As the debate over health care reform reached its climax in Congress during the summer of 2009, President Barack Obama appeared before the American Medical Association in Chicago to build support for his signature legislation. In his speech to the AMA, the president promised unequivocally, “If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”
This promise became the Obama administration’s watchword throughout the push for health care reform, and it was repeated over and over again in the halls of Congress.
Events of recent weeks have shown that this promise has not been kept. Recently, a number of large U.S. employers announced their decision to discontinue health insurance plans for part-time workers. In addition, a wave of blue-chip companies announced separate decisions to move retirees out of existing health plans onto exchanges.
Finally, many Americans in the individual health insurance market have received notice that their insurance provider is dropping coverage and they will be pushed into the health exchanges where they will likely face higher costs.
The stories of Americans losing their insurance has refocused attention on the promises made during the health care debate. What is missing in this commentary about the administration’s broken promise, however, are two critical points. First, Republicans in Congress repeatedly put the administration on notice during the debate that this guarantee could not be kept. Second, the fact that people in the individual marketplace are losing coverage is not collateral damage of the health care law; it is a central purpose of the law.
There are several reasons people are losing their insurance and costs are rising, but the most obvious is that the heath care law mandates “minimum credible coverage,” setting a floor for the level of benefits that a plan must have. Moreover, the guaranteed issue and community rating provisions included in the law essentially turn the concept of risk assessment on its head, thus restricting decisions that underwriters typically make in pricing out insurance premiums.
Simply put, the president’s promise was always in direct conflict with the direct mandates set forth in the law.
As debate continues about the ineffective rollout of the implementation of the Affordable Care Act and the strategies to fix the law, it’s instructive to look back at how the health care law was drafted. This health care law is arguably the largest public policy reform of the past century, and it was enacted entirely by one political party. The decision to eschew bipartisan negotiation in favor of swift political victory should raise caution flags on its ability to stand the test of time.
The recent revelations that the administration knew at the time that it could not keep this promise comes as no surprise to those who were there at the creation. Republican members of the “gang of six” repeatedly questioned the promise that Americans could keep their current health insurance. It was raised again in committee hearings, debate, markups on the floor of the Senate, as well as in dozens of town hall meetings around the country.