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À La Recherche de Promesses Perdues



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Sarah Kliff, who usually writes for the Washington Post’s Wonkblog, has written a handy Poynter guide for the media. In it, Kliff instructs journalists how they might best cover Obamacare, and stay clear of “the common mistakes that I’ve made before, have seen others stumble on and hope you can avoid.” One of these mistakes jumped out at me:

Comparing premiums from before and after the health care law. The health care law will dramatically upend the individual insurance market beginning Jan. 1. That makes comparing premiums from before the health law to those offered afterwards a bit like comparing apples to oranges — or even apples to steak.

Here’s why: The health care law makes four big changes to the individual insurance market. First, it requires health insurance plans to cover all subscribers regardless of whether they have any pre-existing health conditions. This will likely increase premiums, as insurers will have to accept sick patients who, right now, they reject.

Second, it dramatically restricts the factors that insurance plans can use to determine the size of premiums that a subscriber will pay. Right now, they can use hundreds of different elements of an individual’s health. Starting in 2014, they can only use three factors: age, location and tobacco use. This change will likely increase premiums for the young and healthy, but decrease them for the old and sick.

Third, insurance companies are required to cover 10 categories of benefits, like maternity care and hospital visits. Known as the “essential health benefits,” this set of health care services is generally thought to be more robust than what individual market plans cover now. This policy will probably nudge up premiums just a bit.

Fourth and lastly, the health law includes subsidies for low- or middle-income people to purchase health insurance. This will likely decrease premiums, as it provides financial help for those buying their own coverage.

Taken together, these suite of four changes make the insurance market of tomorrow different than what exists right now. It’s one where insurers have to take all consumers — and will have to provide a larger suite of benefits. Many shoppers will get financial help. This makes the market very different than what exists right now, and any comparisons between premiums of the past and future extremely difficult.

This is a fair argument in and of itself, and it is similar to arguments that have recently been made by Ezra Klein, Jonathan Chait, and Jonathan Cohn. Funnily enough, it’s also similar to arguments that conservatives have made for years. This is to say that, despite the flat insistence of the Obama administration and of the law’s advocates, it was always extremely obvious that there was no way that Obamacare could lower everybody’s premiums while doing everything else it promised. Nevertheless, it seems to me that Ms. Kliff, who offers her opinion here because she has “spent the past four years writing about the Affordable Care Act for two different newspapers,” is confused as to why journalists might be interested in comparing ”premiums from before and after the healthcare law.” Well, if she genuinely doesn’t know, here’s a helpful primer: Because the president promised flatly they wouldn’t go up.

I have written at length about this, so I won’t rehash the whole thing here. But I will say this: It is absolutely vital that the Left not be allowed to move these goalposts. Yes, Obamacare structurally guarantees that premiums will go up for some people. But what was promised, remember, was this:

Before, during, and after passage, Americans were promised that Obamacare was going to lower premiums for “everyone” (the goal of merely maintaining premiums being too modest); it was not going to interfere with anybody’s health care or health insurance if they already had it; and it was not going change anybody’s patient-doctor relationship. The message was unmistakable: All the government wanted to do was extend health insurance to people who didn’t have it. This wouldn’t affect you. No need to worry. Period. Move along.

That an economics writer of Kliff’s influence is trying deliberately to obfuscate the issue is telling. Whatever the implications of her advice, the argument made in favor of Obamacare was not that the market needed remaking and that there would be inevitably winners and losers, but that everybody would win and nobody would lose. Judging by local media coverage, many people are surprised at what is happening because they remember the promises. Conservatives must ensure that they are not allowed to forget.



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