President Obama’s promises about healthcare reform are being put to the test.
With major provisions set to take effect between now and the end of the year, here’s a quick checkup on where five of Obama’s predictions stand.
1.) “We will lower premiums for the typical family by $2,500 a year.”
Obama cited the $2,500 figure repeatedly during the 2008 campaign, and the number was questionable even at the time. It came from a rough calculation of savings throughout every part of the entire healthcare system, not just premiums.
The president hasn’t used the $2,500 figure in years, possibly because many health policy experts don’t expect it to happen.
Setting aside the specific number, the effect of ObamaCare on insurance premiums is shaping up to as a mixed bag. Some consumers will see their premiums fall, albeit not as much as Obama pledged. In New York, for example, some policies next year will cost about half as much as the ones on the market now.
But premiums will undoubtedly increase for other consumers. Young, healthy people who buy inexpensive policies will likely face higher premiums next year, and premium hikes will be highest in states that don’t regulate their insurance markets very strongly now.
2.) The law will bend the cost curve.
Obama and congressional Democrats said the Affordable Care Act would “bend the cost curve,” meaning it would slow the rate of growth in healthcare costs. While healthcare costs have slowed in recent years, there’s a debate over how much credit ObamaCare deserves.
Between 2009 and 2011, national healthcare spending grew at the lowest rate in 50 years. Some experts say that’s partially a result of the country’s slow economic recovery overall. Most of ObamaCare's provisions weren't in effect over that time period.
Medicare’s cost growth has seen a particularly steep slowdown, and there, the link to ObamaCare is stronger. The program’s nonpartisan trustees have said the law’s cuts to healthcare providers extended the life of the Medicare trust fund.
3.) "If you like the plan you have, you can keep it."
Obama has made the claim about keeping healthcare plan repeatedly, starting when the Affordable Care Act was first under debate in Congress.
The promise has been part of the administration's effort to tamp down fears and counter what it says are misconceptions about the law.
Republicans say Obama has already broken the promise. The healthcare law explicitly ended one class of policies: so-called “mini-med” plans that capped the benefits they would pay out in one year. The Affordable Care Act also bans annual and lifetime limits and imposes other new rules requiring plans to offer a minimum level of coverage.
The law protects some plans from changes through its "grandfathering" system, but most policies won’t be able to stay grandfathered for very long.
This shift is more likely to hit people who purchase their insurance on the individual market rather than those who get it through their jobs. Republicans have invoked Obama’s promise as employers have considered cutting workers’ hours to avoid offering healthcare benefits. But for large employers that offer coverage now, the law doesn't require especially big changes.
4.) ObamaCare will increase healthcare benefits.
ObamaCare's chief goal, apart from expanding coverage, was to make sure that people who have insurance receive a robust set of benefits. That is why the law allows parents to keep their children insured on their health plans until they are 26 and why insurance companies must spend a certain number of premium dollars on medical care rather than profits.
The healthcare law also prohibits insurers from discriminating against people with pre-existing health conditions and ends lifetime and annual dollar limits on coverage to ease the burden of catastrophic medical bills. Under another rule, new insurance plans have to cover preventive care such as birth control and disease screenings without charging copays.
Millions of people will experience these benefits, and Obama highlighted many of them ahead of ObamaCare's passage and later on the 2012 campaign trail.
But critics argue the new requirements will hurt more than they help. Their primary charge is that the new benefits will increase the cost of coverage for consumers, employers and insurance companies. Among the unintended consequences, they say, will be reduced hiring and fewer firms offering employee health coverage to begin with.
5.) The law will extend coverage to 30 million people.
The size of the law’s coverage expansion is still to be determined. It’ll almost surely be smaller than expected because the Supreme Court gave states the ability to opt out of the law’s Medicaid expansion, which would have covered about 15 million people if every state took it.
The administration is in the midst of a big enrollment push ahead of the state insurance exchanges opening for business on Oct. 1. The goal is to enroll about 7 million people in the first year, and whether the exchanges meet that target will be one of the most important metrics in judging its success of failure.
Conservatives are hoping to stop the exchanges by urging people, especially young people, not to buy insurance. If the administration’s enrollment push isn’t successful, not only will the law fall short of its coverage goals, but premiums in the exchanges could rise and make them less attractive.
The administration, though, says everything is on track to launch the new marketplaces on Oct. 1, and its allies are making an aggressive enrollment push as the deadline nears.