Beyond 'I'm Sorry': 5 Ideas to Help Make Obamacare Work

Sure, the president apologized to those whose insurance has been canceled. But fixing the new program will take more than words.
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Larry Downing/Reuters

President Obama sat down with Chuck Todd on Thursday to issue a remarkable apology for misleading Americans by promising repeatedly “if you like your health plan, you will be able to keep your health plan” under the Affordable Care Act.

"I am sorry that they are finding themselves in this situation based on assurances they got from me," he said, addressing those in already in the individual health-insurance market whose plans are being canceled.

"We've got to work hard to make sure that they know we hear them and we are going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this," Obama said.

The Huffington Post quotes an administration source saying the White House is “looking at an administrative fix for the population of people in the individual market who may have an increase in premiums, but don’t get subsidies”—namely, finding a way to help subsidize the transition to more expensive plans for households that earn more than 400 percent of the federal poverty level, which would otherwise be ineligible for assistance.

That could go a long way to solving the White House's latest political problem with Obamacare. But it will take more than a financial fix to ease the transition overall, as helping these folks is far from the only challenge the ACA rollout faces on the ground.

Insurance policy is inherently fraught because it lies at the intersection of two of the most profound sets of human anxieties: those that attend being sick, weak, and no longer the master of your own fate—and those about finances, value, and worth. That's one reason it's so hard for people to talk about it calmly, and why there will need to be greater public and private efforts to reassure Americans as they confront the changed markets of 2014.

Here are five ideas that could help fix the Obamacare rollout:

1. More Handholding for People With Canceled Plans: The first and most urgent problem is helping people with existing insurance that's being canceled to move to new plans they can afford. Taking the Hippocratic Oath as a model, the priority has to be: First, do no harm. It's not OK if people who are having their plans cancelled don't enroll in a new plan by December 15 because they cannot afford one (or have to pay a lot more) or because they cannot use the website to find one. Unless they select or accept new plans, there will be people who will lose their insurance January 1, thanks to the private-market changes unleashed by Obamacare. A bigger risk is that a lot of people who don't need to be in very expensive plans will accept being rolled over into them by their insurers because they don't know they have any choice. Every effort has to be made to minimize the size of both these populations.

Fixing Healthcare.gov's problems and getting assistance to the people who don't qualify for subsidies would go a long way to solving the issue of people with canceled plans. But it still will not be enough. What's clear from the rash of Obamacare horror stories that have on closer examination proved untrue is that people need more handholding through this process of moving from their old health plans to new ones than the government is providing.

There needs to be a communications and transition-assistance effort targeted just at them—whether it's a special subset of operators on the 800 number, a separate number just for them, or a special web page that routes customers with canceled plans to guides who can help them get new affordable ones. Besides, the group is likely to be healthier than average, since so many of them had plans that excluded those with pre-existing conditions, so it will be good for the exchanges' long-term viability to enroll as many of them as possible quickly.

2. Enroll "Young Invincibles": The second most urgent problem is getting enough young healthy people into the exchanges to keep rates low in 2014. Between Healthcare.gov's technical troubles, the complexity of signing up through the exchange sites, and the fact that many of the uninsured are not the most civically engaged people in America, it's no surprise that most of the uninsured haven't even visited a single exchange website. It is going to take a lot to get them insured. 

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Garance Franke-Ruta is a former senior editor covering national politics at The Atlantic.

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