For the past couple of months, arguments surrounding the Affordable Care Act have centered on how the law will affect premiums for the majority of Americans. Then, something funny happened. The date when open enrollment started and people could first see what they would actually pay for health insurance came and went and all the talk of “rate shock” disappeared. It was replaced first by coverage of the government shutdown and then by the federal health exchange’s major problems. Almost a month later, we are finally starting to talk about the real effects of Obamacare.
Stories about rate shock abound and there hasn’t been time for a more comprehensive overview of how Obamacare is affecting premiums. What has happened though is that President Obama’s oft-repeated line that if you like your health care, you can keep it has proven to be an outright lie and supporters of the law have found themselves on the defensive.
For years, Obama assured Americans that his health care law wouldn’t force them to change insurance if they liked the coverage they had. It was an easy line to tell audiences, but it was clearly not going to be true. Obamacare requires insurance companies to cover 10 “essential health benefits” such as maternity and mental health care. Many plans didn’t cover those services before. The law also mandates that plans limit out-of-pocket expenses to $6,350. There was simply no way that insurance companies could comply with all the new requirements in the law and offer the same insurance plans. It was never a possibility, despite Obama’s repeated assurance that it was a certainty. The president was lying.
Conservatives have jumped on this lie to demonstrate that Obamacare isn’t working. President Obama promised you that you can keep your plan and now you can’t. That’s a fair criticism in and of itself, but it’s not an argument against the law. Just because some Americans can no longer keep their plans does not make the law a failure.
The same is true of conservative remarks about “rate shock.” This was the fundamental argument heading into October 1st. Would most Americans see higher premiums (after factoring the in the subsidies)? That answer is unclear, but liberals have nevertheless found themselves conceding that point while defending other aspects of it. Story after story have emphasized that Americans around the country are seeing higher premiums, not lower ones. Under that framework, it’s tough for the law’s supporters to argue that Americans are not facing “rate shock.” Instead, they’ve hard to argue that the complex nature of the law means higher premiums are not telling the entire story.
This is exactly right. The fact is that many Americans will witness “rate shock.” Their premiums are going to increase, but this isn’t a flaw or a failure of the law. It’s a feature. The law asks healthy, young people to pay more so that unhealthy, older ones have access to affordable coverage. It asks men to pay more so that women pay less. It asks the rich to pay more so that the poor pay less. It’s a law built on making the system fairer.
This doesn’t show up in “rate shock,” but it’s there. The problem is that during the past couple of months, conservatives have framed the success or failure of the law around the cost of premiums. Liberals bought into that framework and argued that premiums would be lower when you factored in the subsidies. That meant that the law would not be judged on the millions of people becoming eligible for Medicaid or Americans with pre-existing conditions finally having the opportunity to purchase affordable health insurance. It would be judged on “rate shock.”
The greater challenge here is that the media has an appetite for digging out and finding stories of people facing higher premiums. Never mind that many of these people are young, middle class Americans – the exact people who Obamacare asks to pay more. The framework ensures that the media treats this “rate shock” as a condemnation of the law.
Obamacare supporters always faced an uphill battle here. It’s easy to judge a law based on premiums. It’s much more difficult to judge it based on newly required services that insurers must cover, reduced discrimination, lower risk of financial catastrophe and the ability of Americans with pre-existing conditions to purchase coverage. This difficulty is not limited to liberals. Conservatives have argued that the law will greatly reduce consumer choices of doctors and hospitals. This doesn’t come up in the “rate shock” framework as well. But that framework is still overwhelmingly tilted in favor of the Republican argument.
Like Obama’s lie above, the existence of “rate shock” does not mean the law is a failure. It was bound to happen and the media was bound to hunt for instances of it and put them on a national stage. They were always much less likely to search out the 55-year old women with diabetes who finally can purchase health insurance. This has put liberals in the precarious situation of emphasizing the nuances about how “rate shock” is a necessity to ensure the many benefits of the law can take place.
The framework has put Obamacare supporters at an inherent disadvantage. In many ways, that disadvantage was unavoidable, but by buying into the use of “rate shock” as the benchmark for analyzing the law, they also brought it upon themselves. Now, they have to find a way to reshape the conversation so that the analysis of the law focuses not on premiums, but on the vastly fairer health insurance environment that will soon exist.