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In Romneycare Birthplace, Obama to Ask for Patience

In Romneycare Birthplace, Obama to Ask for Patience

By Alexis Simendinger & Caitlin Huey-Burns - October 30, 2013

In the shadow of Mitt Romney’s Massachusetts health care model, President Obama will argue Wednesday that Obamacare merits the patience and bipartisan backing the Bay State mustered seven years ago for what was then a radical new approach.

The president will speak at Boston’s Faneuil Hall, hoping to draw parallels to the state-based, mandated health coverage signed by Romney, the former Republican governor defeated by Obama nearly a year ago.

Romney was not invited to attend the event, a White House official said.

Faneuil Hall, with its roots in Colonists’ drive for independence, is meant to serve as a symbol in Obama’s plea for bipartisan cooperation to reckon with the intricacies of the national law, including its much-criticized website.

On Tuesday, the White House fielded criticisms drawn from media accounts that a small percentage of Americans who bought health insurance on the individual market have been told they cannot keep their coverage. Those people are being steered to the state-based exchanges created by the Affordable Care Act to find new insurance because their plans do not meet the minimum benefits now required by the 2010 law.

Because Obama assured Americans for years they could keep their insurance and their doctors if they were happy with them, Republicans have seized on those comments as disingenuous. They say the administration anticipated but masked the fact that certain insurers would by law have to tell some customers their plans had been eliminated, thus compelling them to shop for coverage that might prove more expensive.

White House officials refused to concede the president had not adequately prepared a small subset of an estimated 15 million Americans. That’s the approximate number of people who purchased their coverage on the individual health insurance market before the law was enacted. Those who were not grandfathered in are suddenly discovering their coverage doesn’t measure up to the Affordable Care Act’s post-2010 specifications for “basic” benefits.

“The president was very clear from the beginning,” insisted David Simas, White House deputy senior advisor for communications and strategy, during a conference call with reporters.

West Virginia Sen. Joe Manchin told reporters the administration left all Americans believing they could keep their existing insurance if they liked it.

“It was adamantly pretty much part of the whole talking points forever, and it was almost just like 'Don’t worry, don’t worry, don’t worry,'” he told reporters, explaining how befuddled some of his constituents remain as they try to sort it out.

“Well, people back in West Virginia are worried now, thinking, ‘Okay, I can’t keep it. I got to buy this? The policy I had didn’t meet certain criteria or certain standards? And now there are certain standards that are going to force me to buy?’ This has to be worked through,” Manchin said.

The first-term Democrat joined Sen. Mary Landrieu of Louisiana in assuring reporters that their frustrations are aimed at fixing the Affordable Care Act, not scuttling it. Manchin wants to give Americans more time, perhaps another year, to avert a penalty if they don’t have insurance. He hopes to introduce legislation this week with Georgia Sen. Johnny Isakson, a Republican.

Landrieu, who voted for the ACA and faces re-election in 2014, said the law is here to stay.

“If everybody would get a mindset to fix it and not repeal it, there are lots of things that we could do,” she added.

The administration assumed it could focus Americans’ attention on the flawed insurance system that existed before 2010, but now finds them worried the government is taking coverage away rather than adding to their health benefits.

“We said when we passed [the law] that if you had insurance that was good insurance that you wanted to keep, you can keep it. If that is not happening, we are happy to make some adjustments,” Landrieu told reporters. "But the system that we had prior to the Affordable Care Act -- where people were losing insurance, rates were going up, there was too much pressure on the budget outwardly -- it was not sustainable. So we’re going to move forward. I’m willing to be flexible. I’m willing to adjust. I’m not willing to repeal it."

White House Press Secretary Jay Carney suggested that the technical flaws that have hobbled the HealthCare.gov website impeded not only access to plans but also its function as an educational tool.

“I think it's important to remember, too, that the purpose here wasn't to do anything beyond encourage people to make themselves aware of the options available to them,” he said. “The fact that the website has had the troubles it's had makes that a greater challenge.”

By drawing parallels to the Massachusetts law, as well as the early, rocky rollout of the Medicare Part D prescription drug benefit during the Bush administration, the White House is trying to show that flawed beginnings are not predictors of subsequent performance.

Turning to experts familiar with the Massachusetts law, the president’s communications team sought Tuesday to stress that with time, Americans will not only sign on for coverage under the Affordable Care Act, but will like what they get. Only 123 people in Massachusetts signed up for coverage under the state law in the first month of its existence, growing to 36,000 several months later, said Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who helped conceive his state’s law as well as the much more complex national version.

Gruber, during a 2012 interview with The Daily Beast, said he viewed Obamacare and Romneycare as mirrors of each other.

“They are the same bleeping bill!” he said at the time. “More seriously, the core of the ACA is exactly the same as what we did here in Massachusetts, which I like to call a 'three-legged stool’: end discrimination in insurance markets, mandate insurance coverage, and subsidize that coverage for the poor. The federal law is then more ambitious because, unlike in Massachusetts, it takes on cost control.”

The Obama administration has been tamping down expectations for the number of Americans it expects to enroll by mid-November -- the expected unveiling of one yardstick for public demand. During testimony Tuesday, Marilyn Tavenner, the chief of the Centers for Medicare and Medicaid Services, told lawmakers, “We expect the initial numbers to be small.”

Many Americans who enroll now can begin their coverage on Jan. 1. Those who don’t have insurance or want to shop for better plans still have until March 31 to choose and avoid a tax penalty levied on those who remain uninsured. Some Senate Democrats have asked Obama to extend the enrollment period, defer penalties, or postpone the insurance mandate for a year, to give the Affordable Care Act a longer implementation phase.

Sen. Jean Shaheen of New Hampshire, who asked the White House to lengthen the enrollment period beyond March 31, suggested Tuesday that some Americans’ inability to understand their options after nearly a month contributed to public anxieties that existing insurers are leaving Americans in the lurch.

“We’re hearing that people are interested in signing up on the website and they have not been able to do that. That was the reason for my proposal to extend the enrollment date,” she told reporters.

"We knew they would need to sign up again,” Shaheen said, referring to a minority of Americans whose insurance fell short of the law’s specifications. “But obviously I don’t think anybody thought people would be kicked off their health insurance plan.” 

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Alexis Simendinger & Caitlin Huey-Burns

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