Whitehouse.govWhitehouse.govLess than a week before the October launch of the Affordable Care Act’s health insurance exchanges, President Obama delivered a speech in Largo, Maryland explaining how the new health care would work, and what Americans in different circumstances could expect.

“Even before the Affordable Care Act fully takes effect, about 85 percent of Americans already have health insurance—either through their job, or through Medicare, or through the individual market,” said the president. “So if you’re one of these folks, it’s reasonable that you might worry whether health care reform is going to create changes that are a problem for you—especially when you’re bombarded with all sorts of fear-mongering. So the first thing you need to know is this:  If you already have health care, you don’t have to do anything.”

For the millions of Americans who already had health coverage in the individual market and have since been informed that their existing plan was being canceled in the wake of Obamacare, that is plainly not true. Despite Obama’s assurances, their coverage was not secure from changes brought on by the law.

Obama said these people were wrong to worry that the law would negatively affect them. It turns out those worries were not misplaced.

That’s worth keeping in mind when looking at polls showing that people who lost their individual market coverage are not the only ones worried about the effects the law will have on their current insurance.

Survey data shows a “a striking level of unease about the law among people who have health insurance and aren't looking for government help,” according to an AP report from yesterday. The report draws from information in a newly released Associated Press-GfK poll which finds that almost half of individuals with private coverage say their coverage will be changing next year, and generally those changes will not be for the better: rising costs, high deductibles, and the like. For most people, the culprit is clear: Some 77 percent say Obamacare is to blame.

The reality is more complicated. In some cases, Obamacare may be partially responsible for the insurance changes these Americans are seeing. In many instances, however, there’s no obvious, direct link between the health law and shifts in coverage. Even in cases where it’s possible to establish some connection, it’s often not the entire story. 

But for these Americans, that doesn’t really matter. What matters is that President Obama and his fellow Democrats promised a sweeping overhaul that would improve the nation’s health care system for everyone.

It’s worth taking a few minutes to go back and read President Obama’s big health care speech from September of 2009. He argued that reform was necessary not only to help the uninsured, but to help middle class Americans facing rising costs and coverage insecurities. The law, he said, would “provide more security and stability to those who have health insurance” and would slow the growth of health costs for families and businesses as well as for the government. Obamacare, in other words, was supposed to fix what most Americans felt was wrong with the health care system—not simply expand coverage to the uninsured.

That speech, and others like it, contributed to a sense that Obama, along with the rest of the Democratic party, was not merely attempting to reform a small segment of the health insurance market, but was instead taking responsibility for fixing the entire health care system. When Obamacare passed the next year, that’s essentially what the president and his party did.

So in an important political sense, President Obama, and by extension Democrats in Congress, own the American health care system now. And they own all of it. So when any part of it breaks or goes wrong, Obama, the Democratic party, and the health law they passed will be blamed, regardless of whether or not the law is directly responsible. 

The instinct for the White House and its defenders will be to protest that most of these changes in employer coverage are a longstanding part of the existing market, that they happened before Obamacare, and that the law isn’t the cause of every health insurance woe in the nation. Obamacare, they’ll say, is responsible for the part of the system that’s getting better, not the part that’s staying bad.

But Democrats will have a hard time selling this argument to a skeptical public. Partly because it sounds awfully self-serving, taking all the credit and none of the blame. Partly because the impression has already sunk in that Congress doesn't understand the real-world effects the health care law is having. But mostly, however, because President Obama has already lied about who the health law will affect, and how. For lots of Americans, it won’t be easy to trust the president or his party on the subject again.