By Jon Healey
6:15 PM EDT, November 1, 2013
The Times' editorial Friday about insurance policy cancellations struck a nerve with many readers, who objected both to what it said and what it didn't say.
On the latter front, the editorial board wrote that President Obama "overpromised" when he pledged, repeatedly, that the new law wouldn't force anyone who liked their insurance plan to change it. Wrong, wrote "RicoPanadero," in words shared by many other commenters. "The president did not overpromise. The president lied," "RicoPanadero" wrote.
Point taken. The pledge wasn't worth the air used to utter it. Worse, the president had to know that the law was designed to eliminate a slew of plans in the individual and small-group market -- as well as some in the large-group market -- that didn't meet the new standards it set.
Some defenders of the president note that the law lets people keep even a noncompliant policy if they'd signed up for it before the Affordable Care Act was enacted. But this "grandfather" exemption dissolves if the plan was amended either by the insurer or the customer (say, by opting for a higher deductible). And in the individual market, it's common for people to keep a policy for a year or less. So there's a relatively small percentage of people in that market who can claim that exemption today.
House Republicans have offered a bill that would let insurers continue to offer their current policies, regardless of whether they meet the law's coverage standards, actuarial requirements and limits on out-of-pocket expenses. Sen. Mary Landrieu (D-La.) plans to offer an alternative next week that would allow policies currently held to be grandfathered, enabling people to renew their current coverage (without allowing insurers to extend that coverage to more individuals). Her bill would require insurers to disclose clearly to customers where the policies fall short of the new standards, while also directing customers to their state's exchange to find fully compliant policies.
Grandfathering more policies, however, would undermine the law's efforts to pool risks and costs in the individual and small-group markets. The goal is to give consumers and insurers in those markets some of the advantages now enjoyed by those in the large-group market, including lower and more stable premiums. As The Times' editorial board put it, the new standards for coverage are "part of a larger effort in the law to stop insurers from cherry-picking customers, leaving those who may need expensive treatments unable to find coverage."
On this point, too, numerous readers cried foul. The minimum standards smacked of nanny-statism, they argued, where the government insists that its judgment is better than the citizenry's. And the idea that everyone should sign up for coverage for a set of government-selected benefits struck these commenters as absurd.
"My 'enhanced' Obamacare TAX plan now includes (I'm a 64-year-old MALE) maternity care, prenatal, ob/gyn, pediatric dental and 'free' contraception. I'm still looking for my uterus as this plan says I have one," wrote reader "chardest."
That's an argument in favor of narrow pools, which is the way the individual market is set up now -- to the detriment of those unfortunate (or heedless) enough to require treatment for expensive conditions that other Americans can avoid. But it's not the way employer coverage works, where male co-workers routinely subsidize their female colleagues' prenatal care, and female workers do the same for their male colleagues' prostate problems.
Nevertheless, the nanny-state argument is a powerful one that has gone all but unchallenged by the administration. Instead of giving people false reassurances about keeping their health plans, Obama should have spent the last three years explaining why the individual insurance market will work better for them once it looks more like the large-group market, or why the policies designed by insurers to minimize their risk needed to go away to enable new choices that served the interests of more consumers. Those might not have been winning arguments either, but at least it would have been the right debate to have.
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