The Lookout

Obama’s health care law passed 2 years ago, but where are we now?

Liz Goodwin
The Lookout

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President Obama signs the Affordable Care Act two years ago. (J. Scott Applewhite/AP)

It seems like President Barack Obama's controversial health care reform law has been fodder for Republican swipes and grievances for ages. And it sort of has. Wednesday marks the two-year anniversary of the House narrowly squeezing through health care reform, which the Supreme Court will begin reviewing next week before deciding on its legality sometime this summer.

The law was quickly challenged by states' attorneys general, while congressional Republicans vowed to "repeal and replace" it. The new regulation also galvanized the tea party movement, which was credited with changing the political landscape and driving home a Republican-swinging 2010 midterm election. But since then, the public demonstrations have quieted, in part because the most controversial aspects of the law will not go into effect until 2014. The popular consumer-protection parts of the law were intentionally front-loaded.

Even so, a recent Gallup poll found that Americans are evenly split on whether they think the health care law should be repealed. Only 1 in 7 respondents in another poll said they had experienced something positive from the law. A recent Congressional Budget Office (CBO) report estimated that 5 million people may lose their employer-based insurance between 2019 and 2022. The CBO also found that 2 million fewer uninsured Americans would gain coverage by 2016 than previously thought, and that the law would also be slightly cheaper than original estimates.

With the Supreme Court arguments about to begin, let's make sense out of what's happening health care wise. Here's a quick rundown of what's gone into effect and what to expect in the future, with the help of research from the Kaiser Family Foundation.

Already in effect

The more popular, consumer-protection oriented parts of the law were scheduled to go into effect first, and that's not a coincidence. The president knows he needs to build public support for the law before rolling out the more controversial measures.

Insurance companies have already submitted to new rules, which will prevent them from setting a "lifetime limit" on benefits for any of their paying customers. They can't refuse to cover children who have preexisting conditions or kick off kids from their parents' plans until they reach 26 years old. (About 2.5 million young people have stayed on their parents' plans under that last feature, according to the Obama administration.)

Seniors who reached the Medicare part D prescription coverage gap received extra money for drugs, small businesses that insure their employees qualified for new tax credits, and about 50,000 adults with preexisting conditions who have been denied coverage in the past joined a new high-risk pool created by the law. (And by 2014, insurance companies won't be able to deny coverage to sick adults.)

Hoping for a John Boehner-like glow? Your wallet might take a hit with the new 10 percent tax on indoor tanning, which the law ushered in. But other, more essential services will see savings, with some families benefiting from certain preventative care measures, like checkups, which must be offered free to those on Medicaid.

Some plans that haven't changed significantly since the law passed are "grandfathered" and can sidestep some of these new changes.

What's coming this year

We've already had a preview, with the controversy surrounding Rush Limbaugh's attack on Georgetown law student Sandra Fluke's endorsement of free birth control, but by this coming August, insurance plans must offer contraception to women without a co-pay. It's part of a list of preventative services, like cholesterol screening, that the law says must be given without cost sharing. After religious groups protested, President Obama said religiously affiliated organizations like Catholic hospitals would have another year, until 2013, to comply with the mandate. The administration says the insurer will have to reach out directly to the customer to offer contraception, so that the religious employer does not have to.

Depending on your insurer, you might just benefit from a little extra cash. For the first time this year, some insurance plans that spend more than 20 percent of their customers' premiums on nonhealth-care related expenses such as marketing will be required to send customers cash rebates. This rule is meant to encourage insurance companies to keep premiums down by punishing them if they don't reduce their overhead.

One of the most popular components of the health care law (according to a Kaiser Family Foundation tracking poll) is set to go into effect this fall, when health care plans will have to publish a uniform, easy-to-understand description of their benefits so that customers can comparison-shop.

Other groups that might see higher bills: The pharmaceutical manufacturing industry will have to pay extra fees this year, and the law also begins cutting payment for hospitals that unnecessarily readmit Medicaid patients.

What's coming down the road

In 2013, Americans who make more than $200,000 a year can expect a tax hike, as can medical tool manufacturers, whose goods face a new 2.3 percent tax.

But all the major provisions roll out in 2014, when Medicaid will be expanded to cover most low-income people (defined as a family of four making $30,657 or less each year) under 65. Employers of more than 50 people will be fined if they don't provide health insurance to their employees, while people who don't qualify for the expanded Medicaid but aren't offered insurance from their job can buy from state insurance exchanges. (The federal government has awarded millions in grants to states to set up these health exchanges, though some have raised doubts that they'll be ready for enrollment by 2014.) People who are living at up to 400 percent of the federal poverty level will receive subsidies or tax cuts to buy insurance from the exchanges.

Insurance companies won't be allowed to turn down anyone who is already sick, and won't be allowed to charge higher premiums based on a customer's gender. The law also sets guidelines for what insurance plans must cover and imposes new fees on the industry.

The very last change is a tax on "luxury" health care plans that will go into effect in 2018. Insurers that offer plans costing $10,200 or more will face the tax.

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