If you're still scratching your head about what the Affordable
Care Act means or doesn't mean or does or doesn't do, you're far
from alone. With so many cherry-picking pundits, politicians, and
media sources perpetuating the spinsanity, it's hard to know how to
get agenda-free information. Depending on where you get your news,
opinions about Obamacare run the gamut from a step in the right
direction to the savior of the American economy to the complete
unraveling of democracy to the second coming of Karl Marx.
When Minyanville was searching for an unbiased take on this
labyrinth of a law, we turned to an organization with only one dog
in the health-care fight: the truth.
is an award-winning nonprofit charity that operates with the
explicit purpose of helping the public make informed decisions
about complex social issues. For its 15.7 million readers,
ProCon.org pores through volumes of legislation (in Obamacare's
case, 900 pages worth) and weighs -- in equal measure -- the pros
and cons from experts on both sides of the political aisle.
We spoke with Kamy Akhavan, the president and managing editor of
ProCon.org to see what he found out when his reference site posed
the core question: Is the Patient Protection and Affordable Care
Act good for America?
The answer is a resolute, unequivocal, and thundering... "Eh, we
Unfortunately, the jury is still out on certain nuts and bolts of
the bill. Some questions about Obamacare fall into ProCon.org's
"debated" territory and will likely remain in a sort of speculative
limbo until the law's final implementation. Only then, when it's
laid bare before us in full effect, will we be able to dig in with
that scalpel, dissect all its parts, and -- depending on our
respective political bents -- either marvel at the innards or run
for the restroom.
The good news is, ProCon.org does have definitive answers right now
to many of our burning queries. Following are a sampling with
clear-cut yes or no replies that we thought most relevant to
1. Can this thing still be repealed?
The big challenge to this came from the constitutional question --
which was answered 5-4 -- so it's not going to get repealed by the
Supreme Court. The other place it could've been axed was in
Congress. The House of Representatives has voted over 30 times to
get rid of Obamacare but it'll never happen without passing the
[Democrat-controlled] Senate. And even if it did pass the Senate,
there's no way Obama would sign it. So, between the Supreme Court,
the legislature, and then the president all saying "no," it looks
like Obamacare is here to stay.
2. What parts of the Affordable Care Act have already taken
In September of 2010 we started having coverage for young adults up
to age 26 on their parents' plan. We've had free preventative care
for services such as mammograms and colonoscopies, being done
without a deductible, copay, or coinsurance. Insurance companies
can't rescind your coverage if you make some kind of technical
mistake on your form (like forgetting to put your middle initial).
If your insurer says, "We don't approve your new heart valve, our
policy doesn't cover it" you can appeal that. The lifetime limits
on insurance coverage were lifted. And this is all nationwide, as
federal law. In 2011 we started seeing more services for senior
citizens. They can now get free wellness visits and free
personalized prevention plans on Medicare.
Also, insurance premium rebates took effect if health insurers
profit by more than 15%; so at least 85% of all the premium dollars
they collect have to be spent on health-care services and
health-care quality improvement. If they spend less than that they
have to give back rebates to their members. Here at ProCon.org, we
have received checks from our insurer because they were compelled
to do so as a result of the Affordable Care Act.
3. So what's left to kick in?
January 1, 2014 is when a lot of the meat of Obamacare takes
effect. The big ones are the establishment of state-run health
insurance exchanges and the individual insurance mandate that
requires every single person in the United States to have insurance
coverage. If you're not insured, you have to pay a fine.
4. Is anyone off the hook for buying coverage?
There are literally some exceptions to the mandate. If someone
already has insurance through Medicaid, Medicare, an employer, or a
veterans health program, they don't have to buy insurance because
they already have it.
Prisoners, undocumented immigrants, some religious groups -- those
who have been historically exempt from the Social Security system
such as the Old Order Amish and religious groups whose members pay
for one another's health care. Also, if you're an American Indian
and subject to the sovereign laws of your tribal community.
5. How will the fines work for not buying
It's a little bit complicated. First, they give you a year and they
shake their finger at you. [Referencing the Cleveland Plain Dealer]
in 2014, the penalty is either $95 for every adult and $47.50 for
every child under the age of 18 in the household, or 1% of taxable
income for the household, whichever is larger. And then it gets
In 2015, they start shaking their fist. It's $325 for every adult
and $162.50 for every child (up to $975 for a family), or 2% of
taxable income, whichever is larger.
In 2016, that fist turns into a foot and it goes up to $695 for
every adult and $347.50 for every child (up to $2,085 for a
family), or 2.5% of income, whichever is higher. After 2016, the
penalty increases annually by the cost-of-living adjustment.
6. How will the subsidies work for those who can't afford
coverage, and what kind of criteria need to be met to
There will be no penalty for those who can't afford insurance,
including those who don't make enough to file federal taxes or
whose insurance premiums will cost more than 8% of their household
income. The government will help them pay for it and try to do what
it can to make that insurance affordable.
The White House says broadly that there will be tax credits for
middle class families, small businesses, and millions of Americans
will soon be eligible for tax credits, and if you can't afford
insurance, it basically says don't worry about it, we'll help you.
The way Consumer Reports describes it, if you buy insurance on an
exchange as an individual, you may qualify for a subsidy in the
form of a tax credit if your household income is between 100% and
400% of the federal poverty level.
7. How does the mandate work for employers?
The way the Affordable Care Act is written, the term "applicable
large employer" means a company that employed an average of at
least 50 workers during the preceding calendar year. They'll have
to pay a fine of $2,000 per full-time worker if any of their
employees turn around and get premium tax credits through the new
health insurance exchanges. So if the small business has 51 workers
and one of those workers gets a tax credit to help them buy
insurance, even though they're already getting insured through
their company, then the business has to pay a $2,000 fine per
employee, per year.
8. So the mandate doesn't apply at all to companies with
under 50 employees?
No, and there's no debate.
9. Can you keep your current coverage?
The White House says yes, and the answer is technically true, but
-- and this is a big but -- a lot of the insurance providers will
no longer be offering the exact plan. Part of the reason is that
Obamacare mandates a certain level of quality and a certain number
of services to be offered in their insurance packages. So if the
insurance package you currently have doesn't perform a certain
service that Obamacare requires, that insurance plan will likely
become a different plan. So your exact same plan may no longer
exist because now they have to comply with some of the requirements
of Obamacare, which are the ones intended to increase quality
Whether the forced, low-tier plans will cost more is still subject
to debate because -- and this is one of the main theories of the
Affordable Care Act -- by mandating that everyone get insurance,
they are creating this big carrot for the insurance company.
They're saying we'll give you 30 million more customers and that
will help your bottom line. In exchange for doing that, we're going
to ask that you provide them a little more coverage. And in effect
we hope that, on net, it's a plus for all because more people are
insured, you have more customers, they are still profitable,
everyone's happy. That's the theory.
Whether it increases premiums or not, we won't know until the
mandate has kicked in. I can tell you that [at ProCon.org] for our
particular company plan, our premiums have not gone up. In fact
we've received rebates. Other people will say the opposite, that
their premiums have gone up. So the bottom line is to be determined
on that one.
10. Will Obamacare raise my taxes?
There will be 19 new taxes in the form of brand new taxes, fees,
and penalties that have never existed and in the elimination of tax
deductions. For example, we'll see a $50,000 tax penalty on
charitable hospitals that fail to meet five new requirements, a
2.3% excise tax on medical device manufacturers, and a removal of
executive salary tax deductions for health insurance companies that
compensate executives over 500,000 a year.
For individuals and families, an increased penalty of 20% will
apply to early withdrawals from health or medical savings accounts,
and people who buy indoor tanning products will incur a 10% excise
11. What if I have [insert chronic disease]? Will I get to
participate in the exchange? Will there be a limit on how much
carriers can increase my premium, and how can they afford to cover
A press release from the Department of Health and Human Services
said that under the Affordable Care Act , in 2014, Americans with
preexisting conditions cannot be denied coverage, cannot be charged
significantly higher premiums, be subject to an extended waiting
period, or have their benefits curtailed by an insurance company.
There's specific language to the effect that increases have to be
reasonable. The government will help subsidize what it calls
"high-risk pools" so that it is not as cost-prohibitive for the
insurers to offer those types of plans. But the law is very
specific in that it says they cannot be denied coverage for a
preexisting condition. No debate.
What have we learned today?
For starters, those of us carelessly carting around health
insurance ID cards with no middle initial have been getting away
with murder. So let's all breathe a collective "Whew!" for that
will certainly take a hit from Obamacare, even those among us
without home tanning beds can likely expect raised taxes passed
down from the companies and hospitals, directly incurring the
$1 trillion increase
between the 2013 and 2022 budget periods. We also know much of the
revenue will be squeezed out of a 0.9% payroll tax and a 3.8% tax
on investment income for couples earning over $250,000 and
individuals making more than $200,000.
Some health-care companies are expected to
from the act, however, including the nation's largest hospital
), the largest insurer,
), drug companies like
) and pharmacy manager
), and drug retailers like
Fingers crossed, you're not doing as well, financially, as you
thought. Check out the
Department of Health and Human Services poverty level
. If you're a single earning $44,680, a couple earning $60,520, or
a family of four earning $92,200, congratulations, the government
thinks you're just poor enough for a subsidy!
The rise and/or fall of insurance premiums under Obama's signature
law varies by state. New York Governor Andrew Cuomo says New
Yorkers will see their premiums
drop by 50%
. So, if rates where you live go up, just move to New York. There's
plenty of room.
Since companies with less than 50 employees are exempt from the
mandate, Michael Moore may soon have new fodder for a
If repealing Obamacare is a matter left to the legislative and
executive branches, it seems anti-health-care reformers needn't
despair just yet. The 2014 midterm elections -- when all 435 seats
in the House and 33 in the Senate go up for grabs -- are a mere
doctor's checkup away. A mammogram or prostate exam later, and
America will have a brand-new president.
And if the White House's own decision to
delay the employer mandate provision
is any indication, it may very well be the Obamacare enthusiasts
who are left waiting.
Finally, the success of the Affordable Care Act hinges on the
participation of the young and the healthy. If this demographic
opts out and instead takes the penalty, insurance companies won't
be able to mitigate the cost of the "high-risk pools," and we can
basically count this whole thing as kaput.