“Redistribution is a loaded word that conjures up all sorts of unfairness in people’s minds,” said William M. Daley, who was Mr. Obama’s chief of staff at the time. Republicans wield it “as a hammer” against Democrats, he said, adding, “It’s a word that, in the political world, you just don’t use.”
These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking “socialized medicine.” But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall.
Now some of that redistribution has come clearly into view.
The law, for example, banned rate discrimination against women, which insurance companies called “gender rating” to account for their higher health costs. But that raised the relative burden borne by men. The law also limited how much more insurers can charge older Americans, who use more health care over all. But that raised the relative burden on younger people.
And the law required insurers to offer coverage to Americans with pre-existing conditions, which eased costs for less healthy people but raised prices for others who had been charged lower rates because of their good health.
“The A.C.A. is very much about redistribution, whether or not its advocates acknowledge that this is the case,” wrote Reihan Salam on the website of the conservative National Review.
Having obscured much of that vulnerability before, Mr. Obama has responded to recent political heat by apologizing — and expanding the scope of his discredited “you can keep it” promise.