Let’s Try to Keep Obamacare Anecdotes In Perspective

Examples of how the law impacts Americans are important to the conversation, but need to be observed through a wider lens.

Sen. Lamar Alexander speaks to members of the media at the Capitol October 11, 2013 on Capitol Hill.
National Journal
Nov. 6, 2013, 9:21 a.m.

The ex­per­i­ence of “mil­lions of Amer­ic­ans” has been thrown back and forth re­cently by both parties as evid­ence of Obama­care’s suc­cess or fail­ure, de­pend­ing on who’s talk­ing.

In Sen­ate hear­ings this week, law­makers piled on spe­cif­ic stor­ies from their con­stitu­ents as em­blem­at­ic of lar­ger im­pacts of the health care law. For Re­pub­lic­ans and Demo­crats, there are two dif­fer­ent “mil­lions of Amer­ic­ans.”

“My late friend Alex Haley used to say: Lamar, if in­stead of mak­ing a speech you just tell a story, some­body might listen to you,” Sen. Lamar Al­ex­an­der, R-Tenn., said Tues­day at a hear­ing of the Sen­ate Com­mit­tee on Health, Edu­ca­tion, Labor, and Pen­sions with Cen­ters for Medi­care and Medi­caid Ser­vices Ad­min­is­trat­or Mar­ilyn Taven­ner.

Re­pub­lic­ans like Al­ex­an­der cited the mil­lions of Amer­ic­ans who are re­ceiv­ing plan can­cel­la­tions from their in­sur­ance com­pan­ies as a shot at Pres­id­ent Obama’s re­peated state­ment that “if you like your plan, you can keep it.”

“I re­cently heard from one of those Ten­nesseans whose policy will be can­celed on Janu­ary 1,” Al­ex­an­der con­tin­ued. “Her name is Emily. She’s 39. She has lupus. She told me: ‘I can­not keep my cur­rent plan be­cause it doesn’t meet the stand­ards of cov­er­age. This alone is a trav­esty,’ she said.”

Demo­crats, on the oth­er hand, are em­phas­iz­ing the mil­lions of Amer­ic­ans who will be newly eli­gible for af­ford­able health cov­er­age for the first time, as a res­ult of Medi­caid ex­pan­sion, premi­um sub­sidies avail­able on the ex­changes, and pro­tec­tions against dis­crim­in­a­tion based on preex­ist­ing con­di­tions or gender. 

“Let me first share with you a story from Michigan that was high­lighted in an art­icle in the L.A. Times that talked about a wo­man named Ju­dith,” Sen. Debbie Stabenow, D-Mich., said Wed­nes­day at a Sen­ate Fin­ance Com­mit­tee hear­ing with Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us.

“She’s 48 years old, works in a de­part­ment store, had an in­sur­ance plan that cost her $65 a month. It was af­ford­able. She thought she had in­sur­ance. Then she was dia­gnosed with can­cer and found out that her plan had a $2,000 an­nu­al lim­it for hos­pit­al ser­vices, which would give her about one day in the hos­pit­al. So she delayed her care. Her can­cer got worse, and she was in a very dif­fi­cult, dif­fi­cult situ­ation.” Stabenow noted that un­der the Af­ford­able Care Act, Ju­dith would not face caps on cov­er­age, high­er rates as a wo­man, or re­jec­tion from in­sur­ance com­pan­ies be­cause of her ill­ness.

Both types of stor­ies are hap­pen­ing across the coun­try, and both are im­port­ant. However, the health care law is far more com­plic­ated than any of these an­ec­dotes in­dic­ate at face value, on their own. Some people will face premi­um in­creases. Oth­ers will see their premi­ums de­crease. Many will be eli­gible or able to af­ford cov­er­age for the first time.

In­sur­ance works by bal­an­cing these changes. To in­crease cov­er­age for mil­lions of people, something’s got to give — some people will pay less, but some people will pay more. In any private mar­ket­place, some health­i­er people end up ef­fect­ively sub­sid­iz­ing cov­er­age for oth­ers if they them­selves don’t end up need­ing med­ic­al care.

However, it’s im­port­ant to re­mem­ber that the num­ber of people who pur­chase in­sur­ance on the in­di­vidu­al mar­ket is re­l­at­ively small. The law will not af­fect the ma­jor­ity of Amer­ic­ans, and the num­ber of the newly in­sured is ac­tu­ally much lar­ger than those los­ing their ex­ist­ing policies.

So yes, some will face high­er premi­ums, while oth­ers will be newly or more com­pre­hens­ively in­sured. These are both key sides of the story to high­light as de­bate over the law’s im­ple­ment­a­tion con­tin­ues. But to get an ac­cur­ate pic­ture, the stor­ies must be re­con­ciled and told to­geth­er.

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