Just when you forgot about ScandalFest 2013, Republicans and their media enablers have revived it with the shocking news that the Affordable Care Act is denying your freedom to get scammed … and President Obama knew about it all along. (More)

Let’s not even pretend there’s any real wrongdoing here. President Obama said, repeatedly and truthfully, that most Americans will be able to keep the health insurance they have, if they want to. Yes, that was the truth. Most Americans get health insurance through their employer or the government. Only one-in-twenty families buys insurance on the individual market, and only about half will have to change their policies. This entire ‘scandal’ is about those one-in-forty families … and their “freedom” to get scammed.

“You’ll still be uninsured but out a bunch of money”

The problem is that much the so-called health insurance on the individual market was a scam, as Consumer Reports explained in 2012:

It might seem to be health insurance, if you don’t look too closely, and most people don’t. The premiums are surprisingly affordable. And so millions of unemployed people, service industry workers, and those taken in by fast-talking telemarketers sign up. They may think they’re insured – until they have a medical problem and find out that their coverage is as skimpy as a hospital gown.

The Affordable Care Act was supposed to usher in a new era of consumer-friendly health care. For instance, insurers are no longer allowed to put outrageously low limits on the amount they pay out for medical care in a year or lifetime.

While millions of Americans have benefited from that and other reforms, many are still prey to the kind of skimpy “junk” plans the new law was designed to eliminate. Some plans, known as mini-meds, are operated by employers and brand-name insurance companies with special dispensation from the federal government. Others, such as health discount cards and fixed benefit indemnity plans, from companies you’ve probably never heard of, are so meager that regulators don’t consider them to be health insurance at all – though that’s frequently not clear to consumers. And some of the companies operate one step ahead of the law.
“Don’t buy fixed benefit plans,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation and an expert on individual insurance. “You’ll still be uninsured but out a bunch of money.”

“Essential health benefits”

To be compliant with the Affordable Care Act, all insurance policies must now cover the following “essential health benefits,” listed at Healthcare.gov:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

In addition, qualified plans can’t exclude or charge more for preexisting conditions. They can’t be cancelled if you get sick, or impose annual or lifetime benefit caps for essential health services. And they can’t charge more if you’re a woman. In short, qualified plans have to be real health insurance, not a scam.

“Grandfathered in”

Apparently some people want to be scammed, and under the Affordable Care Act those scams “will be ‘grandfathered in,’ even if [the] plans don’t qualify, as long as there haven’t been any changes to the plan.”

And most scam insurance companies did change their plans: raising the premiums and/or deductibles, lowering annual or lifetime benefits, or adding new exclusions. In other words, they made the scam even worse. And yes, the Obama administration predicted three years ago that many scam insurance companies would do that.

But President Obama didn’t say: “If you like your current insurance, you can keep it, unless it’s a scam and they make the scam worse. Instead, he said: “If you like your current insurance, you can keep it.”

And yesterday both NBC and CBS followed the Republican script and accused the president of lying … because he didn’t mention that scam insurance wouldn’t be grandfathered in if the insurance companies made the scam worse. Just as President Obama’s statement that “Republicans voted to end Medicare” was declared 2011 “Lie of the Year” … because he didn’t include the words “as we know it.”

So welcome back to ScandalFest 2013.


Happy Wednesday!