There are two Affordable Care Acts. There's the legislation passed by Congress in 2009, and then there's the mythical Affordable Care Act – the perfidious “government takeover” decried and demagogued by so many conservatives (and quite a few liberals). The former is quite popular, the latter gets decidedly mixed reviews.
Don't take my word for it. A recent poll by the Kaiser Family
Foundation found Americans split down the middle, with 41 percent
approving of the law, and 40 percent saying they didn't like it (PDF).
But then Kaiser asked about 12 specific provisions in the legislation,
and found that, on average, 63 percent of respondents approved of the
nuts and bolts of Obamacare. Of the 12 measures they tested, only one –
the controversial mandate to carry health insurance or pay a penalty –
received the approval of less than half of Americans (35 percent).
Or consider this divide: while only 12 percent of Republicans had a
positive view of the law overall, 47 percent, on average, viewed its
And here's the kicker: Kaiser found that the most popular parts of the
law were also the ones most Americans weren't aware of, and vice-versa.
Almost everyone knows about the mandate, which most people don't like,
but fewer than half of those polled knew about the law's tax credits for
small businesses that offer their employees coverage, a provision that
eight out of 10 people liked when they heard about it.
None of this should come as a surprise, given the level of mendacity of
the law's opponents. If the Affordable Care Act did in fact feature “death panels,” resulted in deep cuts to Medicare, represented a "massive” tax increase and “Sovietized” our healthcare system, nobody would support it. Fortunately, none of that bears any resemblance to reality.
Obviously, the law should be judged on what it actually contains, but
according to Kaiser, six in 10 say they don't have enough information
about the details to understand how it will impact them personally. So
here, in no particular order, are 10 things you may not know about the
Affordable Care Act.
1. People Will Be Getting Checks
Call it a crazy hunch, but my guess is that the law will look a lot
less tyrannical when people start getting checks in the mail to help pay
for their insurance.
Folks making up to four times the federal poverty line will be eligible
for subsidies. In 2012, that
would mean a family of four making up to
$92,200 (it's a bit higher in Alaska) would see some cash.
Those subsidies will come in the form of “advanceable” tax credits,
meaning that people won't have to wait until they pay their taxes to get
the cash, and they'll be fully refundable, so those who don't pay
enough in federal income taxes will get a check in the mail from the
2. The Richest Americans Are Going to Pay More Taxes
Wealthy investors are outraged, but most people probably don't know that a 3.8% surcharge
on investment income – dividends and capital gains -- kicks in this
January for everyone with an adjusted gross income of over $200,000
($250,000 for joint filers). So those currently enjoying the lowest rate
on investments in our nation's history will pay for a decent chunk of
3. Insurers' Overhead – and Profit Margins -- Are Limited
For the past 18 months or so, insurers have been required to spend 85
percent of the premiums they collect on healthcare (80 percent for
individual and small-group plans). If they spend less than that, they
have to send their customers a rebate to cover the difference.
Forbes' Rick Ungar called
it, “the true ‘bomb’ contained in Obamacare and the one item that will
have more impact on the future of how medical care is paid for in this
country than anything we’ve seen in quite some time.”
4. Much Ado About the Mandate
With the Supreme Court's ruling last week, the mandate is gone, but the
penalty for not carrying insurance remains. If there's one thing
Democrats, Republicans and independents agree on, it's that they don't
And they shouldn't. But most people probably don't know just how modest
the impact of the mandate really is. According to the Congressional
Budget Office, just 1 percent of the population will pay the penalty,
which maxes out at 1 percent of one's income.
A lot of conservatives are convinced that jack-booted gummint thugs
will round them up and stick them in FEMA camps if they don't pay up.
But as Timothy Noah points out,
“the health reform law explicitly states (on Page 336): 'In the case of
any failure by a taxpayer to timely pay any penalty imposed by this
section, such taxpayer shall not be subject to any criminal prosecution
or penalty with respect to such failure.'" They can only dock future tax
5. And Nobody Ever Talks About the Employer Mandate
Starting in 2014, companies with 50 or more full-time workers (two
part-timers count as one full-timer for this purpose) will have to pay
penalties if they don't cover their employees' health insurance. (This
provision is a bit complicated -- all the details are here.)
6. Shaves the Deficit
Mitt Romnney says that “Obamacare adds trillions to our deficits and to
our national debt, and pushes those obligations onto coming
That message appears to be sinking in. According to Kaiser, a majority
of Americans – and a third of Democrats – think the healthcare law will
increase the deficit. But according to the Congressional Budget Office,
the law will reduce the projected deficit by $210 billion over the next decade.
7. Chicks Will Dig This
Many people are aware of the regulation requiring insurers to cover
people with pre-existing conditions. It's one of the most popular parts
of the whole. But fewer know that, beginning in 2014, insurers won't be
able to charge women higher premiums than men.
Also coming in 2014: a ban on insurers placing annual limits on
healthcare (lifetime coverage limits were already banned in 2010).
The Kaiser poll found that few people were aware of another popular new
insurance regulation: since 2010, insurance companies can no longer
charge co-pays or hold you to a deductible for preventive health
8. New Dollars for Community Health Centers
Kaiser didn't ask for people's opinions on this one, but it may be one
of those under-the-radar provisions that actually ends up helping a lot
Community health centers (CHCs) now serve the primary care needs of
about 20 million Americans, and they have a proven track record. But the
system is strained and underfunded.
The expansion of Medicaid will help alleviate some of the pressure, and
the healthcare law also allocates $11 billion over a five-year period
to build new CHCs and upgrade existing infrastructure. Most of the
dollars will end up in poorer communities.
A lot of underserved people live in rural America, and the law also
provides money to train and place 16,000 primary caregivers in rural
communities over a five-year period.
9. Essential Benefits
Starting in 2014, in order for insurers to sell coverage through
state-based exchanges – a place where a lot of the newly insured will
likely end up – they will be required to cover a package of “essential
benefits,” including maternity care, mental healthcare and substance
abuse treatment, pediatric care, ambulance rides and hospitalization.
They don't have to if they don't want to participate in the exchanges,
yet this measure is, according to many, at the heart of the supposed
“government takeover” of our healthcare system.
10. It's Not So Easy to Repeal
There is no doubt that we'll hear lots of Republicans blustering about
how they'll repeal Obamacare on day one if they win the White House and
the Senate, but it's a lot less clear that they'd actually follow
As Igor Volsky notes,
unless the Republicans were to win both the White House and a huge
number of senate seats, they “can do little more than weaken Obamacare’s
regulations and defund some of its provisions.” They also have nothing
to replace it with, and would own our screwed up healthcare system for a
generation. And they'd lose an issue that fires up the conservative
base. They will, however, do their best to gum up the works as the law
The takeaway to all of this is that the healthcare law is only going to
get more popular as it's provisions kick in. People will see some
tangible benefits, and the fearmongering will prove unfounded.
Like the idea of government itself, people are suspicious of the
Affordable Care Act as an abstraction, but when it gets to the specifics
they tend to like it a lot better.