What Is Obamacare?

By James Hamblin
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Only 37 percent of Americans say they're in favor of the 2010 health-care law. When you describe specific changes happening under the law, though, closer to 70 percent are on board with them. That's among data from Kaiser Family Foundation that was highlighted on All Things Considered this weekend. Also of note: 50 percent think the law gives health-care subsidies to undocumented immigrants, 80 percent don't know if their state will expand Medicaid, and 40 percent think the law sets up "death panels." 

Even though the law passed three years ago, there's still a lot of misunderstanding out there about the basics of what it is/does. So hopefully some people will find this of use. I totally relate to situations where everyone is talking about something for a while, and you never really got it, and then before you know it everything you try to read is beyond comprehension because it assumes everyone already knows the basics. So you just nod passively when people bring it up and try to change the subject and continue not to know about it. I'm that way with Syria and food trucks. 

If you consider yourself conversationally fluent in Affordable Care Act banter, then what I write here will bore you. Detailed discussion is at healthcare.gov -- and also like, everywhere else.


Obamacare ... okay to call it that?

Yes. The name used to have a negative vibe, but the President has since owned it

Patient Protection and Affordable Care Act = PPACA = ACA = Obamacare = "the health-care law"

None of these in particular imply that you love or hate Barack Obama or intend to support or subvert the law.

What does it do for people?

SHARK300200.jpgObamacare does not mandate that anyone bend over. This is a playful sodomy reference. (RebeccaCook/Reuters)

The stated purpose is to "increase the number of Americans covered by health insurance and decrease the cost of health care." The most widely relevant and talked-about parts are that no one will be excluded from getting insurance, and everyone will have to get insurance.  

Insurance companies can't refuse to cover people like they used to, and they can't revoke coverage when people get sick. People won't be forced to pay extra for insurance because of pre-existing conditions. There will be a limit on how much insurance companies can legally profit, and they will eventually have to cover all kinds of preventive care. 

Those things, among other measures aimed at containing U.S. health care spending, which was $2.6 trillion last year ...

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This law passed three years ago. It doesn't feel like much has changed.

Changes are rolling out over a ten-year period. So far, things have mostly affected insurance companies and the industry side. Increases in health care spending have (coincidentally?) slowed since 2010. 

The most disputed part of the law -- the "individual mandate" that requires "most Americans to have "minimum essential health insurance coverage" (the part that drove the ACA to the Supreme Court last Spring, where it was upheld) -- goes into effect in January 2014.

45 million Americans don't have health insurance, though. How are so many people supposed to get it by 2014?

First, state and federal governments are setting up exchanges. That will start in October.

What are exchanges?

Exchanges are markets where small businesses and people can shop for insurance and compare prices and benefits. They'll be on web sites.

Well, what if people still can't afford it?

People with "moderate" incomes can get money/discounts from the federal government to help pay for insurance. People with "low" incomes will get their care from Medicaid. More people than ever before will qualify for Medicaid. People who make less than $15,856 (or $26,951 for a family of three) will qualify. As you've heard, Medicaid is expanding, but the federal government is leaving it up to states to decide whether to accept that expansion. The Supreme Court upheld the ACA, but it limited the federal government's ability to enforce expansion, so it's up to states. 

Is my state expanding Medicaid?

Here is where we stand as of last week.

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Where the States Stand The Advisory Board Company

What about undocumented immigrants?

Not eligible for Medicaid or for buying coverage through an exchange

What are death panels?

Not a thing

Why do 40 percent of people think they are a thing, then?

When discussions turn to rationing care -- for example, not spending millions of dollars to keep a 145-year-old person in a coma on life support indefinitely; and, instead, using that money to provide basic preventive care to thousands of underprivileged kids -- someone will bring up the term "death panels." That is, if we are not going to always keep everyone alive at all costs, who decides how care should be rationed? An important question, but "death panels" are fiction.

The law did create an independent nonprofit organization called the Patient-Centered Outcomes Research Institute (PCORI) that compares treatments and tries to figure out which options make the most sense for particular people. That's the closest thing to what someone could somehow call a death panel. But it's actually a body to help make sure more of the decisions made by doctors are supported by evidence.

I get it. How many death panels will Obamacare create? How many astronauts per death panel?

[No response]

Can I still have bacon and giant sodas under Obamacare?

Yes. The only thing in that realm you might care about is that chain restaurants have to list calories on their menus.

Also tanning beds, right? Obama wants to disassemble the free market?

There is a tax on tanning salons. UV rays cause skin cancer, which costs the system money. If you object to taxing things, you could think of it this way: Tanning salons are paying for the costs they create.

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I trust and love my family doctor. Under the Affordable Care Act, is there a chance she will be replaced by a drone?

No

But drones are everywhere. At least robot doctors are in the works? They are. I saw it on the cover of The Atlantic magazine.

If the Affordable Care Act leads to less money wasted on inefficiently providing health care, then more could be invested in tech. So this is not an insane inference. Tech won't replace doctors, though.

I remain unconvinced and am pretty sure there's fine print somewhere that gives undocumented immigrants access to my kids' medical records and whatnot.

You can read the entire act here. It's 955 pages, though. 

And also join the ongoing discussions about health reform everywhere, dinner parties to angry Internet comment threads. I hope this helped a little in getting someone somewhere somewhat more comfortable with that.

This article available online at:

http://www.theatlantic.com/health/archive/2013/04/what-is-obamacare/274509/