This article is not the first I’ve seen that calls into question whether Obama was being truthful when he said that health care reform would be structured so that people would still be able to keep their existing health insurance if they wanted to. And it would seem that his statements did amount to a bit of over-promising. But even before the PPACA came up for a vote, many Americans weren’t in control of whether or not they got to keep their existing health insurance.
Nearly six out of ten Americans get their health insurance through their employers, which means that the employers – not the employees – are in charge of selecting policies and determining how much the employees contribute towards the premiums. Although nearly all large companies in the US do offer health insurance for their employees, they often change carriers and plan designs, leaving the employees little choice but to go along with the new options. Payroll deduction for health insurance premiums has steadily increased over the years, as have deductibles and copays. Some employees who used to have low out-of-pocket health insurance paid for entirely by their employers are now finding themselves unable to afford the coverage offered by their employer, or opting to skip it because the out-of-pocket costs are too high (It’s usually a better idea to have health insurance than not, even if the deductible and copays seem high. But when people have to decide between paying rent and paying for health insurance, high deductible coverage is likely to get cut from the budget first).
In addition to the fact that employers – not individuals – control what type of health insurance coverage most Americans have, there’s also been a steady decline over the last decade in the number of employers who offer coverage. This has been exacerbated by the economic conditions over the last few years. Employers can choose to switch their employees to a new health insurance carrier or plan design, but they can also choose to stop offering health insurance all together. This is much more common among small companies than large ones, but – combined with rising unemployment – it has contributed to an overall decline (from 68.3% in 2000 to 58.9% in 2009) in the percentage of Americans who get health insurance from their employers. All of this was happening before the PPACA was written.
It’s true that there are aspects of the PPACA that might force people to switch to a new health insurance policy. The new MLR requirements might make it tough for some of the smaller health insurance carriers to stay in business, and employers who currently offer “mini-med” policies with low benefit maximums might have to either upgrade their coverage or stop offering the policies. It remains to be seen how the various cost saving aspects of the PPACA will work, but it’s clear that even before the health care reform laws were written, people didn’t always have an option of keeping their existing health insurance if they liked it. Only 6.3% of Americans have individual health insurance (selected by the insured). Far more people are either covered by an employer’s policy, covered by public health insurance (Medicaid, SCHIP, etc.), or uninsured. Many of those people were never really in charge of selecting their own health insurance in the first place.