The NY Times has a piece today noting the trend toward narrower networks under Obamacare means the what the law is not quite delivering what was promised:

When Obamacare was developed, one goal was to allow middle-class Americans to use the new marketplaces to buy the same kind of health insurance they had at their jobs. People could retire early, or quit a corporate job and become a freelancer, and still have the great care and financial protection that come with high-end plans.

But six years into the health law, the reality is that a typical Obamacare plan looks more like Medicaid, only with a high deductible….

The bill said that benefits should be similar to those from employer plans. The law was supposed to help people like middle-class professionals hoping for a change. President Obama infamously promised: “If you like your doctor, you will be able to keep your doctor. Period.” As networks of doctors narrow, that is getting tough for some shoppers.

The large insurers who make most of their money (and are still doing quite well) selling employer-based insurance are losing money on the Obamacare exchanges. The insurers that are doing well on the exchanges tend to be the ones who have experience with Medicaid.

For those moving from more generous employer-based coverage to an Obamacare plan, the difference can be a shock. The NY Times relates the experience of Chris Foley who gave up “his career in finance to begin one in stand-up comedy and acting”:

The transition was a challenge. First, he bought a plan through a New York State program before Obamacare that had skimpier coverage and bigger deductibles than his corporate plan. Then, when he signed up for his first Obamacare plan in 2014, he found that his doctor of 15 years wasn’t covered by any of the options. He needed a colonoscopy last year, and had a hard time finding a doctor who was covered. He was surprised when he was asked to pay $450 out of pocket for a prescription drug at the pharmacy.

“I was frustrated; I was pretty angry about not having good coverage,” said Mr. Foley, who said he briefly considered a return to the corporate world. But over time, he said, he made peace with his skimpier insurance. His premiums were affordable. “I was covered for any kind of disaster or hospital visit or anything like that, and that’s very important,” he said.

The fact that people eventually make peace with what they can get is one of the big underlying stories of health reform. Before Obamacare the vast majority of people said they were happy with the health care they had. That’s exactly why Obama’s pitch was all about keeping the plan and doctor you have (if you like it).

At the same time, Obamacare promised to be much better than what people had because they couldn’t be dropped or charged excessively for their age or a preexisting condition. So the sales pitch boiled down to: Nothing will change except it will be better.

The reality of Obamacare, as this piece points out, is more like a Medicaid plan with a very high annual deductible. That’s still an improvement for people who didn’t have insurance at all and others (like Chris Foley) may get used to it over time, but it’s not what was promised in the glossy brochure put forward by Democrats.