This week in an interview with OZY Media, former president Bill Clinton was asked about what’s become the central “problem” with the Affordable Care Act — that some health insurance customers who apparently like their plans have received cancellation notices. Clinton’s response was bizarre: “I personally believe, even if it takes a change to the law, the president should honor the commitment the federal government made to those people and let them keep what they got.”
Not only does this unnecessarily yank the rug out from under the administration while it’s in damage control mode already, but it also feeds the trolls and scaremongers who are ghoulishly delighted by this one hiccup in the system and are actively blowing it way out of proportion in order to gather support for repealing the ACA.
What do we know for sure? Most of the people who Clinton said should be allowed to “keep what they got” are paying for a big heap of crap on a stick, knowingly or unknowingly. When they receive cancellation notices, they can easily sign up for a better plan that might cost a little more, or a lot less, and which provides considerably better coverage. I’m not sure how altering the law just because one of the president’s memes didn’t work out is such a good idea.
The only real solution is to require all health insurance companies to keep existing plans in place even if the plans don’t contain any of the consumer protections mandated by the law. But one of the consumer protections in the ACA banned the practice of arbitrarily canceling policies, leaving the existing policies that people “like” vulnerable to being canceled anyway. The only way around this loophole is to revise the law so it forces the “no arbitrary cancellations” rule onto existing policies. But if you’re going to do that, why not go ahead and force all of the consumer protections into the existing policies?
The answer is obvious: because many of the policies people claim to “like,” such as junk insurance and catastrophic plans that only provide (barely) minimal benefits with very high deductibles, co-pays, annual limits and so forth, happen to have very low premiums. In most cases, that’s what they like — the low premium. But if we stumble down this tangential path in response to a presidential mistake or Republican spin, grinding our gears instead of letting the law take its course, health insurance companies would be forced to let these people keep the plans they like, but would then simply jack up premiums, co-pays and deductibles to compensate for the additional ACA benefits and consumer protections. Then what? Probably another round of outrage porn.
However, let’s say none of the consumer protections or ACA benefits are shoehorned into these existing plans that people inexplicably want to keep. First of all, not one piece of legislation being proposed includes such a provision. Consequently, we’d have a segment of the population still trapped inside the old, failed system. There’d be an insurance underclass, dealing with punitive rules and archaic business practices — the likes of which have been documented for years as actual health insurance horror stories. And when these people become sick or injured with their substandard plans, and then can’t afford the high deductibles and jacked-up premiums, or when they hit their annual limit and have to go without treatment (remember: they claim to “like” these crap plans) then the rest of us will have to absorb the burden. Costs rise. Premiums rise. For everyone.
Of course the simple solution is for the Obama administration to ride it out, while making it as easy as possible for this relatively small segment of the population to buy new plans. Regardless of whether they’re deathly ill or perfectly healthy, they can all buy new plans, with robust subsidies to help anyone earning less than $45,000 per year. The heretofore successful frame that people are losing beloved insurance policies is clever because it leaves out the other half of the equation: they can sign up the same day for something better and, in many cases, more affordable, either in terms of premiums, or, in the long run, coverage that will keep them out of bankruptcy court.
In the final analysis, change often requires some people to make modest sacrifices. It’s like going to war or altering our airport security measures or requiring seat belts, safety inspections or emissions tests for cars. In this case, in order to improve the healthcare system, people have to transition into the new system. And, trust me, I remember the old system where, yes, millions of people received cancellation notices — many of those people were unable to buy new plans, regardless of cost.
Jonathan Cohn wrote yesterday, “You wouldn’t know it from all the press, but Obamacare actually disrupts very little relative to what it accomplishes.” But regardless of what the former president said, blindly grabbing for perfection by changing the law to compensate for a misstatement (or whatever) will only undermine what the law would otherwise accomplish.