I’m sorry, too, Mr. President…

I’m sorry your aides debated whether to tell the full truth (that people could keep their insurance only if it hadn’t changed and if it met your standards) and decided instead to institutionalize the lie…

I’m sorry you didn’t trust Americans with the truth.

I’m sorry that the Democratic Party’s decades-old chase toward universal health care is now at risk because your law—your legacy, sir—is off to such a miserable start. The online networks don’t work and the people you need bought into the system, particularly young Americans, can’t access the market and now may never trust it … or you.

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ObamaCare’s financing won’t work unless “young healthies” (or their parents) pay through the nose for coverage under parental plans or via the individual mandate. The 18-26 age group is the lowest user of care, the least costly to cover and the most profitable of all health-insurance coverage. Yet the group faces extraordinarily high ObamaCare rates.

A Manhattan Institute analysis of Health and Human Services numbers notes that a 27-year-old male will pay 99% higher premiums under ObamaCare than he would under previously prevailing market rates. One reason is that the law now limits insurers to charging the sickest seniors no more than three times the amount they charge their youngest customers. Given that 64-year-olds use on average six times as much health care as 19-year-olds, the Affordable Care Act forces young people to pay considerably more than the cost of their own care.

Young men and women who pay a fine instead of buying coverage are not making an irrational choice. They know how little care they need and use. They also may be beginning to understand that the high cost of their plans reflects the redistribution of their wealth to older people and a bunch of mandated services that don’t make sense for them.

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Ian Hodge of Lancaster, Pa., fears he’ll lose out financially. He and his wife are in their early 60s, so Hodge said “we really don’t worry about maternal care,” one of the guaranteed benefits in the new plans. The Hodges recently got a cancellation notice and they’re concerned a new plan may costs them hundreds of dollars more than they are paying now.

“We are the persons who President Obama wants to pay more in health care so we can subsidize some of the people who will pay less,” said Hodge.

A new analysis backs up his instinct. The study by the Kaiser Family Foundation found that people who already have individual coverage, like the Hodges, are less likely to qualify for the tax credits that will make coverage more affordable through the health law’s insurance markets.

According to the findings, 73 percent of potential customers who are uninsured will be eligible for tax credits that limit their premiums to a fixed percentage of their income. However, fewer than 40 percent of those who currently have individual health insurance will qualify.

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[O]f 29 million people who might enter the Obamacare exchanges, about 17 million would be eligible for subsidies. That’s about 59 percent who would be eligible for taxpayer-paid assistance, versus 41 percent who are not. That’s a majority on the subsidy side, but not a huge one. Then figure that some of those who are eligible for help will only be eligible for very small subsidies. For example, a family of four in St. Louis, Mo., with one parent who earns $48,000 and another who earns $37,000 would be eligible for a subsidy — all of $13 per year to pay for an $8,088 policy — that is virtually no help at all. (The numbers come from the Kaiser Foundation’s online subsidy calculator.)

Out of the 59 percent who are eligible for subsidies, then, some portion will receive subsidies that do not cover the increased cost of their new coverage. For them, Obamacare will be a net loss. So, it’s unlikely Obamacare will actually help the full 59 percent of those eligible for subsidies by Kaiser’s estimate. The bottom line is, Obamacare could very well hurt substantially more than 41 percent of the people who are currently uninsured or purchase coverage on the individual market. That’s not exactly making the system work “better for everybody.”

And that’s not even beginning to consider the far larger number of people who receive their health coverage through work. If Obamacare means they pay more, either through work or being thrown by their employers into the exchanges, the help vs. hurt ratio could change considerably, and not in the president’s favor.

Obamacare’s future depends on those numbers.

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While I’m sure the Petersens have worked very hard throughout their lives and deserve a comfortable retirement, but let’s examine what this story actually represents: Two people who can easily obtain insurance on the individual market, despite their preexisting conditions, have to pay a lot for the health care they consume, but an amount they can afford at their income levels – but not at their expected level of retirement income. Because Obamacare provides direct subsidies from the federal fisc, and indirect subsidies from the higher premiums paid by younger people and healthier people, their rates have dropped low enough that they can now close their small business and live off of their retirement savings — at the expense of others.

Lots of decisions we all make involve implicit tax subsidies and social costs. But early retirement, needless to say, doesn’t really have much to do with the stated intent of Obamacare — expanding insurance to people who can’t get it or can’t afford it. The NPR story acknowledges that this is a rather odd side benefit of the law, and notes that we don’t know just how widespread it will be yet: 53 percent of employees in one survey of American workers in 2012 said they stay in their jobs for more years than they want to ensure access to affordable health insurance. These are many people’s highest-saving, highest-earning, and most productive years; enabling them to draw down their savings rather than work hampers economic growth. In a post-industrial society, is there any reason to provide a subsidy for retirement at age 59? Most Americans would presumably agree there is not, which is why almost no one is suggesting we lower the starting age for federal retirement programs. But that’s in effect what Obamacare’s elaborate system has accomplished — while also providing implicit subsidies to people who happen to have health-care problems, some of which, like diabetes, are influenced by their personal choices.

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Gonzales acknowledged that there will be winners and losers in this transition. “There are going to be people out there that are going to find that their premiums are about the same, some are going to have them go up, some are going to have them go down,” Gonzales said.

Of the 900,000 or so people whose policies are being canceled in California, she said, about 310,000 will qualify for financial assistance, in the form of premium subsidies, which will lower the cost of coverage. The rest will not…

Hammack told me that he doesn’t know what he’s going to do. He makes slightly more than 400 percent of the federal poverty level — $62,000 for a couple — which means he isn’t eligible for premium subsidies. But he’s considering reducing his income below that level, which would reduce his premiums substantially.

Wood says that’s smart. If Hammack is able to get his income at or below $62,000, he stands to save $10,740, Wood told me in an email.

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The architects of the Affordable Care Act, like everybody who understands health policy, knew this would happen. And they crafted the law in a way that would cushion the impact for most people. The most obvious method is those subsidies, which offset higher premiums in part or in whole for the majority of people buying coverage on the new exchanges. The law has other, less well-known provisions to help restrain insurance prices—most notable among them, a “medical-loss ratio” requirement that effectively limits how much profits insurers can make. These steps will reduce the number of people unable to find better coverage or facing the prospect of actual “rate shock.” But these steps won’t help everybody. Some people will end up with worse options.

You probably want to know how many people fall into this category. Good question! The data on people buying their own insurance is incomplete, ambiguous, and conflicting. But most experts I’ve consulted believe that, of the small percentage of Americans who buy their own coverage, a minority should end up paying more next year. (For an alternative view, read Avik Roy of the Manhattan Institute.) The ones facing the most severe sticker shock will tend to be more affluent, since they will get little or no help from federal subsidies. It’s almost surely a small group of people. But how small is impossible to say with certainty…

The truth is that, until now, people in this situation have been among the few, fortunate souls for whom American health insurance is a bargain. They’ve been relatively healthy, and they’ve had relatively good incomes, making it possible to buy comprehensive policies at prices they could afford. But the practices that made insurance cheap for them made it expensive—and in many cases unavalable—for others. Their good fortune was the by-product of bad fortune for many others. As one ends, so must the other.

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Like many others, I’ve been extremely hesitant to use the word lie to describe President Obama’s oft-repeated statements that “If you like your health plan, you can keep it, period.” A lie incorporates both inaccuracy and intention. While I am and have been a fierce critic of the Affordable Care Act, I have been extremely hesitant to write that President Obama lied. But based on all the available evidence I can’t reach any other conclusion, and the importance and impact of this lie justify the accusation.

Senior White House staff debated whether the President should say this, knowing it was inaccurate. This isn’t a point one could have missed–a principal goal of the ACA was to change (they argue “strengthen,” I disagree) the individual insurance market, to replace old plans with new ones. The statement is patently false and its legislative and substantive impact were crucial. Policy staff were overruled by “political aides.” The President and his advisors knew both that this promise was essential to rounding up the votes in 2010, and that it would not be true for something like 10 million people. For me the kicker is that President Obama said it more than two dozen times, including as recently as six weeks ago. The President knew it was false and he knew it was important, and still he said it over and over again…

As someone who spent countless hours ensuring Presidential policy accuracy, the idea that an Obama White House staffer would lose such an internal battle, that they would give President Obama a speech staff knew was wrong, is beyond my experience. A White House Chief of Staff who permits President Obama to say something he knows is false violates everything I learned about serving a President. A President must not lie to the American people and Congress about a core element of his signature domestic policy initiative, even if doing so is necessary for that initiative to become law. When he did this, President Obama breached the trust America needs to have in her President.

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