President Barack Obama’s advisers deliberately crafted his signature healthcare law to fulfill his oft-repeated promise: those who like their insurance can keep it.
Even with that provision, Obama administration officials knew by June 2010 that as many as 10 million people with individual insurance probably would be thrown off existing plans anyway.
That didn’t stop Obama from coming back to the line over and over, saying as recently as June 2012, “If you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance.”
Republican congressional leaders yesterday seized on reports that hundreds of thousands of Americans received insurance cancellation notices, questioning the president’s credibility and renewing calls to delay provisions of the health-care law.
White House officials showed no sign of backing down, saying that just 5 percent of the population is affected, and that insurance company practices, not the law, caused the spate of cancellation notices in Florida, California and elsewhere.
One person involved in the creation of the law, Ezekiel Emanuel, formerly of the White House Office of Management and Budget, said administration officials knew they had to make the law live up to the president’s promises.
So they wrote in a “grandfather clause” designed to allow people to keep their insurance policies that were in place as of law’s start date of March 2010, as long as there were no major changes in the policies.
“That was a very explicit approach,” Emanuel, now vice provost at the University of Pennsylvania, said in an interview.
Even so, at least as long ago as June 2010, the administration was aware that the provision wouldn’t cover millions of Americans.
A notice published in the Federal Register on June 17, 2010, as interim regulations on the grandfather clause were released, estimated “40 percent to 67 percent” of Americans who purchase individual health-insurance policies would lose their grandfather protection each year because of either turnover from plan to plan or changes in the plans’ terms.
In 2012, 15.8 million Americans, 5 percent of the population, purchased health insurance through individual policies rather than the more common route to coverage through employer-based group plans, Medicare, Medicaid, or veteran’s benefits, according to a Kaiser Family Foundation analysis of U.S. Census data.
As many as 80 percent of people currently on individual health plans may have to find new health insurance for next year, said Robert Laszewski, an insurance-industry consultant in Arlington, Virginia. He estimates that 19 million people currently hold such policies.
Florida’s Blue Cross and Blue Shield announced it sent notices to about 300,000 members, canceling policies because they didn’t meet requirements of the new law such as prescription drug coverage or free preventive care. California’s Blue Shield and Oakland-based Kaiser Permanente will withdraw policies for a combined 280,000.
The people with company insurance or the government health plans like Medicare and Medicaid aren’t affected.
House Majority Leader Eric Cantor, a Virginia Republican, told reporters yesterday the cancellations were a reason to delay the health-care law, known as the Patient Protection and Affordable Care Act.
“If the president knew that these letters were coming and still indicated that you could keep your health care plan if you liked it, now that raises some serious questions about the sales job of Obamacare,” Cantor said as he emerged from a party leadership meeting.
Obama has been using the line about people keeping their insurance for years, dating back to his 2008 campaign for president, including at a presidential debate with Republican John McCain, an Arizona senator.
Once in office, he continued to make the promise, for instance at a town hall meeting in 2009 in Green Bay, Wisconsin, and in a White House Rose Garden event and a radio address later that year. He said it in Fairfax, Virginia, and Portland, Maine, in 2010. And he repeated the line in an address after the U.S. Supreme Court decision upholding the law in June 2012.
Obama travels to Boston today to argue that the experience Massachusetts had with its 2006 health-care law portends eventual success for the federal law. Health and Human Services Secretary Kathleen Sebelius will face questions about start-up difficulties for the program at a hearing this morning in the Republican-controlled House.
White House press secretary Jay Carney yesterday repeatedly cited the grandfather clause in the health law as he defended Obama against criticism.
“The president was clear about a basic fact,” Carney said, “If you had insurance that you liked on the individual market, and you wanted to keep that insurance through 2010, ’11, ’12, ’13 and in perpetuity if you wanted it and it was available, you could. You were grandfathered in.”
“What no healthcare reform could envision or could responsibly stipulate,” Carney added, “is that, any plan that might come along in the next few years would be grandfathered in, because that would undermine the basic premise of providing the minimum benefits for the American people.”
Democratic pollster Geoff Garin, who worked for Hillary Clinton’s presidential campaign in 2008 and later for advocates of the health law during the congressional debate, said Obama’s repeated reassurances that people could keep insurance they were happy addressed a core anxiety of voters and were crucial to building public support.
Polling consistently demonstrated a “cross-pressure” in people’s feelings on health care, with Americans simultaneously dissatisfied with the healthcare system and fearful of a change in their own health plans, Garin said.
“The swing vote on healthcare reform was comprised of people who thought the system needed to be changed but were happy with their own health care,” Garin said. “It was then and continues to be important that voters who felt their needs were met in the health care system continue to feel their needs will be well met in an Affordable Care Act world.”
–With assistance from Michael C. Bender in Washington and Alex Nussbaum in New York. Editors: Craig Gordon, Michael Shepard
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