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 2:49 PM EDT, Tue April 15, 2014
Kathleen Blee says the KKK and white power or neo-Nazi groups give haters the purpose and urgency to use violence.
updated 7:46 AM EDT, Tue April 15, 2014
Sen. Sheldon Whitehouse and Rep. Henry Waxman say read deep, and you'll see the federal Keystone pipeline report spells out the pipeline is bad news
updated 1:43 PM EDT, Tue April 15, 2014
Frida Ghitis says President Obama needs to stop making empty threats against Russia and consider other options
updated 5:29 PM EDT, Tue April 15, 2014
Peter Bergen and David Sterman say the Kansas Jewish Center killings are part of a string of lethal violence in the U.S. that outstrips al Qaeda-influenced attacks. Why don't we pay more attention?
updated 12:41 PM EDT, Tue April 15, 2014
Danny Cevallos says families of the passengers on Malaysian Airlines Flight 370 need legal counsel
updated 11:23 AM EDT, Mon April 14, 2014
David Frum says Russia is on a rampage of mischief while Western leaders and Western alliances charged with keeping the peace hem and haw
updated 7:56 AM EDT, Mon April 14, 2014
Most adults make the mistakes of hitting the snooze button and of checking emails first thing in the morning, writes Mel Robbins
updated 1:54 PM EDT, Mon April 14, 2014
David Wheeler says as middle-class careers continue to disappear, we need a monthly cash payment to everyone
updated 7:55 AM EDT, Mon April 14, 2014
Democrats need to show more political spine when it comes to the issue of taxes.
updated 11:55 AM EDT, Mon April 14, 2014
Donna Brazile recalls the 50th Anniversary of the Civil Rights Act as four presidents honored the heroes of the movement and Lyndon Johnson, who signed the law
updated 9:17 AM EDT, Mon April 14, 2014
Elmer Smith remembers Chuck Stone, the legendary journalist from Philadelphia who was known as a thorn in the side of police and an advocate for the little guy
updated 2:56 PM EDT, Sun April 13, 2014
Al Franken says Comcast, the nation's largest cable provider, wants to acquire Time Warner Cable, the nation's second-largest cable provider. Should we be concerned?
updated 11:22 AM EDT, Fri April 11, 2014
Philip Cook and Kristin Goss says the Pennsylvania stabbing attack, which caused grave injury -- but not death, carries a lesson on guns for policymakers
updated 3:06 PM EDT, Fri April 11, 2014
Wikipedia lists 105 football movies, but all too many of them are forgettable, writes Mike Downey
updated 10:32 AM EDT, Fri April 11, 2014
John Sutter and hundreds of iReporters set out to run marathons after the bombings -- and learned a lot about the culture of running
updated 12:49 PM EDT, Fri April 11, 2014
Timothy Stanley says it was cowardly to withdraw the offer of an honorary degree to Ayaan Hirsi Ali. The university should have done its homework on her narrow views and not made the offer
updated 10:16 AM EDT, Fri April 11, 2014
Al Awlaki
Almost three years after his death in a 2011 CIA drone strike in Yemen, Anwar al-Awlaki continues to inspire violent jihadist extremists in the U.S, writes Peter Bergen
updated 9:21 PM EDT, Fri April 11, 2014
David Bianculli says Colbert is a smart, funny interviewer, but ditching his blowhard persona to take over the mainstream late-night role may cost him fans
updated 1:31 PM EDT, Thu April 10, 2014
Rep. Paul Ryan says the Republican budget places its trust in the people, not in Washington
updated 5:28 PM EDT, Thu April 10, 2014
Aaron David Miller says Obama isn't to blame for Kerry's lack of progress in resolving Mideast talks
updated 11:22 AM EDT, Mon April 14, 2014
David Weinberger says beyond focusing on the horrors of the attack a year ago, it's worth remembering the lessons it taught about strength, the dangers of idle speculation and Boston's solidarity
updated 12:32 PM EDT, Thu April 10, 2014
Katherine Newman says the motive for the school stabbing attack in Pennsylvania is not yet known, but research on such rampages turns up similarities in suspects and circumstances
updated 7:03 AM EDT, Fri April 11, 2014
Simon Tisdall: Has John Kerry's recent track record left Russia's wily leader ever more convinced of U.S. weakness?
updated 12:40 PM EDT, Thu April 10, 2014
Mel Robbins says Nate Scimio deserves credit for acting bravely in a frightening attack and shouldn't be criticized for posting a selfie afterward
updated 2:39 PM EDT, Wed April 9, 2014
Wendy Townsend says the Rattlesnake Roundup -- where thousands of pounds of snakes are killed and tormented -- is barbaric
updated 9:45 AM EDT, Thu April 10, 2014
Dr. Mary Mulcahy says doctors who tell their patients the truth risk getting bad ratings from them
updated 9:28 AM EDT, Wed April 9, 2014
Peggy Drexler says the married Rep. McAllister, caught on video making out with a staffer, won't get a pass from voters who elected him as a Christian conservative with family values
updated 7:43 AM EDT, Wed April 9, 2014
David Frum says the president has failed to react strongly to crises in Iran, Syria, Ukraine and Venezuela, encouraging others to act out
updated 4:57 PM EDT, Wed April 9, 2014
Eric Liu says Paul Ryan gets it very wrong: The U.S.'s problem is not a culture of poverty, it is a culture of wealth that is destroying the American value linking work and reward
updated 7:51 AM EDT, Wed April 9, 2014
Frida Ghitis writes: "We are still seeing the world mostly through men's eyes. We are still hearing it explained to us mostly by men."
updated 10:08 AM EDT, Thu April 10, 2014
Chester Wisniewski says the Heartbleed bug shows how we're all tangled together, relying on each other for Internet security
updated 3:26 PM EDT, Wed April 9, 2014
Danny Cevallos says an Ohio school that suspended a little kid for pointing his finger at another kid and pretending to shoot shows the growth in "zero tolerance" policies at school run amok
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT