Here’s the skinny on this: workers who have employer coverage cannot shop in the exchanges and receive subsidies if their share of the employer’s premium is less than 9.5 percent of their gross income. They can, however, shop and get no subsidy, but most workers are not likely to do that. Those who will lose their employer coverage are the millions of workers who have those Cadillac plans, the top-notch coverage that the law prompts employers to drop come 2017, to be replaced by plans that offer fewer benefits. That’s part of the “skin-in-the game” strategy for holding down costs that makes workers assume more of the cost of their care.
That brings us to Politico’s second hard truth, “Costs aren’t going to go down,” even if a video released by the Obama administration seems to suggest otherwise. “If the law works as the administration hopes, premiums may not rise as fast. But they’re not going to plummet,” Politico reported. If premiums don’t rise as much, the costs people see are going up through higher deductibles and higher coinsurance, the percentage of a bill that the consumer pays. The word “costs” is tricky, and seems to apply to whatever either party wants it to mean.
“It’s just a guess that the law can pay for itself,” is Politico’s third hard truth, even though the administration and the Congressional Budget Office continue to say that the law will reduce the deficit, because it will pay for itself through reimbursement cuts to hospitals and Medicare Advantage plans—which, as I’ve just noted, have yet to fully take effect and pinch both insurance companies and seniors. Although the CBO assumes Congress is going to let those cuts happen, Politico says to “watch for plenty of lobbying pressure on Congress to cancel those cuts.” Small business are already lobbying hard to repeal new taxes they claim would simply be passed along in the form of higher premiums, and cause more lost jobs.
Politico cites polling data for the fourth inconvenient truth, “The more they know, the more they’ll like it isn’t happening.” Those data suggest that people know less about the law now than they did when it passed. Only 56 percent now know that people will get subsidies to pay for health insurance, compared to the 75 percent who knew that in April 2010 shortly after the law passed. Politico argued that the part most people knew about was the individual mandate, and didn’t like it. Actually, most people didn’t know much about the mandate as it moved through Congress. Most learned about it when the law’s opponents turned it into political fodder.
So, you see, the biggest gift the media can present for the Affordable Care Act’s birthday party are stories that tie up all these threads from the AP and Politico in a nice, neat bow that will help guide the public through the political spin from Dems and the GOP as the Act heads Monday to the Supreme Court.