As the battle over health care raged in the summer of 2009, President Obama made a very specific promise about what would become the Affordable Care Act. "When I say if you have your plan and you like it," Obama explained that June, "or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform."
Nevertheless, Republicans and their media enablers are seizing on a new CBO report estimating that three to five million Americans could lose their current employer-provided health insurance to wrongly charge President Obama with violating a pledge he didn't make.
For the most part, the new Congressional Budget Office assessment is little changed from its previous forecast. Over ten years, the Affordable Care Act is now estimated to reduce the national debt by an additional $50 billion while enabling insurance coverage for 30 million people. But the CBO did increase its guess of the number of Americans who might lose their workplace coverage. As Jonathan Cohn pointed out:
CBO now projects the number of people with employer-sponsored insurance will drop by 4 million people, on net. It's still a small effect, representing less than 2 percent of the total population with employer-sponsored coverage. That's well within the margin of error of these models. It's also difficult to tell why CBO thinks this will happen--whether it's fewer employers offering insurance, fewer employees accepting coverage, or workers moving into firms that are less likely to provide benefits. Any of those would be consistent with lower economic growth, as CBO now expects. Still, the issue merits attention.As the CBO noted, "there is clearly a tremendous amount of uncertainty about how employers and employees will respond to the set of opportunities and incentives under that legislation." While incentives for small business owners will lead to millions of new workers being covered, many larger employers may opt instead to pay penalties for dropping coverage altogether and shifting their employees into the ACA's new insurance exchanges. (Massachusetts, it should be noted, has boosted the percentage of residents covered by workplace insurance from 70 to 77 percent.) For that reason, the CBO looked at a range of scenarios which ranged from employers adding 3 million more workers to their insurance rolls to cutting 20 million instead.
And it's those numbers the press and the Republican Party have seized to charge President Obama with breaking his word. As The Hill warned in an article ominously titled, "CBO report says healthcare law could cause as many as 20M to lose coverage":
The figure represents the worst-case scenario, CBO says, and the law could just as well increase the number of people with employer-based coverage by 3 million in 2019...Republicans immediately pounced after the new numbers came out because they appear to violate Obama's pledge that people who like their health plans will be able to keep them. Last year, CBO's best estimate was that only 1 million people would lose employer-sponsored coverage.GOP Congressman Paul Ryan, whose own plan to privatize and ration Medicare would dramatically shift the costs of health care onto millions of American seniors, jumped at the chance to bash Obama:
"President Obama's string of empty promises is quickly becoming a disappointing trail of broken promises. He promised Americans that his overhaul of the health care sector would not jeopardize the health coverage of those who liked what they had. As nonpartisan analysts made clear today, millions of Americans will soon learn the hard way that Washington's overreach into their health care decisions will result in sharp disruptions to their coverage and their care."In Politico, David Nather did the Republicans work for them by decrying "4 hard truths of health care reform":
President Barack Obama promised over and over during the health care debate that "if you like your health care plan, you can keep your health care plan."There's only one problem with Nather's supposed inconvenient truth: it's not true. What Nather touted as "Obama's signature promise -- 'If you like it, you can keep it'," isn't the vow the President made to the American people.
It turns out that, for a lot of people, that isn't true...
For Obama, it's an inconvenient truth at a really inconvenient time -- coming less than two weeks before the Supreme Court begins oral arguments on the law and just as the administration touts the law's early benefits on its second anniversary.
Throughout the explosive health care debate in 2009, Obama made clear time and again that when he said, "nobody is talking about taking that away from you," the President was referring to the government. His was an obvious - and understandable - effort to debunk a Republican talking point dating back to the demise of the Clinton health care debacle.
For example, at a June 23, 2009 press conference, President Obama left no doubt about the meaning of his message:
"When I say if you have your plan and you like it, ... or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform."June 24, 2009 interview with Diane Sawyer of ABC News, Obama was even more explicit in clarifying that while employers or private insurers might continue to force workers to switch plans, the government would not under his proposals:
"I can guarantee you that there's the possibility for a whole lot of Americans out there that they're not going to end up having the same health care they have," he said Tuesday. "Because what's going to happen is, as costs keep on going up, employers are going to start making decisions: 'We've got to raise premiums on our employees. In some cases, we can't provide health insurance at all'"...Two months later at an August 15, 2009 town hall event in Grand Junction, Colorado, President Obama was again very precise about what he was - and wasn't promising by trying to bring coverage to 32 million Americans, banning lifetime caps and exclusions for pre-existing conditions:
"That's the case whether we pass health care or not. The fact is that right now, all across the country, people are losing their health care. Every day," he said.
"If you're happy with it, and your employer's happy with it, keep it," he said. "If your employer is not providing you the health care that you need, then we're going to give you a set of options to make sure that you continue to have health care."
First of all, what we're proposing is a common-sense set of consumer protections for people with health insurance, people with private insurance. I expect that after reform passes, the vast majority of Americans are still going to be getting their insurance from private insurers...Finally, in his September 2009 address to Congress, President Obama made this commitment:
I just want to be completely clear about this; I keep on saying this but somehow folks aren't listening -- if you like your health care plan, you keep your health care plan. Nobody is going to force you to leave your health care plan. If you like your doctor, you keep seeing your doctor. I don't want government bureaucrats meddling in your health care. But the point is, I don't want insurance company bureaucrats meddling in your health care either.
"First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have."But private employers and private insurance companies are another matter.
AS the CBO noted, without the reforms of the Affordable Care Act, millions of workers would have lost their workplace insurance regardless. As the data show, the deterioration of the employer-based health insurance system was well underway before the onset of the Bush Recession in December 2007. A February analysis by the Economic Policy Institute found that employer-sponsored coverage plummeted from 68.3% of those under 65 years old in 2000 to just 58.6% in 2010. That translates to 7.3 million more people without workplace coverage in less than a decade. In September 2011, the U.S. Census Bureau put the percentage of Americans covered by employer health care plans at 55.3 percent, down from 64.1 percent in 2000. While the Census announced last fall that the ranks of the uninsured jumped to 16.1 percent, a recent Gallup poll put the figure as high as 17.1 percent.
These grim figures would be grimmer still without the actions of President Obama and his Democratic allies in Congress. The Affordable Care Act has lowered the uninsured rate among young adults by enabling parents to add 2.5 million of their children to their existing policies. And as EPI rightly notes, "The only reason why the drop in employer-sponsored insurance (ESI) did not translate into an even larger increase in the total share uninsured is because 4.9 million more people under 65 were covered by Medicaid/SCHIP in 2009." A year ago, the Commonwealth Fund revealed that since the start of the recession, almost 60% of Americans who lost a job and their health insurance - 9 million people - could not afford to regain coverage. Medical costs pushed four million more into bankruptcy. But when fully implemented, the Fund concluded that the ACA will bring relief to "nearly all of the 52 million working-age adults who were without health insurance for a time in 2010."
The fact that some employers would alter or drop their insurance coverage with or without health care reform was a major reason that President Obama was so careful to emphasize that "nothing in our plan requires you to change what you have" and that "government is not going to make you change plans under health reform." But there was one other important consideration as well.
President Obama knew his history and learned its lessons well. His choice of words was no accident. After all, the 1993 Clinton health care reform effort was undone by specious claims that "staying with the doctors you use now will be hard" and would "prevent you from going outside the system to buy basic health coverage you think is better." Like the later lies about "death panels" and "a government take-over of health care," those myths perpetuated then by the likes of Betsy McCaughey and her Republican allies weren't true then.