Skip to main content

The real promise of Obamacare

By Timothy Jost
updated 1:44 PM EST, Fri November 15, 2013
STORY HIGHLIGHTS
  • President Obama, in response to widespread criticism, offered a fix to Obamacare
  • Timothy Jost: Allowing the sale or renewal of 2013 policies in 2014 is a problem
  • He says real promise of Obamacare is affordable health insurance for all
  • Jost: We'll have to see if the fix can clear the hurdles to achieve Obamacare's long term goal

Editor's note: Timothy Jost is a professor of law at Washington and Lee University.

(CNN) -- On Thursday, in response to widespread criticism, President Obama announced that the administration was delaying enforcement of the Affordable Care Act's insurance market reforms as necessary in order to allow insurers to renew coverage that does not comply with those reforms for individuals and small groups who have been covered in 2013.

This change was the President's response to a challenge that he had broken his promise, "If you like your health care plan, you can keep your health plan." But this promise has been seriously misunderstood.

The promise of the Affordable Care Act was never that if at some point in the future you found a health care plan you liked, you could keep it forever. Rather, it was: "Nothing in this Act ... shall be construed to require that an individual terminate coverage ... in which such individual was enrolled on the date of enactment of this Act." This promise has been kept.

Timothy Jost
Timothy Jost

The Affordable Care Act did, however, offer other assurances that are at risk of not being met. One was that people with pre-existing medical conditions who have been unable to purchase health insurance at an affordable price, or even perhaps to purchase it at all, would, as of January 1, 2014, be able to find affordable insurance that would meet their medical needs.

To fulfill this, health insurers were told that if they sold qualified health plans at affordable premiums without considering health status, they would get a sustainable mix of healthy and unhealthy enrollees.

But now, Congress is considering allowing health insurance policies that we being sold in 2013 to be sold throughout 2014, even though they violate the 2014 reforms.

The good news is that the Obama administration's fix does not go that far, only allowing the renewal of 2013 policies for 2014, and not the sale of new policies that don't comply with the law.

What are the Obamacare trade-offs
Obamacare: What's next?

But even allowing the sale or renewal of 2013 policies in 2014 is a problem. Insurers have already set their rates for the exchanges based on the promise that they would be getting healthy and as well as unhealthy enrollees. If some healthy individuals instead opt for bargain-basement 2013 policies, insurers are unlikely to get premiums that will cover their costs in the exchanges.

Some insurers -- current market leaders -- may be able to survive for a year doing this. But new entrants, including the new cooperative plans backed by federal loans, may not survive. Insurers that lose money will be bailed out to some degree by the taxpayers through the law's premium stabilization programs.

But insurers will substantially raise their premiums for 2015 to protect themselves in case this happens again. The promise of affordable coverage for people with medical problems is therefore at risk.

It was clear from the beginning that there would be winners and losers under the Affordable Care Act. If insurance is going to be affordable for people who have heretofore been closed out of the insurance market, and if it is going to cover services that have not been covered before -- like equal coverage for mental health services -- it will cost more than it has in the past for those who have been blessed with good health and low premiums.

Is this fair? That's debatable. Perhaps it would be more fair for the public generally to bear the cost of insuring those with high medical costs, as we do with Medicare. But let us be clear. Individuals who are paying more for coverage in 2014 than they did in 2013 are not doing so because a promise was broken.

On the other hand, turning the exchanges into a high risk pool, and expecting insurers to cover exchange enrollees with premiums based on projections of a normal health insurance market, would break the real promise of the Affordable Care Act: That health insurance would be affordable to all Americans, regardless of whether they were healthy or sick.

The Obama administration's fix tries to steer a middle path. Whether it can clear the short-term hurdles to achieve its long-term goal remains to be seen.

Follow us on Twitter @CNNOpinion

Join us on Facebook/CNNOpinion

The opinions expressed in this commentary are solely those of Timothy Jost.

ADVERTISEMENT
Part of complete coverage on
updated 2:52 PM EST, Wed December 24, 2014
Danny Cevallos says the legislature didn't have to get involved in regulating how people greet each other
updated 6:12 PM EST, Tue December 23, 2014
Marc Harrold suggests a way to move forward after the deaths of NYPD officers Wenjian Liu and Rafael Ramos.
updated 8:36 AM EST, Wed December 24, 2014
Simon Moya-Smith says Mah-hi-vist Goodblanket, who was killed by law enforcement officers, deserves justice.
updated 2:14 PM EST, Wed December 24, 2014
Val Lauder says that for 1,700 years, people have been debating when, and how, to celebrate Christmas
updated 3:27 PM EST, Tue December 23, 2014
Raphael Sperry says architects should change their ethics code to ban involvement in designing torture chambers
updated 10:35 PM EST, Tue December 23, 2014
Paul Callan says Sony is right to call for blocking the tweeting of private emails stolen by hackers
updated 7:57 AM EST, Tue December 23, 2014
As Christmas arrives, eyes turn naturally toward Bethlehem. But have we got our history of Christmas right? Jay Parini explores.
updated 11:29 PM EST, Mon December 22, 2014
The late Joe Cocker somehow found himself among the rock 'n' roll aristocracy who showed up in Woodstock to help administer a collective blessing upon a generation.
updated 4:15 PM EST, Tue December 23, 2014
History may not judge Obama kindly on Syria or even Iraq. But for a lame duck president, he seems to have quacking left to do, says Aaron Miller.
updated 1:11 PM EST, Tue December 23, 2014
Terrorism and WMD -- it's easy to understand why these consistently make the headlines. But small arms can be devastating too, says Rachel Stohl.
updated 1:08 PM EST, Mon December 22, 2014
Ever since "Bridge-gate" threatened to derail Chris Christie's chances for 2016, Jeb Bush has been hinting he might run. Julian Zelizer looks at why he could win.
updated 1:53 PM EST, Sat December 20, 2014
New York's decision to ban hydraulic fracturing was more about politics than good environmental policy, argues Jeremy Carl.
updated 3:19 PM EST, Sat December 20, 2014
On perhaps this year's most compelling drama, the credits have yet to roll. But we still need to learn some cyber lessons to protect America, suggest John McCain.
updated 5:39 PM EST, Mon December 22, 2014
Conservatives know easing the trade embargo with Cuba is good for America. They should just admit it, says Fareed Zakaria.
updated 8:12 PM EST, Fri December 19, 2014
We're a world away from Pakistan in geography, but not in sentiment, writes Donna Brazile.
updated 12:09 PM EST, Fri December 19, 2014
How about a world where we have murderers but no murders? The police still chase down criminals who commit murder, we have trials and justice is handed out...but no one dies.
updated 6:45 PM EST, Thu December 18, 2014
The U.S. must respond to North Korea's alleged hacking of Sony, says Christian Whiton. Failing to do so will only embolden it.
updated 4:34 PM EST, Fri December 19, 2014
President Obama has been flexing his executive muscles lately despite Democrat's losses, writes Gloria Borger
updated 2:51 PM EST, Thu December 18, 2014
Jeff Yang says the film industry's surrender will have lasting implications.
updated 4:13 PM EST, Thu December 18, 2014
Newt Gingrich: No one should underestimate the historic importance of the collapse of American defenses in the Sony Pictures attack.
updated 7:55 AM EST, Wed December 10, 2014
Dean Obeidallah asks how the genuine Stephen Colbert will do, compared to "Stephen Colbert"
updated 12:34 PM EST, Thu December 18, 2014
Some GOP politicians want drug tests for welfare recipients; Eric Liu says bailed-out execs should get equal treatment
updated 8:42 AM EST, Thu December 18, 2014
Louis Perez: Obama introduced a long-absent element of lucidity into U.S. policy on Cuba.
updated 12:40 PM EST, Tue December 16, 2014
The slaughter of more than 130 children by the Pakistani Taliban may prove as pivotal to Pakistan's security policy as the 9/11 attacks were for the U.S., says Peter Bergen.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT