Washington -- House Minority Leader Nancy Pelosi, a key architect of the Affordable Care Act, is trying to restrain nervous Democrats from backing a measure that could knock the foundations from under the law - even as erstwhile Democratic allies Sen. Dianne Feinstein of California and former President Bill Clinton endorse similar changes.
The changes would allow millions of people who bought health policies on the individual market, including 1 million people in California, to keep their plans even if those plans fail to meet minimum coverage standards under the new law. Insurance companies' mass cancellations of such policies since the law took effect Oct. 1 have been a public relations nightmare for President Obama, who promised repeatedly over the years that no Americans who liked their current plans would be forced to change them under his signature law.
On Tuesday, Feinstein signed onto a bill by Sen. Mary Landrieu, a Louisiana Democrat up for re-election next year, that would allow those who already hold such policies to keep them indefinitely. The Senate bill is less dangerous to the law than the one confronting Pelosi in the House, by Rep. Fred Upton, R-Mich., which would allow insurance companies to continue to sell the old policies to new enrollees.
The House bill is scheduled to come to the floor for a vote Friday. On Wednesday, Pelosi, D-San Francisco, sought to quell unrest at a meeting of House Democrats freshly back from their districts. They demanded that the White House not only fix the troubled website for the federal health insurance exchange, but also deliver some way to allow the old policies to continue.
Anxious members want "an administrative fix by Friday," said a House Democratic aide. "We need one that is credible."
Threat to law
That's a tall order. Experts said that even more than the website meltdown, halting the cancellations of old policies would undermine the structural integrity of the entire law.
Many of the canceled policies cover healthy people, whose premiums are necessary to make the Affordable Care Act work. Allowing those people to remain outside the insurance market exchanges that are at the heart of the new law will funnel a sicker, costlier population to the exchanges, said Edwin Park, vice president for health policy at the liberal Center on Budget and Policy Priorities.
That would lead to price spikes in the exchanges next year. Over time, the sicker insurance pool and higher prices would "threaten the long-term viability" of the exchanges by further discouraging healthy people from signing up, Park said.
In addition, the Affordable Care Act's backers say allowing policies to ignore the law's minimum coverage standards would eviscerate its most popular reforms by creating a separate market outside the rules. Those reforms include banning denial of coverage for people with pre-existing conditions, prohibiting charging higher rates for women and sick people, and eliminating caps on lifetime benefits that can expose people to catastrophic medical expenses.
Pelosi tries to hold line
The changes could also deepen the public confusion already sowed by the website failures, discouraging the enrollment of healthy young people needed to make the exchanges work. Under the law, anyone who doesn't sign up for a plan will be charged a fee, but those fees are much lower than the insurance premiums.
Pelosi, who was instrumental in pushing the Affordable Care Act through the House in 2010 as speaker, is telling Democrats to hold firm and ride out the turmoil.
"The American people want to strengthen the Affordable Care Act, not undermine it," Pelosi spokesman Drew Hammill said. "The Upton bill makes matters worse by creating a new insurance market that will discriminate against people with pre-existing conditions while causing insurance premiums to spike for everyone else."
Pelosi has been quick to note that the policy cancellations affect just 5 percent of the health insurance market - those people who buy individual policies directly on the market, rather than getting coverage through their employer or the large federal health care programs such as Medicare and Medicaid.
The administration released figures Wednesday showing that just 106,185 people have enrolled in the exchanges and selected a plan through October - just a fifth of the goal by that date. Officials also told Congress that it would be difficult to fix the website by the end of this month as promised.
Health insurance consultant Robert Laszewski said the low number of enrollees shows the program "is in very serious jeopardy of collapsing. ... The Obama administration doesn't have a hill to climb; it has Mount McKinley to climb."
Feinstein's safe seat
Feinstein's defection stung Democrats. Having handily won re-election in 2012, Feinstein is immune to the political pressure faced by the red-state Democrats on the ballot next year - including Kay Hagan of North Carolina and Mark Pryor of Arkansas - who are also co-sponsoring Landrieu's bill.
Feinstein said she was reacting to upset constituents, and called the fixes "simple" and "common sense." Her endorsement was followed Wednesday by one from another blue-state Democrat, Oregon Sen. Jeff Merkley.
Clinton told an interviewer Tuesday that Obama "should honor the commitment the federal government made to these people and let them keep what they got." He added, "The big lesson is that we're better off with this law than without it."
"With all due respect to former President Clinton, he said exactly the wrong thing at the wrong time," said Jim Manley, a former aide to Senate Majority Leader Harry Reid, D-Nev.
Wait it out
Manley called the fix that Feinstein is backing "unworkable."
Democrats "have got to keep their heads down and grind it out and wait for the program to start working like it should be by the end of the month," Manley said. "I understand that Sen. Feinstein has a lot of upset constituents, but the fact of the matter is that the principles behind this bill are still solid."
GOP political strategist Ford O'Connell surmised that Feinstein is trying to pressure the administration to come up with a fix, given that failure could topple the Democratic majority in the Senate, and with it, every Democratic committee chairmanship, including Feinstein's. She heads the Senate Select Committee on Intelligence.
"As a realist, she understands that Republicans are going to take control of the Senate if Democrats are sitting there doing nothing," O'Connell said.
As for Clinton, O'Connell said the former president is "trying to create a firewall for Hillary," his wife and the front-runner for the Democratic presidential nomination in 2016.
Carolyn Lochhead is The San Francisco Chronicle's Washington correspondent. E-mail: clochhead@sfchronicle.com
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