Putting aside Obama’s egregious bullshit about Americans being able to keep their current coverage, Jonathan Cohn argues that the non-group health insurance market is in great need of Obamacare’s reforms:
By nearly everybody’s reckoning, the ”non-group” market is the most dysfunctional part of the American health insurance system. The dysfunction takes two primary forms. First, insurers have been selective about whom they would cover and how—charging higher premiums, covering fewer services, or simply denying benefits outright to people with pre-existing medical conditions. About half of all Americans have at least one such condition, according to official estimates, so roughly speaking about half the population couldn’t reliably find comprehensive, affordable coverage if they had to buy it on their own.
The second big problem with the non-group market has been the lack of protection it provides even those people who think they have good insurance. At worst, plans in the non-group market border on fraud. They are “mini-med” plans that cover no more than a few hundred dollars of bills, which will last you about ten minutes if you visit the emergency room. But even the better, more respectable plans can exclude whole categories of services, like maternity care, rehabilitation, mental health, or prescription drugs. Typically they also have high deductibles and co-payments.
These policies may seem alluring, because they don’t cost much upfront. But these premiums are notoriously unstable. From time to time, insurers will “close” blocks—in other words, they stop letting new people into the plan—and then jack up rates once a few of the insured get sick.
Sarah Kliff also has a useful primer on the subject. The problem for the ACA, it seems to me, is that many Americans who have bought cheap and light insurance on the individual market are seeing their premiums go up to account for the minimal standards of the ACA, but have real difficulty now in finding out if ACA subsidies will make up some or most of the difference. That’s because of the website clusterfuck. What amazes me about the Obama administration’s gross incompetence on this is that it should have been their strong suit. Obama’s key demographics – young, minority – are precisely those the ACA needs to reach and enroll to work; and Obama’s own record in his campaign infrastructure was of innovative and flawless website management. He had all the advantages for making this work, and blew it.
Nonetheless, it’s obviously impossible for the government to be as flexible as campaigns in hiring talent and these large reforms are infinitely more complex than any campaign.
And as I noted last night, plenty of Republicans were once talking about inevitable glitches and the need for patience after their much more expensive Medicare D entitlement got off to a rocky, protracted start. Romneycare took months and months to enroll everyone. And since this is now the law – do Republicans fully grasp that fact? – it has every chance of getting on track eventually.
Today, we were told the following about the president’s management of this:
Aides said that Mr. Obama had been fixated on details of the law’s carrying out and that advisers did not withhold information but were likewise surprised by the scope of the problems. “From the moment the health care bill was signed into law the president was very focused on making sure it was implemented correctly,” said Dan Pfeiffer, a senior White House adviser. “In just about every meeting, he pushed the team on whether the website was going to work. Unfortunately, it did not, and he’s very frustrated.”
Mr. Pfeiffer insisted that the president wants to hear what he needs to hear and would not accept advisers’ keeping negative information from him. “He’ll know if you don’t tell him the bad news he needs to hear, and that’s the quickest way to be on the outside looking in,” Mr. Pfeiffer said.
So he was fixated on the details but unable to manage the critical website construction to avoid what Sebelius this morning called a debacle. I don’t think that’s more reassuring than the trope of a “bystander president.”