The tumultuous Beltway fight over Americans who lost their health plans because of Obamacare is shifting to the states, where regulators will decide whether to heed President Obama's proposal to let Americans renew their plans — or rebuff him to preserve the core mission of his signature law.
Mr. Obama kicked off a 50-state debate from the White House last week by deciding, through administration action, to let people with coverage that does not meet the Affordable Care Act's standards to extend their plans for one year. House Republicans and 39 Democrats pushed back on his proposal the next day, passing a bill that allow insurers to offer the bare-bones plans to existing and new enrollees in the coming year.
"Let's face it, millions of people right now have a canceled policy," Rep. Ron Barber, Arizona Democrat, said before voting Friday for the Keep Your Health Plan Act filed by Rep. Fred Upton, Michigan Republican.
The debate — fallout from Mr. Obama's oft-repeated, yet mistaken, vow that Americans could keep their health plans if they liked them under his health care law — roiled Washington throughout the week. Yet as lawmakers decamped from Capitol Hill, state insurance commissions faced tough decisions.
Insurance chiefs from at least three jurisdictions — Washington state, Louisiana and the District of Columbia — quickly spoke out against Mr. Obama's renewal plan, saying it could keep healthier people from enrolling in the state-based health exchanges set up under Obamacare.
The exchanges are a key pillar of Mr. Obama's law. But they could fail and send premiums soaring if younger, healthier people do not sign up and balance out older, sicker consumers who enroll because insurers can no longer deny people with pre-existing conditions.
The flawed rollout of Mr. Obama's reforms — notably, website glitches that prevent people from viewing new coverage options — has intensified partisan wrangling over Obamacare. Even so, attempts to patch the overhaul have spawned a patchwork of positions among Democrats who are trying to reconcile their support for the law with the political fallout of its wobbly implementation.
In turn, their political concerns do not always mesh with state-level attempts to stabilize the insurance market.
Washington State Insurance Commissioner Mike Kreidler rejected Mr. Obama's plan mere hours after the president's announcement.
Rep. Jim McDermott, Washington Democrat, commended his insurance commissioner's decision from the House floor on Friday, noting his state has worked hard to implement Mr. Obama's reforms with a robust health exchange. But he lambasted the Republican-led House bill for allowing plans with limited protections to be extended and take on new enrollees in the coming year.
"You're going to create endless confusion in this country in the insurance market," Mr. McDermott said.
Sen. Mary L. Landrieu, Louisiana Democrat up for re-election next year, is pushing a bill that would let existing customers hold onto their health plans indefinitely.
Yet Rep. Ami Bera, California Democrat and a physician, said Friday the Republican-led bill from his chamber was better than proposals in the Democrat-run Senate and provided his constituents some flexibility while they browse plans on the state's health exchange, which is functioning relatively well.
The House passed its bill 261-157 despite a veto threat from Mr. Obama and objections from Democrats who said the legislation was an insidious attempt to rot the law from the inside out by letting new enrollees gain substandard plans.
South Carolina Rep. James E. Clyburn, a member of the House Democratic leadership, on Sunday dismissed talk of a "revolt," saying most Democrats who backed the Upton bill were "insulating themselves against sound bites."
Rep. Kyrsten Sinema, Arizona Democrat, voted for the bill, yet urged her state's insurance chief to implement Mr. Obama's fix.
Reps. Lois Capps and Zoe Lofgren, California Democrats who voted against the House bill, made a similar plea to California Health and Human Services Secretary Diana Dooley.
(Corrected paragraph:) Early on, Sen. Bill Nelson, Florida Democrat, urged his state officials to implement Mr. Obama's fix.
Four Republicans bucked their party and voted against the House bill, perhaps because it could be viewed as an attempt to smooth over Mr. Obama's controversial reforms.
Meanwhile, the insurance industry is left to sort it all out.
"The question is what happens. Who will join the markets?" Karen Ignagni, CEO of America's Health Insurance Plans, said on Fox. "Will it be the young and the healthy balancing out the old and the sick?"
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