“Death panels” are out. “Sticker shock” is in. For the last few weeks, critics of Obamacare have spent less time on their more hysterical claims and focused, instead, on a practical argument. Because the new health care law mucks up the insurance market with regulations on pricing and benefits, they say, you’re going to pay a lot more for insurance. “Health insurance costs are going up,” Sally Pipes, president of the Pacific Research Institute and one of the law’s most persistent critics, wrote recently in a Forbes column. “And for that, you can thank Obamacare.”



It’s the kind of argument that gives the administration and its political allies night sweats, because it has some basis in fact. Come next year, when the Affordable Care Act takes full effect, some people are going to start paying more for their health insurance than they would otherwise. But notice the key word in the previous sentence: “Some.” The real story about Obamacare, the one the law’s critics don’t emphasize, is that far more people will actually pay less. And while those paying more may not be happy about it, they’ll also be getting something for the extra premium dollars they pay up front.

Who are these people? Before we get to that, let’s talk about who they are not. If you are like most non-elderly Americans with private insurance, you get health benefits from a medium- or large employer. It’s part of your compensation. Obamacare isn’t going to have much effect on your premiums one way or the other—except, hopefully, in the long run, as the law’s efforts to control health care costs gradually reduce the annual increases to which you’ve become accustomed.

No, the real action in the health care law will take place in what’s known as the “non-group” market, which affects far fewer people (a few million) but does so in some pretty profound ways. If you’ve ever tried to buy insurance on your own, then you know what a nightmare it is. Here is where insurers screen carefully for bad medical risks. If carriers decide you are one of these people—maybe you have diabetes or a history of gastro-intestinal problems, or maybe you beat cancer a few years ago—they will charge you higher premiums, withhold benefits for anything related to your pre-existing conditions, or deny you coverage altogether.

The non-group market is also notoriously unstable. Premiums can jump wildly from year to year, depending on how well your insurer is doing financially and what’s happening to other people in your “block.” (That’s what insurers call a group of people who pay premiums into a common pool, from which insurers take money to pay those beneficiaries’ bills.) Benefits and networks vary enormously, from plan to plan. Even careful, conscientious consumers frequently discover that their insurance leaves them without coverage they expected—or, in cases of outright fraud, without coverage at all.

