current insurance plans. That reflects poorly on President Barack Obama. But it doesn’t necessarily reflect badly on Obamacare.
First things first: Obama had no business promising, as he did repeatedly, that people who like their insurance would be able to keep it under the new law. The reality is that the federal government doesn’t have the power to prevent insurers from canceling or changing the plans they offer, and the law doesn’t empower it to do so.
So Obama made a foolish promise he couldn’t possibly keep. Insofar as that argument was used to attract and justify support for the law, he undermined the political legitimacy of his signature achievement.
It may be too much to expect Obama to admit as much, and he didn’t in remarks he made in Boston, instead reiterating the benefits of the new law. Better if he had explained what he failed to make clear three years ago: Moving some people off their current plans in the individual insurance market, which is how about 11 million people get their health coverage, isn’t some unfortunate side effect of Obamacare. It’s part of the point.
The law sets minimum requirements for insurance plans. They must cover benefits such as maternity care and mental health care, for example, and provide preventive care without copayments. Insurance companies cannot deny coverage or charge more because of a pre-existing condition.
The lack of such requirements is essentially what allowed insurers in the individual market to offer the cheap plans that are now being canceled. Plans that already existed when the law was passed were protected — but only so long as they didn’t contain significant changes.
Obamacare was designed to take that thicket of individual plans with variable costs and benefits and replace it with a smaller range of uniform products that people can compare on an apples-to-apples basis. The cost of insurance for many people will go up as their coverage improves, which is why the law includes premium subsidies for those who need them.
In other words, the individual market under Obamacare was always going to look dramatically different from what came before it. If it didn’t, the law wouldn’t work. It is no surprise that some people who bought individual insurance are now seeing their policies canceled. The surprise — check that, the outrage — is that the problems of HealthCare.gov are preventing them from shopping for other plans.
The benefits of reshaping the individual insurance market don’t excuse Obama for making a promise he couldn’t keep. At the same time, the fact that he misled the public doesn’t mean that the change now underway isn’t a good one.
At any rate, the real promise of Obamacare has always been as much about systemic change as individual coverage — that is, making a health care system that is more effective, efficient and inclusive. If it works as planned, the Affordable Care Act will help millions of people get health insurance, and it will make that insurance more affordable for millions who already have it.
