The debate over the health care law has been particularly messy and misleading in the past week, and there is plenty of blame to go around over who created the confusion.
Let's start with what is clear. President Barack Obama said, "If you like your plan, you can keep it," at least 34 times in some form, both before and after passage of the Affordable Care Act. But that is literally not true for hundreds of thousands and likely millions of people.
Also clear: Pundits and politicians are spinning those statements in many different ways.
So what's really happening in the health insurance market?
Before we get into what Obama said, what he says he meant, and how everyone is interpreting his comments, it's important to remember how people get their health insurance today. Generally, coverage comes one of three ways: through a government-managed program like Medicare, through their employer or by purchasing insurance themselves.
• About 15 million people purchase insurance individually (6 percent);
• About 90 million people receive insurance through the government (35 percent);
• About 150 million people receive insurance through their work (59 percent).
The 2010 health care law makes changes of varying degrees to the insurance programs for all three groups. But the most recent back-and-forth centers around people purchasing health insurance through the individual market.
Spin from the left
Make no mistake, the blame for the mess happening now starts with Obama.
His promise that you could keep your plan if you like it was always going to be correct for some people — and wrong for others. PolitiFact pointed that out in June 2012, after the Supreme Court upheld the law. Back then, we rated his statement Half True.
His comment oversimplified the changes that the health care law imposed on insurers and overemphasized the two biggest ways people receive health insurance, through their work or through government.
For many, if not most of those people, their health care will largely stay the same — except for the usual, annual adjustments that pre-dated the law.
The regulations implementing the new law included a technical out — that employer and individual plans in place before the health care law was passed could remain in place so long as they weren't changed substantially. That's the "grandfather" clause.
But the regulations defining what constitutes a significant change are tight. One says that a plan's grandfathered status must end if co-payments rise by more than $5 plus the cost of medical inflation, an easy trigger to hit.
What's the upshot? Obama and Democrats likely knew that some plans for some people would be discontinued or changed substantially. In fact, that is the intent of the law.
It mandates 10 "essential health benefits" for insurance policies, including emergency services, maternity care and mental health care. That means no more bare-bones plans if they aren't grandfathered in.
In a technical sense, insurers are pulling the plug on these old, grandfathered policies. But that's deceptive. The law places grandfathered plans in such a straitjacket that it's only a matter of time before companies are driven to pull the plug.
Obama recently has suggested he was clear about all the caveats, but the evidence is razor thin.
Obama restated his promise in comments Monday, saying, "What we said was, you can keep (your plan) if it hasn't changed since the law passed."
But the record is long and clear — Obama never said anything like that. Health and Human Services Secretary Kathleen Sebelius mentioned it in June 2010, when new e rules were rolled out. But her mention is the equivalent of the fine print on a TV commercial running in heavy rotation.
Obama's words this week don't stand up, so we said Pants on Fire.
Spin from the right
The president's opponents have done their fair share to mangle an-already complicated issue.
The universe of people facing significant changes or insurance cancellations remains small, with talk ranging between 6 and 10 percent. Stated in the reverse, most people will be able to keep their health insurance plan, if they like it.
Yet, it didn't stop conservative talk radio host Glenn Beck from claiming this week that "half of the population of the United States would lose their health insurance." And Fox News aired a segment Monday entitled "Expert predicts 129 million people will lose health coverage."
Both claims are wrong, even by the admission of the person who created an estimate that Beck and Fox News cited as proof. We rated Beck's claim Pants on Fire.
Christopher Conover, a scholar at the Center for Health Policy and Inequalities Research at Duke University and an adjunct scholar at the conservative American Enterprise Institute, recently estimated the number of people that would lose their existing health insurance coverage by the end of 2014. His number: somewhere between 18 million and 50 million.
Conover said a larger number of Americans, about 130 million, would combined see their coverage dropped or their plans changed. But he specifically wrote: "Let me clear that I am not predicting that 135.8 million Americans have or will have their policies canceled due to Obamacare."
Many people will keep their insurance, while others will find insurance elsewhere.
And, though it's gotten lost in the back-and-forth, uninsured Americans will get insurance because of the health care law. Official estimates from the Congressional Budget Office show the law should lower the number of the uninsured from 55 million in 2013 to 29 million in 2017.
Talking about the health care law in the context of Obama's "if you like your plan, you can keep it" promise is challenging, particularly in 30-second sound bites. That's led to distortions by Republicans and Democrats.
Here are three, key points:
1. "If you like your plan, you can keep it" is true for the majority of Americans who have insurance but not for everyone, particularly people in the individual market.
2. The health care plan was largely designed so that some health care plans would go away. If not this year, then at some point down the road. That's what ultimately makes Obama's promise such a misstep.
3. Opponents of the law are so obsessed that they have consistently overstated attacks against the health care law, and they are guilty of oversimplifying Obama's original "if you like it" promise.
To read more, visit PolitiFact.com/subjects/health-care. Aaron Sharockman is the editor of PunditFact and can be reached at [email protected]