Promises, Promises: Obama's health plan guarantee

President Barack Obama seems to leave little room for doubt when he promises that his health care plan will let people keep the coverage they have. His vow sounds reassuring and gets applause, but no president could guarantee such a pledge.

Employers sponsor coverage for most families, and Obama's plan still leaves companies free to change their health plans in ways that workers may not like. Employers can even drop insurance altogether.

"No matter how we reform health care, we will keep this promise to the American people," Obama said Monday, addressing the American Medical Association. "If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what."

He didn't let up.

"If you like what you're getting, keep it," Obama said. "Nobody is forcing you to shift."

Yet the legislation the Obama administration is working on with the Democratic-controlled Congress would make major changes in how Americans pay for health care. The goal is to slow cost increases and bring in nearly 50 million uninsured, and the consequences are bound to affect how employers design benefit plans.

Americans could be headed for a frugal era in which doctors order fewer tests and procedures and insurers monitor medical decisions more closely.

Few are predicting a stampede by employers - especially major companies - to drop coverage. But some just might, to avoid the hassle of dealing with insurance companies, and take advantage of the fact that some workers would qualify for new financial assistance from the government.

Earlier this week, a preliminary analysis by Congressional Budget Office estimated that 10 million people would have to seek new insurance under a Democratic plan that a Senate committee is working on, because their employers would no longer offer coverage. Those workers and their families would shop for a plan through new insurance purchasing pools called exchanges. About 160 million to 170 million people now get employer coverage.

Though the impact seems small, Sen. Mike Enzi, R-Wyo., said the budget office analysis shows the legislation "fails to deliver" on Obama's promise.

Republicans seized on the issue Friday. "Once the bill is finished, tens of millions more could also be forced to lose coverage," said Senate Minority Leader Mitch McConnell, R-Ky.

Obama's opponent in last year's presidential election, Sen. John McCain of Arizona, declared: "I don't believe this is a promise the president can keep."

Neutral observers are also skeptical. Dallas Salisbury, head of the Employee Benefit Research Institute, called Obama's promise "an aspirational statement."

"If he was a king, he would deliver that, but he's not king," said Salisbury. His group is a nonpartisan information clearinghouse on health and pension benefits.

White House officials suggest the president's rhetoric shouldn't be taken literally: What Obama really means is that government isn't about to barge in and force people to change insurance.

That very issue became a huge political problem for former President Bill Clinton in the 1990s. His proposal would have required many employees to change how they got insurance, by joining new purchasing co-ops. Opponents branded it a big-government power grab.

The last thing Obama wants is a groundswell of opposition, driven by Americans' fears of being forced to change their insurance or losing it.

"The president is committed to enacting reform that will lower costs, protect choice of doctors and plans, and assure quality and affordable health care for all Americans," said Linda Douglass, a spokeswoman for the White House health reform office. "He has made it clear that we would not support a reform plan that would require people to leave their current insurance plans."

The coverage pledge is not Obama's promise to make, especially at this early stage, said Republican health policy expert Gail Wilensky, a former Medicare director.

"Until we see details, we can't say how likely it is that the plan you have now will be around going forward," added Wilensky, now a senior fellow with the Project Hope health care philanthropy. "They may not force you to leave in any direct sense, but they could put rules and procedures in place that make it impossible to continue what you have now."

MIT's Jonathan Gruber, a leading health economist, said Obama's promise shouldn't be taken as a sign that Americans will be able to keep indefinitely the same coverage they have now.

"With or without reform, that won't be true," said Gruber. "His point is that the government is not going to force you to give up what you have, but that's not to say other circumstances won't make that happen." He predicts only a small share of employers will drop coverage, and they will use the money they would have spent on premiums to give raises to their workers.

But Salisbury said he thinks it's unlikely workers will get back every dollar that had been going to premiums.