President Obama's pledge that those who liked their health care plans could keep them wasn't the only broken promise made when selling the health care law. The troubled rollout of Obamacare has produced a growing list of things that Americans like about their current health care experience that they may not be able to keep. Below are five examples.
1. Health insurance plans
Millions of Americans have received notices canceling their existing health plans because they did not meet the requirements of the health care law, which forced insurers to include one-size-fits-all benefit packages in all plans.
In theory, Obamacare was supposed to allow Americans to keep their plans so long as those plans weren’t acquired after March 2010, when the law’s requirements took effect. These were the “grandfathered” plans of which Obama spoke.
But on June 17, 2010, three months after Obamacare was signed into law, the Department of Health and Human Services issued a regulation detailing a number of modest alterations that would cause plans to lose their grandfathered status, thus subjecting them to the new rules.
This is what led to many of the more than 4 million cancellation letters Americans have received across the country.
The situation was so bad that Obama issued a “fix” to the law that told insurance companies they could extend cancelled plans for another year, at the behest of state regulators.
But that fix was merely an attempt to shift blame from Obama to insurers. In reality, insurance companies for the past three years had been building insurance plans and rates based on Obamacare's rules. Obama's idea of a fix was to tell them to reverse course at the last minute.
“Asking them, at the 11th hour, to reverse-engineer business decisions that were years in the making, and then trying to say they’re to blame if they can’t make the changes, is beyond unreasonable,” Phil Klein of the Washington Examiner said.
Regulators in at least 18 states (including California and Massachusetts) and Washington, D.C., have declined to go along with Obama's proposal.
2. Health plan premiums
“Thousands of Californians are discovering what Obamacare will cost them -- and many don't like what they see,” the Los Angeles Times reported on Oct. 26.
This story is playing out around the country, as Americans – particularly those who are younger and healthier – are seeing higher premiums due to Obamacare’s requirement to cover pre-existing conditions and provide “essential” benefits that not every insured American needs (like maternity care for single men).
Americans may not be able to keep their doctors, either. That's because insurance companies, to keep rates down while abiding by the new requirements of Obamacare, narrowed their networks of doctors.
So to get a cheaper plan, one might have to sacrifice one's preferred doctor. But Americans can keep their doctor, they'll just have to pay more for them, according to Zeke Emanuel, who served as a health care adviser to Obama when the law was being crafted.
These changes are happening as an increasing number of doctors have stopped accepting Medicaid due to low payment rates. Some doctors are choosing to retire rather than continue practicing under such conditions.
It turns out that some prescriptions won't be covered under Obamacare. As Scott Gottlieb, a former commissioner for the Food and Drug Administration and current scholar at the American Enterprise Institute wrote:
“The out of pocket caps on consumer spending only apply to costs incurred on drugs that are included on a plan’s drug formulary. This is the list of medicines that the health plans have agreed to provide some coverage for.
“If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).”
Gottlieb likened Obamacare to 1990s HMOs, saying that to pay for the extra benefits, the new health care law had to “skimp” on things like access to doctors and fewer name-brand prescriptions included in coverage plans.
Obamacare could also make it difficult for individuals to have their choice of hospitals.
Due to the problems with restricted networks mentioned above, many hospitals also are being excluded from plans on the exchanges, including famous hospitals such as Cedars-Sinai in Los Angeles.
On top of this, Medicare changes made by the law that cut payments to hospitals could prompt some of them to stop accepting Medicare.
To combat these unpleasant side effects of Obamacare, HHS released guidance for insurers asking them to continue covering some drugs, and to treat out-of-network providers as being in-network.
The request suggests that the administration is worried about potential chaos that will hit once the new plans take effect next year – and the effects that chaos will have on the popularity of the president’s signature legislation.