On November 7, President Barack Obama made a first tentative
stab at an apology for the fact that, despite his often-repeated
assurances to the contrary, millions of Americans were losing their
health insurance plans as a result of the Patient Protection and
Affordable Care Act (ACA). "I am sorry that they are finding
themselves in this situation based on assurances they got from me,"
he told Chuck Todd of NBC News.
The president's reluctant apology was as empty as the promise
that he broke. Obama was not sorry for the law or its impact on the
health insurance status of millions, which was not only predictable
but intended. Nor did he apologize for misleading the public, as he
most certainly had. At a press conference the following week, White
House Press Secretary Jay Carney struggled to explain what exactly
the president was contrite about.
Despite its insufficiency as a mea culpa, the
president's interview was a tacit acknowledgement that the
disastrous rollout of his signature legislative achievement had
produced a crisis of confidence not just in Obama's competence but
in his credibility. This development was underscored five days
later when a Quinnipiac poll found that 52 percent of Americans no
longer trusted him.
In a rambling, unusually reflective press conference on November
14, a weary-looking Obama actually swallowed a bit of crow instead
of just picking at it. "I completely get how upsetting [the
cancellations] can be for a lot of Americans, particularly after
assurances they heard from me that if they had a plan that they
liked, they could keep it," he said. "There is no doubt that the
way I put that forward unequivocally ended up not being accurate."
The president also acknowledged that "we fumbled the rollout on
this health care law," saying, "I did not have enough awareness
about the problems in the website." He added that "I think it's
legitimate for [people] to expect me to have to win back some
credibility on this health care law."
But Obama's broken promise that people who liked their health
plans could keep them only scratches the surface of the
administration's health care mendacity. As the following list
illustrates, it was one of at least a dozen false or misleading
statements that senior administration officials and ranking
Democrats made before, during, and after Obamacare was signed into
law. The persistent misrepresentations and outright lies were in
fact integral to the law's passage, to its implementation, and to
the damage-control phase that began with the botched launch of the
online insurance exchanges in October. Judging by how badly the
rollout has been managed thus far, it is possible that the
president's apology tour has only just begun.
1. "If you like your insurance plan, you will keep
it."
The most notorious of Obama's promises was arguably the most
critical for Obamacare's passage. Here is how he put it a week
after signing the ACA into law: "If you like your insurance plan,
you will keep it. No one will be able to take that away from you.
It hasn't happened yet. It won't happen in the future."
Obama offered some variation on this promise dozens of times
even after the summer 2010 release of rules governing which
pre-existing insurance plans would be "grandfathered" into legal
acceptability despite not otherwise complying with the new law.
Those regulations prompted bureaucrats at the time to quietly
estimate that between 40 and 67 percent of individual market health
insurance plans would not be covered by the grandfather clause.
Indeed, the rules were crafted narrowly to guarantee this result,
so that healthy people on low-cost plans would end up switching to
more expensive insurance, in effect subsidizing sicker people
covered by the policies sold on the exchanges.
Obama's advisers knew full well that his original promise could
not be kept. As The Wall Street Journal reported on
November 13, the White House policy team pushed for more nuanced
language than its political staff wanted. The wonks lost out to the
hacks.
Reality: According to a November 4, 2013,
report in Politico, more than 3.5 million Americans have
been hit with health plan cancellations. Millions more are expected
to follow.
2. "What we said was you can keep it if it hasn't
changed since the law passed."
It wasn't enough for President Obama to mislead millions of
people about whether they could keep their health plans. When
initially called out on it, the administration responded with a lie
about the lie.
"FACT: Nothing in #Obamacare forces people out of their health
plans. No change is required unless insurance companies change
existing plans," White House adviser Valerie Jarrett declared in an
October 28 Tweet, simply ignoring the reality that the plans being
canceled were terminated because of minimum coverage requirements
that were built into Obamacare.
Cornered, the president attempted to rewrite history. "If you
had one of these plans before the Affordable Care Act came into law
and you really liked that plan," he said in a November 4 speech,
"what we said was you can keep it if it hasn't changed since the
law passed."
Reality: President Obama promised repeatedly,
with no caveats or qualifications, that people who liked their
plans could keep them, and that no one would ever take them away,
period. Versions of the promise were captured on video at least 36
times.
3. "If you like your doctor, you will be able to keep
your doctor, period."
This promise was nearly as central to passing the law. In a June
2009 speech to the American Medical Association, the president put
it this way: "No matter how we reform health care, we will keep
this promise to the American people: If you like your doctor, you
will be able to keep your doctor, period."
Reality: People who can't keep their plans
often can't keep their doctors, because doctors are affiliated with
particular networks and insurers. Many of the new plans offered
through the law's insurance exchanges were built with narrow
networks to keep costs down. Top hospitals are available under
relatively few of the exchange plans, generally those with
relatively high premiums.
4. "We'll start by reducing premiums by as much as
$2,500 per family."
Just as Obama made the wildly unrealistic promise that his
health care overhaul would not have any effects that people did not
like, he also promised that it would have an effect everyone
would like: lower insurance premiums. "It's easy to have
good ideas and make big promises," he said in a campaign trail
speech in 2008. "You've all heard plenty of that these past 20
months. The hard part is coming up with a concrete, detailed plan,
and translating that plan into action. So today, I want to take a
few minutes to tell you exactly what I plan to do, how I'll get it
done, and how I'm going to pay for it. We'll start by reducing
premiums by as much as $2,500 per family."
Obama made the promise at least a dozen times in the run-up to
the 2008 election. But eventually the claim receded as average
health insurance premiums continued to rise. Health and Human
Services Secretary Kathleen Sebelius backtracked in March 2013,
saying that under the law some "folks will be moving into a really
fully insured product for the first time, so there may be a higher
cost associated with getting into that market." In short, maybe you
can't keep your plan-and, oh yeah, your plan might be more
expensive too.
Reality: The average annual premium for an
employer-provided health plan rose from $13,375 to $16,351 between
2009 and 2013, according to a survey by the Kaiser Family
Foundation. Prices for individual market plans like those found on
the exchanges are also up, with the average state facing premium
increases of 41 percent, according to a November 2013 analysis by
Manhattan Institute health policy analyst Avik Roy.
5. "It will create 4 million jobs-400,000 jobs almost
immediately."
It wasn't enough to pitch Obamacare as a premium-reducing law
that would not have any negative consequences. Democrats also
argued that it would create jobs. "This bill is not only about the
health security of Americans," Rep. Nancy Pelosi (D-Calif.), then
speaker of the House, said in February 2010. "It's also about jobs.
In its life, it will create 4 million jobs-400,000 jobs almost
immediately."
Reality: The gush of jobs never materialized.
The unemployment rate slowly receded in the months after Obamacare
passed, but largely because more people had quit searching for
work. By 2021, according to projections by the Congressional Budget
Office, the law is expected to shrink the nation's work force by
about 0.5 percent, since fewer people will hold onto their jobs to
maintain their health insurance.
6. Obamacare "pushed back on the undue influence of
special interests."
When he signed the Affordable Care Act into law on March 23,
2010, President Obama proclaimed that it represented a triumph of
the little guy over the politically powerful. "Tonight we pushed
back on the undue influence of special interests," he said. "We
proved that this government-a government of the people and by the
people-still works for the people."
Reality: Obama cut deals with major incumbents
in the health care industry to obtain their nearly unanimous
support. America's Health Insurance Plans, an industry group,
backed the law because of the individual mandate to buy health
insurance. The American Medical Association was reportedly promised
that, in return for its support, Democrats would fix the way
Medicare pays doctors-a fix that never came. And as documents
released by congressional Republicans eventually revealed, the
White House cut an explicit deal with the pharmaceutical industry
guaranteeing that the administration would not pursue several
policies that drug makers opposed, in order to get the industry's
support for the law. Meanwhile, Obamacare has never been popular
with the public it was supposed to be working for.
7. "We are on schedule, and will be ready for the
marketplaces to open on October 1."
Democratic, Republican, and independent experts all repeatedly
expressed skepticism about the administration's ability to deliver
a functional health insurance exchange system by October 1, 2013,
the day it was set to launch. Over and over again, federal health
officials insisted that they would be ready on schedule. "I am
confident that states and the federal government will be ready in
10 months," said Gary Cohen, who ran the exchange implementation
project inside the Centers for Medicare & Medicaid Services, in
December 2012. He repeated the claim in February 2013, and his
colleagues followed suit.
In July, just weeks after a scathing Government Accountability
Office report warned that the project had missed a slew of
deadlines and might not be ready on schedule, the Department of
Health and Human Services (HHS) released a web video titled "HHS is
on Schedule," that ended with a dated promise: "10/01/2013: The
Health Insurance Marketplace Will be OPEN for ENROLLMENT." Health
agency spokespersons continued to proclaim the project's readiness
right up to the moment of launch.
Reality: The launch was a disaster, with
serious problems in many state exchanges and with the federal
website freezing up just minutes after going live. It was a
catastrophe that some in the administration knew was on the way.
"Confidential progress reports from the Health and Human Services
Department show that senior officials repeatedly expressed doubts
that the computer systems for the federal exchange would be ready
on time," The New York Times reported on October 12,
2013.
8. "Regardless of how the Marketplace is managed,
consumers will be able to access the Marketplace with
ease."
The administration did not just signal that the federal exchange
site, HealthCare.gov, would be ready on time. The president and
others also insisted it would be a snap to use.
"Starting on Tuesday," Obama said in a Maryland speech less than
a week before the exchanges opened, "every American can visit
HealthCare.gov to find…the insurance marketplace for your state."
Using the exchange would be "real simple," he said. "It's a website
where you can compare and purchase affordable health insurance
plans, side by side, the same way you shop for a plane ticket on
Kayak-same way you shop for a TV on Amazon."
Cohen, the senior exchange official, sang the same tune to
Congress in February: "We have been hard at work to ensure the
Marketplaces will be easy to use when they become operational."
Reality: As Obama and Cohen were making their
promises, they had no idea whether the site would even be
functional. On September 26, the day of Obama's Maryland speech,
"there had been no tests to determine whether a consumer could
complete the process from beginning to end," according to an
October report in The Washington Post. That month
Businessweek reported that such testing still had not been
conducted.
9. "We expect to resolve these issues in the coming
hours."
Following the disastrous launch of the exÂchanges,
administration officials said not to worry, that problems would
soon be resolved. On October 1, the day the exchanges opened, one
anonymous federal health official told Reuters that "we expect to
resolve these issues in the coming hours."
But the system continued to struggle. A few days later,
officials promised yet another fix was on the way. "To make further
improvements to the system, we will be taking down the application
part of the website for scheduled maintenance during off-peak hours
over the weekend," an HHS official explained in a statement to the
press on October 4. "We expect that Monday, less than a week after
the marketplace opening, there will be significant improvements in
the online consumer experience."
Reality: The problems went much deeper than the
administration initially claimed. Six weeks after launch, online
enrollment in the federal exchanges was still stymied by serious
technical failures. "The website is not working well," White House
Press Secretary Jay Carney admitted on November 7, and it "hasn't
been working well for the first month of the rollout." An HHS
report later revealed that the site had been accessible just 42
percent of the time during the month of October.
10. "Take away the volume, and it works."
As the launch of the exchange system continued, top members of
the administration began to admit they had a problem. But it was,
in the words of HHS Secretary Sebelius, "a good problem to have."
The failure, they claimed, was due to higher-than-expected traffic,
meaning there was even more initial interest in the exchanges than
the administration had anticipated. It would therefore be an easy
problem to solve. "These bugs were functions of volume," White
House Chief Technology Officer Todd Park told USA
Today on October 5. "Take away the volume, and it
works."
Reality: Volume dropped, but malfunctions
continued. Outside experts contacted by multiple news organizations
found many shortcuts, messy construction, and unnecessary functions
in the visible portions of the code. And insurers reported that the
enrollment information they were receiving from the system was
frequently flawed. The system was not just overwhelmed; it was
poorly designed.
11. "No, we don't have that data."
How big were the problems with HealthCare.gov? The most obvious
way to find out was by counting the number of people able to fully
enroll in health coverage. But as the rollout continued to flail,
the administration refused to release any data. In fact, in the
first few days, officials simply denied they had access to the
numbers.
"No, we don't have that data," White House spokesperson Jay
Carney told reporters on October 3. "I can't tell you, because I
don't know," HHS Secretary Sebelius told The Daily Show's
Jon Stewart on October 7. Their pleas of ignorance strained
credulity.
Reality: Leaked notes from the administration's
daily Obamacare war room meetings later revealed that on launch day
there were a total of six enrollments through five
different insurance issuers. By the second day, the number had
climbed to 248. The numbers were terrible, so the administration
pretended they did not exist.
12. "[We] follow high standards regarding the privacy
and security of personal information."
Beyond the issue of whether the exchanges would work at all,
many had questions about whether they would be secure. The
exchanges were designed to judge eligibility for Obamacare's
insurance subsidies, which would require applicants to submit
Social Security numbers, addresses, income numbers, and other
sensitive personal information.
The administration insisted that Web security would be tight.
"The final Marketplace rule," Gary Cohen, the top exchange
official, told the Senate Finance Committee in February 2013,
"ensures Marketplaces develop and follow high standards regarding
the privacy and security of personal information while following
Affordable Care Act requirements regarding the use of data."
Reality: By launch day, the deadline-driven
operational demands outweighed security concerns. The exchange went
live under a last-minute temporary security authorization signed by
Marilyn Tavenner, the head of the Centers for Medicare &
Medicaid Services. It said "aspects of the system that were not
tested due to the ongoing development exposed a level of
uncertainty that can be deemed as a high risk."