[classicman]

"If you like your health care plan, you will be able to keep your health care plan."

Throughout the long health care reform debate, that promise from President Obama was one of the few constants, made to reassure the bulk of Americans who already have insurance that the sweeping legislation would not have a downside.

But now that regulations about existing employer-sponsored plans have been issued, it's becoming clear that many of the 160 million Americans with job-based coverage will not, in fact, be able to keep what they currently have.

Republican critics of the Patient Protection and Affordable Care Act point to the Obama Administration's own estimates that by 2013, 39% to 69% of employer plans will be subject to new regulations and not grandfathered in, or exempted from the new rules. House minority leader John Boehner issued a press release about the new regulations with the headline "New ObamaCare Tagline Should Be 'If You Like Your Health Care Plan, Too Bad.' "

That partisan rhetoric may be heated, but it's not entirely off base. The truth is that employer-based plans, which many assumed would easily be categorized as grandfathered, will be subject to the full regulatory thrust of the new law if they are altered in ways that are standard practice in the industry. Plans that increase the percentage of costs patients must pay out of pocket - known as co-insurance - lose their grandfathered status. The same is true for plans that significantly decrease the percentage that employers contribute to premiums or those that significantly increase deductibles or co-payments. An employer that switches health-insurance providers also loses its grandfathered status. These kinds of changes are common year to year in the current marketplace, since employers are constantly looking for ways to limit their expenses in the face of rising costs.

Still, while many employer-based plans will be snared in the regulatory net of the Patient Protection and Affordable Care Act, many of those with this coverage could actually stand to benefit.

It will be years before it's clear exactly how much the employer-based health-insurance system will be upended, and only then will consumers know precisely how costs will be affected. It's already apparent, however, that protecting the current system of private job-based insurance was not a mission of the Patient Protection and Affordable Care Act, promises about keeping your plan notwithstanding.

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