The Government Won't Force You to Change Your Health Insurance (But It Might Give You a Strong Nudge)

In a press conference this afternoon, President Obama seemed to tacitly allow that, if health-care reform includes a government-administered "public option," many Americans will end up on plans other than those they're on now. Previously, Obama had argued that Americans would not be forced off their current plans, saying that they would always have a choice to stay with their current provider. He's sticking by that story, but in the press conference today, he clarified to say that what he meant was only that the government would not directly require anyone to switch plans: "What I'm saying is the government is not going to make you change plans under health reform."

That's true enough. But even if the government doesn't require you to change your plan, structural changes in the health-care system would likely move many away from their current insurance provider.

How might this happen? In some cases, it might simply mean that individuals, particularly those currently paying the entire cost of their health-care premiums, would choose to switch to the government plan because they believed it better fit their needs. In other cases, employers might decide to stop offering their current health-insurance options, preferring their employees purchase health insurance elsewhere. How often employers might choose to do this would depend on yet to be determined details of the "pay-or-play" employer mandate, which would require employers to either "play" by providing insurance to employees or "pay" by paying into a system that helps fund public health care. Right now, only two of the three notable bills making their way through Congress have an employer mandate, and on one of those, the details — such as how much employers would have to pay — are blank. 

Obama's statement isn't surprising given that a Lewin Group study recently pointed out that, depending on the details of the plan, anywhere from 10.4 million to 119.1 million people could end up switching from their current plans. Reform advocates continually stress that this would only be by choice, but that's only sort of true. Depending on how the employer mandate is structured and what regulations insurance companies end up subject to, many of which would surely raise the cost of premiums, it's almost certain that some number of people would end up without access to a plan they currently have and enjoy and, instead, get stuck with a plan they like less. (And of course, by the same token, others will end up with plans they like more.) The President's remark wasn't a game changer by any means, but it does serve as a reminder that any overhaul as massive as what he's championing will inevitably create some losers, including some people who no longer have access to plans they like and the networks of doctors and providers that come with them.