We found this interesting back-and-forth between White House Press Secretary Jay Carney and reporters at today’s press briefing on the Affordable Care Act worth sharing. Carney is being grilled over differences between what President Obama has said on the implementation of the Affordable Care Act and some of the more obvious realities.
Q: Can you explain in just really clear and plain terms the disconnect between what the President said about if you want to keep your plan you can keep it, and what we see people complaining about, which is being kicked out of their plan or being told they have to buy a more expensive plan, or just general unhappiness in that segment? Can you explain that?
MR. CARNEY: I appreciate the question and I thank you for the opportunity to explain this. And I understand that there’s a lot of attention being focused on it and that it deserves fuller explanation — and I think fuller explanation by us and fuller explanation by everybody reporting on it, so that viewers and readers and listeners are getting the full picture about this issue.
So let’s step back. If you are one of the 80 percent of the American people who receive insurance coverage through your employer or through Medicaid or Medicare or the Veterans Administration, this conversation doesn’t apply to you. These reports do not apply to you. If you’re one of the 15 percent of the American people who are uninsured entirely right now, this conversation does not apply to you. So what we’re talking about here is the 5 percent in the country who currently purchase insurance on the individual market.
And that market has been like the Wild West. It has been under regulated. It is the place where Americans have most keenly felt the challenges posed by the insurance system in this country, where, for example, insurers could deny you coverage if you have a preexisting condition, or they could offer you coverage that in its fine print excluded benefits specifically related to your preexisting condition. So if you have hypertension or you’re a cancer survivor, they could carve out coverage on those specific issues and then give you a plan that would cover you on other things.
They could also, and did, routinely, change your plan or eliminate it altogether, annually. They could throw you off. They could jack up your premiums. They could change your coverage. And one of the issues that the affordable care act was designed to address was the need to provide greater security to those Americans who had no other option but to seek insurance on the individual market.
So that’s the universe we’re talking about: 5 percent of the population. And I think it’s important to know that, because in some of the coverage of this issue in the last several days, you would think that you were talking about 75 percent or 80 percent or 60 percent of the American population. So there’s that.
As the law says, and as the President made clear in the statements that you cite, if you had insurance coverage on the individual market when the affordable care act was passed into law and you liked that plan and you wanted to stay on it, even though it didn’t meet the minimum standards that the affordable care act would bring into place on January 1, 2014, you can keep the coverage. You’re grandfathered in. That plan and your association with it are grandfathered in, in perpetuity — not for a year, not for five years, but forever.
But what is not the case is if your insurer basically threw you off that plan by telling you after a year or two that it was changing and said, here’s your new option because your plan has changed, that that new plan is grandfathered in. Because how could that be? You can’t grandfather in a plan in 2010 that didn’t come into existence until 2012 or 2011?
Q So it’s the insurers that are at fault is what you’re saying?
MR. CARNEY: It’s not about fault. The insurers, in the lead-up to the creation of these marketplaces, were doing what they’d always done, based on the incentives that existed in the existing insurance market for individuals.
The good news is that for every one of these individuals who might have a plan that is almost by definition providing less than minimal benefits, and that may, as is normally the case, charge you twice as much if you’re a woman, or penalize you because of your age or because of a preexisting condition, you now are being offered a variety of options, including options by the very insurer that covers you today, for new coverage.
And what is also true is that you can look at those options and then go and check what your qualification might be for tax credits, and you might discover, as a significant portion of this 5 percent will discover, that you’re actually going to pay less come January for better coverage than what you’re paying now for far worse coverage.
There was a story the other morning that highlighted this phenomenon, the sending of letters, that featured a woman in Florida who was worried because she could not continue coverage under her existing plan. And as reported, it made it sound like she had a plan and she wanted to keep it, but she couldn’t. And the reason for that would be that this is a new plan that has been created since the affordable care act passed, or that she dropped coverage and reinstated it, again, after the affordable care act passed. But what the report didn’t say is that her plan doesn’t cover her for hospital visits; that her plan is basically one of the most basic kinds of plans available that provide almost no security.
And what we stipulate that the Affordable Care Act, as campaigned on by the President, as the health care reform that he campaigned on, and as drafted and passed into law by Congress and signed into law by the President, and upheld by the Supreme Court, was designed specifically to protect those Americans who were getting a raw deal in the existing insurance market, and protect them by ensuring that everybody could get affordable coverage, or the universe of people who could affordable coverage would expand greatly, and that that coverage would provide basic benefits that are not currently covered in many of these plans.
So I know it’s hard to explain all that when you’re writing about it, and I know it’s hard especially if you’re doing a TV package on it — two minutes it not a long time. But it is important to remember the context here. We’re talking about 5 percent, and we’re talking about — when you look at what actually happened since the passage of the affordable care act and the clause that allows you to grandfather in, the fact is that millions of Americans who have been subject to the whims and vagaries of this individual insurance market are going to have security that they’ve never had before, and better coverage, in most cases, than they’ve ever had before, and cheaper coverage, in many cases, than they’ve ever had before.
Q So people who are unhappy are misinformed about the quality of the insurance that they have?
MR. CARNEY: I think a couple of things. One, every individual story has a story behind it. So someone may not have had insurance coverage when the affordable care act passed, or maybe they were covered by their employer. So maybe last year they lost their employer coverage or they lost their job or they changed jobs, and now they don’t get employer coverage. And they saw and purchased a plan on the individual market, an individual market that provides very few options and very little desirable coverage at affordable costs.
So what is certainly the case is that come January 1st, 2014, plans that don’t provide these basic benefits, plans that don’t provide maternity care, plans that don’t provide mental health care, plans that don’t provide other preventive services, plans that place caps on your annual benefits or caps on your lifetime benefits — all of those can no longer exist, because the purpose here was to create some minimum benefits for the American people so that they could enjoy the security of health insurance coverage, quality health insurance coverage.
But for people who were on a plan when the affordable care act was signed into law and who want to keep that plan, and they’ve stayed on that plan, and the insurer hasn’t pulled that plan away from them and replaced it with something else in the interim that does not meet the standards of the Affordable Care Act, they can keep that plan if they so choose. They may want to investigate their options on the marketplaces, because in so many cases those options are superior to their existing plan.
Q The context and the caveats that you just presented there about the President’s repeated claim that if you like your plan you can keep it was never really mentioned to the American people when the President was time and again saying this in the run-up to the passage of that law. Is an essential question here, Jay, did the President mislead the American people when he made that comment repeatedly?
MR. CARNEY: Jim, no, the President was clear about a basic fact: If you had insurance that you liked on the individual market and you wanted to keep that insurance through 2010, 2011, 2012, 2013, and in perpetuity if you wanted it and it was available, you could — you were grandfathered in.
What no health care reform could envision or could responsibly stipulate is that any plan that might come along in the next few years would be grandfathered in, because that would undermine that basic premise of providing the minimum benefits for the American people.
So, again, in all of these cases, what is absolutely true is that if you had a plan before the affordable care act that you liked on the individual market, and your insurance company didn’t take that away from you and offer you instead something else that you then purchased, but they provided you the same plan this would time, you can keep it. And that’s true and if you’re — again, I would encourage you and others to —
Q There are people out there who don’t — or who do like their plan, as crummy as it might be, in the views of this White House. Those folks are not being able to keep their plan in some of these cases in the individual market because it does not meet the requirements of the law as it stands now or as it will be next year. So I just don’t understand how you can say that the President’s claim back in 2009 and 2010, if you like your plan you can keep it, was an accurate claim.
MR. CARNEY: Well, Jim, again you’re –
Q Because there are people now who are now losing their insurance. It just doesn’t –
MR. CARNEY: But, Jim, you’re basically saying that if somebody bought a plan on December 15th that did not provide hospital coverage, did not provide maternity benefits, charged your sister — if you have one — double what they charged you, even if she is a twin and genetically the same –
Q But if you’re a 27-year-old male who doesn’t want maternity coverage or isn’t worried about being put in the hospital?
MR. CARNEY: Well, isn’t worried about being put in the hospital? That is precisely the point, because there are 27-year-olds out there —
Q His choice.
MR. CARNEY: Well, that goes to the fundamental debate about whose responsibility it is to cover the cost of that 27-year-old when he or she ends up in the emergency room. Because if he’s not covered or she’s not covered, you’re paying the costs and you’re paying the costs and I’m paying the costs. And that’s not fair to taxpayers who deal with those costs or to individuals on the private insurance market who absorb those costs through their own insurance plans.
Q But this isn’t really a new issue. PolitiFact said back in 2010 that this was “half-true.” Factcheck.org said, “The President can’t make this claim” back in 2009. So there are questions about this claim –
MR. CARNEY: Well, wait. You’re saying, on the one hand, people didn’t know, and on the other hand they did. So the claim the President was making, the only claim we could make, because we couldn’t predict what plans would exist between the passage of the law and the full implementation of it, was that if you had a plan prior to the passage of the affordable care act that you like, you could keep that plan and stay on it even if you might get a better deal with better benefits through the marketplaces.
But it is true — and there was a debate about this and I’m sure there will continue to be a debate that a fundamental premise of the affordable care act is that there ought to be minimum standards for insurance coverage for everybody. And that is what the marketplaces provide.
Q One of the top Democrats in the House, Steny Hoyer, said this morning, “I think preciseness would have been better.” He was making that comment about the President’s claim if you like your plan you can keep it.
MR. CARNEY: Jim, I appreciate that and as I was saying —
Q Is Steny Hoyer missing –
MR. CARNEY: — to another reporter, look, if you want to make that point, you can. Again, I’ve explained exactly what was possible when the law was written. You can’t grandfather in plans that didn’t exist. You can’t grandfather in people who didn’t have insurance and then bought it in the interim.
Q Some precision might have been better on the President’s part.
MR. CARNEY: Well, Jim, again, you can focus on that level, or if you do –
Q It’s an important point to focus on, Jay –
MR. CARNEY: Absolutely, focus on it –
Q This is something that the President said time and again to sell the health care law to the American people, and it was something that reassured millions of Americans out there that their plan would not be changed. So it’s not something that we’re just picking on one little thing here to make a big political point or conflate –
MR. CARNEY: All I ask is that when you do the report, you note that anybody who had a plan the day before the affordable care act passed and was signed into law, and has not been thrown off that plan and had it replaced by their insurer, has not dropped coverage of their own volition and then purchased it again in the interim, but has had that plan, is grandfathered in and can keep that plan. That is what we were saying and that is a fact.
Also, when you do this story, just please remember that the universe you’re talking about here is 5 percent. That’s the whole individual insurance market — 5 percent of the population. And that’s an important 5 percent. That’s a 5 percent that is of outsized concern to the drafters and implementers of the affordable care act because they’re the ones — those are the Americans who have been most subject to the wild vagaries of the system as it existed before the Affordable Care Act, who at the drop of a hat could have lost coverage or been told that their premiums were doubling, or that they would have no longer been able to get coverage for a specific condition because it was preexisting. All that changes come January 1st.
Q All right. Finally, does the President regret making that claim?
MR. CARNEY: Jim, I think I’ve answered the question.
Q Does he believe he should have been more precise?
MR. CARNEY: The President said, as many others said, that if you had a plan that you liked on the individual insurance market — and, again, that’s the individual insurance market. Obviously, if you’re on a plan that your employer provides or if you’re on Medicare and you like it — as virtually every recipient of Medicare seems to — or Medicaid, or you get benefits through the va — again, when you report this, make that clear — all of these populations are not affected by what happens on the individual market. But if you had a plan on the individual market and you liked it and you like it, and you’ve kept it, you can keep it forever as long as your insurer offers it. We can’t — you have to remember —
Q It’s your requirements. It’s your law’s requirements that are putting insurers in that situation.
MR. CARNEY: Jim, I stipulate that — and I think it’s important to talk to insurers, Jim, because if you ask them do they want those consumers, those customers out there who are now shopping around for the options available to them on the individual market — options that, almost by definition, are superior to the ones they’ve had before — the answer the insurers will tell you is, yes.
And they are going to aggressively pursue those customers, because the affordable care act has changed the entire dynamic of the marketplace so that you don’t have a marketplace in which it is the sensible business decision for insurers to deny coverage to you if you’re sick, or charge a woman twice the price, or refuse basic services like maternity care or mental health services. It is in their interest now to sign up as many customers as they can, because this system now allows for individuals on this market to purchase affordable health insurance that they haven’t been able to purchase before.
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