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On January 29, 2010 the House Republican caucus had its winter meeting in Baltimore, and Obama came there to speak to them and answer questions.

In the course of his discussion of the healthcare bill, he said this:

"If you look at the package that we've presented -- and there's some stray cats and dogs that got in there that we were eliminating, we were in the process of eliminating. For example, we said from the start that it was going to be important for us to be consistent in saying to people if you can have your -- if you want to keep the health insurance you got, you can keep it, that you're not going to have anybody getting in between you and your doctor in your decision making. And I think that some of the provisions that got snuck in might have violated that pledge."

My questions are,

  • what provisions was he talking about?

  • Did he manage to eliminate them in the final law?

Note: that this was after Ted Kennedy died and Scott Brown was elected, so the Senate bill was already set in stone, so any changes after he made those remarks would have come in the budget reconciliation bill that was designed to fix the bill.

Still, I'd like to know if there's some provision in the law that may have exacerbated this problem, and which they either forgot to take out during reconciliation or were not allowed to take out during reconciliation due to rules saying that everything in the reconciliation bill had to be germane to budgetary matters.

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    It is unclear what provisions he is referring to. Many of the rules (government regulations) were written after the fact by bureaucrats, hence Pelosi's, "we need to pass the bill to find out what is in it." Yes, some plans have lost their grandfather status, but the admin. knew millions would lose theirs since Jun' 2010 – user1873 Nov 14 '13 at 5:34
  • @user1873 Regulations interpreting laws is of course standard practice, but Obama was clearly talking about provisions of the law, not provisions of the interpreting regulations. As far as the administration knowing about people losing grandfather status, that's mostly due to people voluntarily going from a grandfathered plan to a non-grandfathered (non-exchange) plan. Obama didn't say "If you like it and you drop it, you can get it back", so that report wasn't really acknowledging that any promises he made would be broken. – Keshav Srinivasan Nov 14 '13 at 6:07
  • I am not sure how you came to that conclusion. The Health and Human Services regulations on the matter state, "These interim final regulations are necessary in order to provide rules that plan sponsors and issuers can use to determine which changes they can make to the terms of the plan or health insurance coverage while retaining their grandfather status" The regulators writing the rules were aware of the millions that would lose their old grandfathered insurance plan because the plan changed, not people... – user1873 Nov 14 '13 at 6:31
  • choosing not to buy it. So, you question is specifically about what provisions Obama is referring to? How would we know, unless Obama answered that question in a news conference? Or, are you just asking if regulating agencies like the Health and Human Services Department can "sneak" in and make changes to the law? – user1873 Nov 14 '13 at 6:35
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    @user1873 you quoted the doctored version of the Pelosi quote. The acqual quote is "We need to pass this so YOU can find out what's in it away from the fog and controversy". snopes.com/fact-check/… Find out what's in it away from the fog and controversy is very different from "we don't know what is in it", which is how the quote is often and unfairly represented. – userLTK Jun 7 '18 at 18:31
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No one but President Obama knows, but nothing in the ACA or the Health Care and Education Reconciliation Act that followed caused a health plan to lose its grandfathered status.

The President's remarks at the GOP House Issues Conference in Baltimore seem to indicate that he was specifically speaking about provisions that were in the bill that they were working on eliminating, but couldn't without going back to the floor of Congress. He gives as an example, the pledge that you can keep the health insurance you have, as a pledge that was violated by a provision of the Affordable Care Act.

If you look at the package that we've presented -- and there's some stray cats and dogs that got in there that we were eliminating, we were in the process of eliminating. For example, we said from the start that it was going to be important for us to be consistent in saying to people if you can have your -- if you want to keep the health insurance you got, you can keep it, that you're not going to have anybody getting in between you and your doctor in your decision making. And I think that some of the provisions that got snuck in might have violated that pledge.

ABC News sought clarification about specifically which provisions he was referring to in the Affordable Care Act (ACA), but got no response.

White House officials did not respond when asked specifically what provisions the president was referring to and how they got added to the bill.

So, the best we can do is to take Obama at his word, that some provision of the ACA in the final law prevents you from keeping the plan you have. The ACA only mentions "grandfathered" health plan in 32 places, none of which determine the grandfathered status of a health plan:

  • Section 1251.(e): It loosely defines a 'grandfathered health plan' as any one which applies.

  • Section 1312.: multiple times to exclude them from the risk pool

  • Section 1311, 1343: to exclude them from risk assessment

  • Section 1401.: to exclude them from tax credits

  • Section 5000A.: to include them as essential coverage under the individual mandate

  • Section 2002.: to allow individuals to remain eligible if they would be considered in eligible by using modified gross income calculation.

  • Section 2402.: to include projections and extensions of home and community-based services.

  • Section 3201.: allow rebates under Medicare Advantage

  • Section 2718.: to include reporting to the Secretary of premiums to losses, and restrict that ratio to 80%-85% or more, as determined by the Secretary.

  • Section 2709.: to include them in Section 2715 [Uniform Definitions] & 2718 [Ratio & Refunds]

The subsequent law that modifies the ACA, only include 3 instances of grandfathered health plan, none of which determine status:

Section 1231(a)(4)IN GENERAL.—The following provisions of thePublic Health Service Act (as added by this title) shall apply to grandfathered health plans for plan years beginning with the first plan year to which such provisions would otherwise apply:

(i) Section 2708 (relating to excessive waiting periods).

(ii) Those provisions of section 2711 relating to lifetime limits.

(iii) Section 2712 (relating to rescissions).

(iv) Section 2714 (relating to extension of dependent coverage).

(B) PROVISIONS APPLICABLE ONLY TO GROUP HEALTH PLANS.—

(i) PROVISIONS DESCRIBED.—Those provisions of section 2711 relating to annual limits and the provisions of section 2704 [...]

(ii) ADULT CHILD COVERAGE.—For plan years beginning before January 1, 2014, the provisions of section 2714 of the Public Health Service Act [...]

The Health and Human Services Department is ultimately responsible, in their final regulations. Those regulations determined precisely what could be modified without a health plan losing it's grandfathered status.

"These interim final regulations are necessary in order to provide rules that plan sponsors and issuers can use to determine which changes they can make to the terms of the plan or health insurance coverage while retaining their grandfather status"

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  • Were there any provisions in the budget reconciliation bill having to do with keeping your health insurance? That should clarify whether any such provisions were changed. – Keshav Srinivasan Nov 14 '13 at 7:49
  • I think you're confusing reconciliation with conference committees. Conference committee is where people go behind close doors and iron out differences between two bills. Budget reconciliation is a method to get around the filibuster in the Senate, but the limitation is that it has to be at least ostensibly related to the budget. So what they did in the case of Healthcare was the following: they passed the actual bill through regular order and it was signed by the President. Then after it became law, they passed a second bill through reconciliation to make changes to the law. – Keshav Srinivasan Nov 14 '13 at 8:02
  • The reason they did this was that Scott Brown replaced Ted Kennedy, so Democrats could no longer overcome filibusters. And they couldn't pass the whole healthcare bill via reconciliation, because not all of the bill could be labeled budget-related. So they took the Senate bill (which had already passed the Senate when Ted Kennedy was still alive) and passed it through the House with no changes (although promising House members that there would be changes more to their liking in the future with a 2nd bill), got it enacted into law, then passed a 2nd bill through both Houses via reconciliation. – Keshav Srinivasan Nov 14 '13 at 8:09
  • @KeshavSrinivasan, I am confused, Obama couldn't be referring to the second bill, because it wasn't introduced until March. So, your question is specifically if anything was modified between the senate amendment (set in stone), and the final Public Law, right? – user1873 Nov 14 '13 at 8:25
  • No, after Ted Kennedy died, they couldn't make any changes to the Senate bill, because if they did that they would have to pass it through the Senate again, which they couldn't do because they wouldn't be able to overcome the filibuster. So when I say "the Senate bill was set in stone" what I mean is that Senate bill was passed by the House and became law exactly as written. So the Senate bill and the Public Law you linked to are identical. But the thing is, the House didn't like some of the provisions of the Senate bill, but for the above reason they couldn't make any changes to it. (cont'd) – Keshav Srinivasan Nov 14 '13 at 8:36
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Extant employer-sponsored disappeared from the market because they could not be marketed to new employees by companies that had the plans already. Trying to obtain health insurance in two group plans when one of the groups only has a couple of members in it doesn't work. This forced employers to drop and rebuild all of their group plans.

Obama's claim was always false because most of the plans that people wanted to keep weren't open-market plans, they were employer-sponsored group plans.

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