President Obama made repeated promises before, during, and after signing his landmark Affordable Care Act into law. One of those promises was that if you like your health care plan, you can keep your health care plan.
When hundreds of thousands of people recently began receiving notices that their health plans were being terminated because they did not comply with ACA requirements, the president had to face angry Americans and anxious Democrats facing re-election.
With news media repeatedly repeating his earlier assurance, he did what a leader should do: He apologized and pledged to regain public trust.
Continued divisiveness regarding his signature health care reform law, plummeting poll numbers, a botched rollout of the highly touted healthcare.gov health insurance marketplace, and the recent admission that statements about keeping your health plan were, at best, misleading have certainly been setbacks to the Obama administration.
There is reason to believe that the healthcare.gov website will function better by the time midterm elections roll around. There is also the possibility that there will be greater support for the ACA once more people are insured in 2014, especially if premiums do not skyrocket next fall, when insurers reset rates after this initial year of a hard-to-predict risk pool of newly insured members.
However, the next shoe is about to drop, and it will be another blow to the presidents credibility and a significant challenge for his party.
At the same time the president and other Democratic leaders made assurances regarding health care plans, they also told Americans that if they liked their doctors, theyd be keeping their doctors.
For many Americans, that will not turn out to be true, either. And between now and February, I think this is going to blow up on the administration just as the health plan issue did.
This is not because of requirements in the ACA, but rather insurers response to the ACA.
Its also not the design of the ACA, as was the issue relating to whether health care plans would qualify as of 2014, but the narrow networks that are emerging in response to the pressing need to reduce health care spending.
The ACA shifts a lot more risk to insurers, who now have to cover everyone regardless of pre-existing illnesses. The law prescribes a rich packet of benefits.
Many predict that younger, healthier people will be reluctant to buy insurance, which insurers count on to help subsidize the costs for older and sicker participants. To respond to the cost pressures, insurance companies already are creating narrow networks and obtaining price concessions from hospitals and physicians in return for greater numbers of patients.
These are natural and necessary responses of the market to cut costs. And in this case, the outcry will not be a consequence of the presidents doing, but will become a problem for him because he went out on a limb and promised the American people that they could keep their doctors.
Its one thing to change plans. It is an entirely different matter to have to change doctors. My prediction is that this will be a much greater crisis of credibility for the president and the ACA than the health plan issue has been.