The Obama administration calls it an adjustment, Republicans call it a bailout and insurance companies call it the one thing that might keep them from raising rates and angering policyholders.
The “it” in question is a quiet shift in a provision of the Affordable Care Act that makes billions of tax dollars available to insurers if they find themselves losing money on the healthcare law’s new insurance exchanges. The administration felt compelled to do this because of another, more public revision of the law that was made a few months ago.
Remember when the President Obama famously promised that, despite the big changes in the healthcare system, anyone who liked their old medical plan could keep it? As it turned out, that was not exactly true. A lot of people did, in fact, have their plans canceled because those plans did not match the new minimum standards of the healthcare law. They raised a big stink. Republicans called the president a liar. And, already reeling from the near collapse of the Obamacare website at its launch, folks at the White House did not want to deal with another big political problem.
So they changed the rules and said, for now, people could hang on to their old plans, even if those plans failed to comply with the new standards. That calmed the waters but created a new wrinkle.
The folks who kept their old healthcare deals tended to be a bunch of healthy individuals -- the kind that insurers need to balance the costs of the more sickly people who now have guaranteed access to the insurance exchanges.
The industry was not happy with this switch and let the White House know they would increase premiums on their customers to a higher level than expected -- and that this would occur not too far in advance of the November congressional elections. The only thing that might dissuade them from a big rate hike would be a guarantee that the government would reimburse them for unanticipated higher costs.
A piece of the healthcare law called the Temporary Risk Corridors Program was supposed to do just that: cover insurers hit too hard with the added expense of taking care of all the new customers with compromised health.
The insurance industry, however, feared the program would not be adequate. To calm that fear, the administration made the small adjustment to tap other federal healthcare funds to compensate insurance companies, if necessary, and hold down premiums.
Now that they have gotten wind of this, Republicans are crying foul, branding the move with the politically charged term “bailout.” They accuse the administration of playing politics, cutting a deal for the insurance industry as a way to protect Democratic incumbents in the fall campaign who might otherwise face the ire of outraged constituents with bigger insurance bills.
The Republicans may well be right. Politics is likely a factor. But the ploy to keep premiums down is also just another desperate toss in the ongoing juggling act that Obama is performing. His healthcare law is hugely ambitious and incredibly complex. As the decision to let people keep their old plans has proved, moving one small part at one end of the contraption sets off a chain reaction through the whole machine. Each adjustment leads to several others adjustments, most unforeseen.
Add in all the monkey wrenches of politics and it’s easy to see why big change is easier to promise than to accomplish in Washington. When trying to do right, there is so much that can go wrong.