Members of the House of Representatives leave after a vote to let insurance companies sell individual health coverage, Nov. 15, 2013.
J. Scott Applewhite/AP

Obamacare ‘fixes’ scramble partisan lines

Updated

For years, the two parties’ positions on the Affordable Care Act have been simple: Democrats want it to work. Republicans want to kill it. 

Those positions remain the same. But in a bizarre tactical turn, these conflicting goals have led the parties to confusing and partially overlapping territory this week in response to the law’s “fumbled” rollout. 

On Friday, 39 Democrats joined with 222 Republicans to pass a bill by Republican Congressman Fred Upton that would allow insurance companies to continue selling old policies that are now considered substandard under the Affordable Care Act. The move was billed as relief for Americans who’ve received cancellation notices despite earlier assurances from President Obama that Americans would be able to keep their plans if they liked them.

The White House and most Democrats derided the bill as a sneak attack on the law. Not only would it allow insurers to keep people on their old plans, it would allow them to sell those plans to new customers. The result would keep the health care status quo alive (or at least undead) for thousands of people, thus discouraging many of them from entering the new exchanges in sufficient numbers.

“This bill is offered by people who, according to their own rhetoric, want to repeal the Affordable Care Act,” Democratic Minority Whip Steny Hoyer said in a floor speech. “That’s a fair position,  but now they are trying to do so with a Trojan Horse they call the Upton bill.”

That may be accurate. But the White House’s own fix contains some of the same elements. It allows insurers to offer their old plans to existing customers for one more year while requiring them to inform customers facing cancellation exactly what benefits they’d be missing out on under the new Obamacare plans – maternity coverage, say, or mental health services.

Not only that, a proposal by Democratic Senator Mary Landrieu, who faces re-election in Louisiana next year, would go even further than the Republican plan in one regard. It wouldn’t just allow, but require insurance companies to keep people on their old plans if they so choose.  

These subtle differences are hugely important in their policy implications, but boil down to talking points that are basically identical: Obama said you can keep your plan if you like it, this would allow insurers to give it to you.

That ambiguity is sort of the point. The White House’s plan, a legislative version of which was voted down in the House Friday despite near-unanimous Democratic support, was designed to head off the more corrosive Upton bill by handing nervous lawmakers a safer, rhetorically similar alternative.

But the scrambled lines don’t end there. In another case of odd bedfellows, the groups most opposed to the above proposals are progressive health care advocates and large insurance companies. 

Health care experts and their Democratic allies argue that the cancellations were not only predictable, but absolutely necessary to make the law function.

“This is not a glitch or an accident,” The New Republic’s Jonathan Cohn, who wrote an entire book on insurance company abuses, argued in a blog post. “This is the way health care reform is supposed to work.”

To progressives, the White House move is a case of cowardly trading short-term political gain for long-term policy success.

One of the problems Obamacare sought to fix was that many insurance policies on the indvidual market lacked critical benefits, potentially leaving policy holders unable to obtain needed care without racking up huge out-of-pocket costs. These cancellations make those plans a thing of the past by transitioning customers to more comprehensive plans on the exchanges. If the exchanges were working properly, many would have already discovered they were getting a decent deal, perhaps with subsidies to help pay for their premiums. 

The White House plan – and especially the Upton and Landrieu plans – would keep some of these customers in the old system. Until now insurance companies have been able to deny insurance to people with pre-existing conditions, meaning the customers for these zombie plans are more likely to be young and healthy. These people are the exact demographic that the White House needs in the exhanges to offset the costs to insurers of taking on older and sicker patients who are now guaranteed coverage under the law. Without their participation, premiums could rise next year, creating yet another political backlash.

Meanwhile, insurance companies strongly oppose the last-minute tweaks as well.

“Premiums have already been set for next year based on an assumption of when consumers will be transitioning to the new marketplace,” America’s Health Insurance Plans, the industry’s lobbying group, said in a statement on Thursday decrying the White House plan. “If now, fewer younger and healthier people choose to purchase coverage in the exchange, premiums will increase and there will be fewer choices for consumers.”

To them, Obama’s move is the political equivalent of dropping a flaming bag of manure on their doorstep and running away. By giving them the last-minute option to offer plans they may or may not want to offer at this point, the White House is essentially telling Americans to blame the insurers for not offering their old plan.

“I think the industry wants a predictable, stable, and well-regulated structure in which to do business and link with a decent risk pool of customers,” Harold Pollack, a University of Chicago professor and strong Obamacare supporter, told msnbc. “They have a legitimate beef at the moment.”

Obamacare 'fixes' scramble partisan lines

Updated