ObamaCare in Plain English: What it Means for You

This article was originally published in the Blue Street Journal. Since then the questions and misinformation about Obamacare haven’t faded and, in fact, there will be some changes as the law is implemented across the nation. Here’s an introductory primer:

There’s a lot of hype going around about ObamaCare, and by now you are probably getting mixed information about what the law actually is and how it will affect you.  The purpose of this post is to lay out the basic facts in plain English so you know exactly what to expect as this reform takes effect over the next few years.  However, before we get started, allow me to clarify a few very important things about the Patient Protection and Affordable Care Act, otherwise known as “ObamaCare.”

  • ObamaCare will not use your tax dollars to fund abortions
  • ObamaCare is not and will not lead to a government takeover of health care
  • ObamaCare will not increase the national debt or deficit
  • ObamaCare does not hurt health insurance companies, but actually increases their business
  • ObamaCare is not unconstitutional
  • ObamaCare is not  socialism

ObamaCare is NOT  Government-Run Health Care

This is the biggest, and perhaps most dangerous, misconception about ObamaCare, and I want to debunk this myth from the very beginning.  Despite what many Republicans and Tea Party members are claiming, ObamaCare is NOT government-run health care.  The politicians and pundits who are misrepresenting it in this fashion are acting irresponsibly and are purposefully misleading the American public.  Government-run health care would involve a health insurance program that is entirely implemented and managed by the government: i.e., Medicare and Medicaid.  ObamaCare is actually designed to promote a competitive free market for private insurers to offer their services to the American people, so one could actually argue that this is a highly capitalist endeavor.  If ObamaCare fell under the title of government-run health care, then all of us would be getting Medicaid and there would be no option for anything else.  That is not what ObamaCare does.  Instead, the Patient Protection and Affordable Care Act is a federal mandate (meaning a federal law) that requires all Americans to have health coverage by 2014.  Just like you are required to have car insurance to drive, you must now have health insurance to live and work in the United States. Before you get upset or frustrated by this new expense, let me explain how ObamaCare makes this a much more attainable reality for everyone while increasing the quality of available health care and saving billions of dollars in the process.

How Will ObamaCare Affect my Insurance Costs and Available Coverage?

Prior to ObamaCare, your health insurance premiums (the price a company charges you for coverage) were determined by several factors, including age, health, and geographical location.  Furthermore, insurance companies could deny anyone coverage due to health status, genetic information, pre-existing conditions, evidence of domestic violence, and essentially any other reason they saw fit.  If they believed you would cost them too much money, they would either charge you an outrageous premium or deny you coverage and send you on your way.  With ObamaCare, new regulations prohibit such actions.  As of September 23, 2010, insurance companies are no longer allowed to deny coverage to children under the age of 19 who have  a pre-existing condition.  Additionally, insurance companies can no longer place a cap on a child’s lifetime coverage.  Prior to ObamaCare, many children who were born with life-threatening illnesses used up their lifetime coverage before the age of ten.  Thanks to ObamaCare, insurance companies can no longer end coverage for these children or anyone else by implementing a lifetime cap.  Beginning January 1, 2014, these same protections will be extended to all Americans above the age of 19.

Under ObamaCare, premiums will be determined solely by family structure, geographical location, tobacco use, participation in a health promotion program, age (by not more than three to one), and actuarial value.  Actuarial value is the percentage of medical expenses covered by the insurance plan.  For example, if the actuarial value is 80%, your insurance plan would pay for 80% of your medical costs while you would be responsible for 20%.  The higher your actuarial value, the higher your premium.  However, you will no longer be charged a higher premium due to your current state of health or pre-existing conditions.  Your insurance company can still deny you coverage of a particular treatment, but only if that specific treatment is not offered to anybody enrolled in the plan.  For example, if your policy does not cover a specific prescription drug, you will be required to pay out-of-pocket for the medication or seek a different prescription from your doctor.  This stipulation cannot single out individual members, and must apply to everyone or no one.


Read the rest of Molly Gum’s post here.


me2Molly Gum is the creator of the Blue Street Journal. She is a high school English teacher, an independent small investor, a progressive Democrat, and a closeted Sarah McLachlan fan.