The Top 5 Things You Need to Know About the Health Care Law at Year One

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With the Patient Protection and Affordable Care Act turning one today, there are a slew of anniversary pieces out there about the law. Here's what you need to know about where things stand, culled from some of the best of them:

1. The law hasn't covered many people yet. Though the law was never intended to cover most of those eventually eligible until 2014, it still has fallen dramatically short of expectations on the proof of utility front. Reports The Washington Post, "Nearly 12,500 Americans have joined high-risk pools that were created to cover people who were rejected by insurance companies because of medical problems. The enrollment so far is about 3 percent of government forecasts." A further "nearly 4 million older Americans on Medicare with especially large prescription-drug expenses received $250 rebate checks last year.... about one in eight people with the program's drug benefit." And "no one knows how many people" are being aided by the change to allow kids to stay on their parents' coverage until age 26, or by the one barring insurance discrimination against kids with pre-existing conditions.

2. The Supreme Court decision on whether it is constitutional will probably come down just as the GOP 2012 presidential primaries are in full swing. "Are you ready for a dispositive ruling on the federal health-care law just in time for the heart of the presidential primary season?" asks Andrew Cohen, after examining the history of judicial review of major legislation dating back to the New Deal. "Cue the chattering class. Book the air time. Dust off the cloistered law professors and other 'experts.' One year from today we'll either know, or be very close to knowing, whether the Act stands or falls." Until that decision is in, all talk about what the law is expected to do in the future comes with the caveat, "if the court agrees."

3. Support for the law has not increased -- nor has public understanding of the what the Act seeks to do. This, despite administration efforts to sell it. "According to monthly surveys by the Kaiser Family Foundation ... support for the law has never quite broken 50 percent. The dominant feeling about the legislation, the surveys show, is confusion -- now reported by 53 percent, just two percentage points less than 11 months ago," reported The Post. A CNN/Opinion Research Corporation survey released today found that, one year in, "37 percent of Americans support the measure, with 59 percent opposed. That's basically unchanged from last March, when 39 percent supported the law and 59 percent opposed the measure."

4. The outside group that was supposed to help Democrats sell the law appears to have fallen by the wayside. This might have something to do with the continuing low level of public understanding. Reports Politico Pro's Jennifer Haberkorn: "Democrats are under siege as they mark the first anniversary of health care reform Wednesday -- and they won't get much help from the star-studded, $125 million support group they were once promised. Wal-Mart Watch founder Andrew Grossman unveiled the Health Information Campaign with great fanfare last June. Tom Daschle and Ted Kennedy's widow, Vicki, were expected to lead the effort. They'd have help from former White House Communications Director Anita Dunn. They'd have an office in Washington with 10 or 15 operatives backing the Affordable Care Act and those who supported it. ... But nine months later, the Health Information Campaign has all but disappeared. Its website hasn't been updated since the end of last year. Its executive director and communications director are gone. There's no sign that it has any money. And neither Daschle nor Dunn will return calls asking about it."

5. The law won't fix America's health-care financing problem -- the biggest budgeting worry -- in the long run. TNR's Jonathan Cohn reports that, even if the law is implemented as written, "ten years from now, the best projections suggest we'll have spent roughly as much on health care--as a government and as a country--as we would have if the law never passed." That said, it will slow the rate of increase in costs, he writes: "The official projections suggest that, as of 2021, government spending (and, apparently, the country's total spending) on health care will not be rising as fast as it is now."

All of that said, if you think you're eligible and might like to try to get coverage under the new law, The New York Times recently published a very helpful piece walking readers through how to do so.

Image credit: Jonathan Ernst / Reuters

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Garance Franke-Ruta is a former senior editor covering national politics at The Atlantic.

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