If last week's election proved anything, it showed we're far from finished with the debate over 2010's massive - and massively misunderstood - health-care reform, a law that strangely seems to get blamed for stuff it didn't cause.

Senate leader-apparent Mitch McConnell and House Speaker John Boehner are once again promising Obamacare's repeal, arguing that it's "hurting the job market along with Americans' health care" - an odd critique of a law that has insured nearly 10 million people while the nation's jobless rate continues to fall.

McConnell is a standout when it comes to spreading Obamacare misinformation. During the recent campaign, he bizarrely suggested that his home-state voters could keep their popular Obamacare health-insurance exchange, Kentucky's Kynect, even after a "root-and-branch" repeal of the law it was designed to implement.

Today's case in point for Obamacare Derangement Syndrome: blaming the law for the spread of high-deductible insurance plans.

Let's start with what's actually happening on the ground. Obamacare - especially in states that agreed to expand Medicaid to cover all their lower-income residents, a list Pennsylvania will join a year late after the Supreme Court made it optional - is doing largely what it promised. This week, new plans and prices will be unveiled for Pennsylvania, New Jersey, and other states on the national exchange, HealthCare.gov, where shopping for 2015 begins Friday.

Unless the Supreme Court throws another wrench into the law, by siding with Obamacare foes who claim its backers meant to offer premium subsidies only in states that set up their own exchanges, the law's biggest challenges are operational.

Obamacare is far from perfect, as even its most avid defenders point out. It was designed to end some of the worst practices of the old system - such as insurers' ability to drop your coverage if you get sick, exactly when you need it most, or to refuse to cover you because of a "preexisting" condition - as well as to make coverage affordable. But that last goal was always a tall order in a country where the average price tag for an employee-group family plan is nearly $17,000 a year - more than a quarter of the average household's income.

If there's one place where Obamacare often falls short, that's it - as illustrated by consumers who complain about facing high deductibles before coverage kicks in.

But here's the rub: Obamacare didn't create high-deductible plans. Instead, it's helping shine a spotlight on a trend that long predated it - a push to give consumers "more skin in the game" to slow the overall rise of health-care costs. It's even helping to curb that trend.

"It was not uncommon before last year to see nongroup plans with $10,000, $15,000, or $20,000 deductibles," says Karen Pollitz, a health-insurance researcher at the Kaiser Family Foundation.

What changed? Obamacare put hard limits on out-of-pocket expenses in qualifying plans. Next year, policies must cap total costs at $6,600 for an individual or twice that for a family. Beyond that, consumers are fully protected for in-network care.

The problem, Pollitz says, is that for most families, even those kinds of numbers are budget- busters. They show why cost sharing is a blunt instrument that's as likely to scare people away from seeking necessary care - maybe till it's too late - as to cut needless medical expenses.

The good news is that Obamacare offers cost-sharing help for families with modest incomes - next year, for a family of four earning up to $59,625. Tax credits capping premiums will assist such families earning up to $95,400. As before, a range of preventive services are free.

But the real key for anyone shopping for an Obamacare plan may be to get help from a specially trained "navigator," such as Caroline Picher of the Health Federation of Philadelphia. (For an appointment, call 215-977-7255.)

Last year, Picher was able to offer information on options such as Independence Blue Cross' Keystone HMO Silver Proactive, which used a "tiered network" to slash deductibles and co-pays at preferred providers.

Making health care available and affordable was always a huge challenge. But forget the ugly politics. This law is a real start.


215-854-2776 @jeffgelles