WASHINGTON — Just days from now, the government will roll out the health insurance marketplaces that form the heart of President Barack Obama's signature domestic policy initiative — and the White House is launching an all-out sales job.
Specifically, administration officials this week are highlighting the cost of plans that will be offered through the new marketplaces that go online Oct. 1. They say the costs are shaping up well below original projections.
In a letter to top congressional leaders, Lew warned that a repeat of the debt brinksmanship of 2011 could inflict great harm on the economy and that “if the government should ultimately become unable to pay all of its bills, the results could be catastrophic.”
Lew again warned that President Barack Obama would not negotiate with Republicans over the debt limit.
» In a 100-0 vote, the Senate advanced legislation to prevent a partial government shutdown. The vote came shortly after Texas Sen. Ted Cruz held the Senate in session overnight with a near-22-hour speech.
The final vote on the budget plan by the Democratic-run Senate should come no later than Saturday, which then would send the plan back to the Republican-ruled House.
— World-Herald press services
But Republicans on Capitol Hill continue pushing to pull the plug on the whole thing. The latest bid by some hard-line conservatives would risk a government shutdown in order to eliminate financing for the law.
A House-approved spending measure that would block funding for the health care law cleared a procedural hurdle Wednesday in the Senate, but Democratic senators plan to strip out the health care defunding provisions before sending it back. Even if Republicans lose this round, they expect to mount another bid against the health care law in exchange for raising the debt ceiling next month.
Republicans say that the health care law is hurting the economy and that the numbers released by the White House this week are misleading. They say that even if marketplace premiums have beaten previous estimates, there still could be hefty increases for some individuals. And they say the numbers don't show what's going on with the majority of Americans who receive health insurance through their employers.
The White House numbers represent the first state-by-state peek at some of the plans and rates that will be available in the new marketplaces.
There will be an average of 40 private insurance plans available to Nebraskans, for example.
Monthly premiums for the lowest-cost plan for a single 27-year-old Nebraskan would be about $159. If that 27-year-old earns less than $25,000, tax credits would lower those premiums to $98.
Midrange plan premiums for a Nebraska family of four would be $744 a month. For families earning less than $50,000, tax credits would lower the cost to $282.
Iowans will have an average of 39 plans to choose from. The lowest-cost plan for a 27-year-old is $139 a month, which falls to $96 with tax credits for those making less than $25,000.
The midrange, family-of-four plan in Iowa would be $683, or $282 after tax credits for those making less than $50,000.
“I can tell you right now that in many states across the country, if you're, say, a 27-year-old young woman, don't have health insurance, you get on that exchange, you're going to be able to purchase high-quality health insurance for less than the cost of your cellphone bill,” Obama said Tuesday, speaking at a health care forum in New York City with former President Bill Clinton.
However, the figures released by the White House provide only a partial picture of the reality that consumers will face. The government did not identify the insurance companies offering policies in the federal marketplaces, also known as exchanges.
Nor did it provide any information about the many policies that will cost more than the amounts cited in its report. Such information will not be available until the marketplaces open, federal health officials said.
The figures provide a favorable view of costs, highlighting the least expensive coverage in each state.
And the marketplaces are largely intended for Americans who are without insurance or those who buy individual plans.
The overwhelming majority of the 259 million Americans who already have insurance receive it through their employer.
Sen. Deb Fischer, R-Neb., said she hears from Nebraskans constantly who say their insurer is raising their premiums as a result of the law, or whose plans have been changed unexpectedly.
Fischer also said that the marketplace prices released this week may have beaten projections, but they are more expensive than what is available currently.
“What they aren't telling you is the cost is still much higher than (costs) are right now,” she said.
For example, according to one insurance website, a 27-year-old man in Nebraska can purchase a plan for about $26 a month — a fraction of the cheapest plan that will be offered in the new marketplace.
Administration officials say that kind of comparison is not apples-to-apples, however, in part because of the practice of underwriting. That's where insurers require applicants to submit detailed information about their own health background and that of their family. Once an applicant discloses a family history of heart disease or an asthma condition, that $26-a-month premium goes up.
Or the insurer simply refuses to issue the policy altogether.
David Simas, a senior adviser to the president, shared data from the Kaiser Family Foundation showing that denial rates have been as high as one-third of applicants in some states.
In Nebraska, the denial rate has been 26 percent. In Iowa, 17 percent.
Under the new law, insurers generally will not be able to jack up the rates or deny people coverage because of pre-existing conditions.
Also, under the 2010 law, health benefits are supposed to be similar to those provided under a typical employer-sponsored plan. But the new policies will be more comprehensive than many now sold in the individual insurance market. They will, for example, have to cover certain services like maternity care that may now be sold separately, for an extra premium, under a rider to a basic or standard policy.
Republicans and Democrats on Capitol Hill have agreed on a few changes to the law and a few more might win bipartisan approval, like eliminating a medical device tax.
But on the broader questions, both sides seem pretty dug in.
Most Capitol Hill Republicans want to ditch the new law altogether, while most Democrats say no way.
Those on both sides say, just give it time.
Fischer predicted that there will be more of an outcry as people see their premiums rising and look at the plans on the marketplaces.
Sen. Tom Harkin, D-Iowa, on Wednesday defended the law on the Senate floor. Harkin said the marketplaces will create for the first time a place where people can shop and have the same purchasing power as big buyers such as corporations or governments.
“Most importantly, these exchanges are a centerpiece of a system that will bring coverage ... to more than 25 million Americans who otherwise would be uninsured, living with the oppressive fear of being one illness away from bankruptcy or not knowing if they can afford a doctor visit for their child,” he said. “So why would anyone want to stop this?”
Simas made a couple of predictions as the new law continues to be rolled out. He said many people will wait a while before signing up because the benefits don't kick in until Jan. 1.
He also said that some bumps in the road are to be expected.
“News flash: there will be glitches,” Simas said. “When glitches arise, we will fix them.”
This report includes material from the New York Times.