Opinion

Out with the old, in with Obamacare

The math for the Affordable Care Act in California is stark: Kick 1 million Californians off the private health care plans they already have at the end of the year so that a million Californians can enroll in subsidized Obamacare plans. Another million or so can stay in their old plans, and the state will sign up an additional 1.1 million for Medi-Cal.

The losers are Californians, many of them Obama voters, who run their own shops and did the right thing by buying private health care, probably after Obamacare passed. If they are among the two-thirds of private policyholders expected not to qualify for federal subsidies, they face an ugly case of rate shock.

Here are the details.

California Insurance Commissioner Dave Jones estimates that 900,000 to 1 million Californians will lose their individual health care plans on Dec. 31. Peter Lee, executive director of Covered California, the state's new health insurance exchange, estimates that 800,000 to 900,000 Californians will have to switch to Covered California plans at year's end.

"Out of the gate, some individuals will pay more," Lee told The Chronicle editorial board recently. On the bright side, with no caps on benefits and guaranteed issue, consumers will be able to "shop as they never did before."

Problem is: Those protections are driving up premiums for people who had affordable care.

As insurance commissioner, Jones has had to deal with fallout. Individual policyholders represent about 8 percent of the health care market, but they are the wrong people to anger - they are proactive enough to have bought their own coverage, successful enough to afford it, and vocal when they realize that their premiums are likely to rise - even double for some.

On Monday, Jones was able to play the hero for some 115,000 of the newly enraged. Because of a legal technicality, he was able to cut a deal with Blue Shield to allow its policyholders to keep their coverage through March 31, 2014. "Health insurers and Covered California are allowing small businesses to renew their existing plans past Dec. 31," Jones said in a statement, "and should have allowed individuals and families to do the same."

On the one hand, Jones' move undercuts Covered California. Providers were banking on enrolling today's healthy individual-plan owners when they calculated their 2014 rates. Jones himself suggests that consumers figure out if they qualify for subsidies before deciding to extend coverage. Blue Shield warns that consumers who stay through March face two annual deductibles.

In the end, about 600,000 Californians who don't qualify for subsidies should expect to pay more.

I asked Lee: Is there anything that can be done for those folks?

"As clearly and compassionately as possible, describe the benefits to them, to their neighbors, to their family, of having a health care system that has everyone insured" and of having families protected from being wiped out financially after an illness, Lee answered.

Compassion is in order. Folks who did everything right now know that they cannot keep the plans they had - and they're the first in line to be handed the real bill for the Affordable Care Act.