PROMISES, PROMISES

Health plan maps Obama pledges

[April 20, 2010]  WASHINGTON (AP) -- The nation may be divided over the wisdom of President Barack Obama's big new health care law, but it largely delivers on more than 30 specific promises he made as a candidate.

Americans basically got what the majority voted for when they elected Obama in 2008, although many people today might not realize there are costs as well as benefits in the health plan's fine print.

"No one has the right to say they were misled during the campaign," said health care industry consultant Robert Laszewski, a critic of the law. "For all the controversy, what (Obama) has done in health care is consistent with what he promised. It's really very close."

Obama kept most of his promises, but not all.

As a candidate, he called for putting the U.S. on a path to coverage for all by building on the existing health care system, in which most workers and their families get private insurance through an employer.

He proposed tax credits to help people whose jobs didn't come with health benefits, and he wanted large employers to contribute to the cost of coverage.

His plan required insurers to accept all applicants, regardless of medical problems. It recommended a new, competitive health insurance market for people buying coverage on their own and expanding Medicaid to more low-income people.

The 10-year, nearly $1 trillion plan Obama signed into law March 23 incorporates those major elements, with some tweaks.

The tax credits and the Medicaid expansion won't come until 2014, to keep down the initial cost of the bill. The ban on denying coverage to any person in poor health also won't be in place until then.

New health insurance markets for individuals and small businesses will be state-based, instead of national as Obama originally sought. The Congressional Budget Office says the plan will cover 95 percent of eligible Americans under age 65 by the year 2016, compared with 83 percent now.

Obama's effort to deliver doesn't seem to be helping him with the public. Polls show the public is split over the law, and those who don't like it hold stronger opinions. That's a worry for Democratic lawmakers running for re-election this fall.

"After huge debates in American history, sometimes the public rallies behind whatever the decision turns out to be -- in this case they remain divided," said Robert Blendon, a Harvard public health professor who follows opinion trends.

One promise that Obama broke -- and one that many doubt he ever will fulfill -- may help to explain the unease.

Most of the tax increases in the bill fall on upper-income earners. But middle-class households will bear some. It's a broken promise from a president who gave broad assurance he would not raise taxes of any kind on families making less than $250,000.

For example, people who fail to get health insurance face a tax penalty starting in 2014, and the brunt of that tax will fall on the middle class, congressional budget analysts say. The tax is in the law because Obama changed his mind on requiring all individuals to carry health insurance. As a candidate, he had proposed only a requirement that parents get their kids covered.

Economist Joe Antos of the business-oriented American Enterprise Institute says billions of dollars in fees on insurers, drugmakers and medical device manufacturers also will be passed on to average consumers. "It is a political fiction that only the companies pay," Antos said.

The Web site PolitiFact.com counts nine health care promises kept and three broken. The latter list includes Obama's tax promise -- one his critics aren't likely to overlook.

PolitiFact, a project of the St. Petersburg Times, lists more than 15 additional promises in stages of delivery, usually due to long lead times for major changes under the law. Others say most of those promises should count as kept because the law says they will be carried out.

PolitiFact lists two other broken promises: negotiating the health care bill in front of C-SPAN cameras, and creating a government health plan to compete with private insurers.

But it's the yet-to-be-fulfilled promise that's most likely to determine whether the health care overhaul ultimately wins broad acceptance.

Obama promised to cut the cost of a typical family's health insurance premiums by $2,500 from projected prices if no changes had been made. Economist Karen Davis says the goal can be reached over time, particularly if the tax credits to millions now uninsured are counted. Estimates of the possible savings of the bill have been overly conservative, she contended.

"This will largely eliminate the problem of families not being able to pay for medical care," said Davis, president of the Commonwealth Fund, a research clearinghouse that supported the broad goals of the overhaul.

Perhaps. But polls show many people believe their premiums will go up.

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On the Net:

PolitiFact: http://www.politifact.com/

Commonwealth Fund:
http://www.commonwealthfund.org/

American Enterprise Institute:
http://www.aei.org/ra/43

[Associated Press; By RICARDO ALONSO-ZALDIVAR]

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