Public confusion and partisan divide as Obamacare turns two


HAPPY BIRTHDAY, PPACA: At a birthday party March 23 for the Patient Protection and Affordable Care Act, U.S. Senator Jeff Merkley (D-Ore.) greets Jose Gonzalez, a member of the Oregon Insurance Exchange Board.

The Patient Protection and Affordable Care Act (PPACA) — better known as Obamacare, the name its opponents gave it — turned two on March 23. Three days later, the U.S. Supreme Court heard arguments on whether it should be struck down.

PPACA is an extraordinarily complex health insurance reform law, and the public has been divided over it ever since President Barack Obama signed it two years ago — according to monthly tracking polls by the Kaiser Family Foundation, a non-partisan health care information clearinghouse. In the group’s March 2012 poll, 41 percent of Americans had a favorable view of the PPACA, while 40 percent had an unfavorable view.

Two findings stand out in the foundation’s two years of polling — partisan polarization, and lack of public knowledge about the law.

PPACA passed without the vote of a single House or Senate Republican, and two years later, the poll shows three-fourths of self-identified Republicans have an unfavorable view of the law, while two-thirds of Democrats view it favorably. Meanwhile, of the 40 percent who said they have an unfavorable opinion about PPACA, more said it was more about their general feelings about the direction of the country and what’s going on in Washington right now than said it was based on what they know about the law.

In fact, the public doesn’t know much about the law, the poll has found. Six in 10 say they don’t have enough information about the law to understand how it will impact them personally. That’s the same proportion that said so in April 2010, immediately after the law’s passage.

The poll also shows that some of the most popular provisions of the law are among the least widely known, whereas the law’s best-known feature  — the individual mandate — is its most unpopular part. Only one in three Americans supports the mandate, PPACA’s requirement that starting in 2014 all otherwise-uninsured individuals purchase private health insurance or else pay a tax penalty. The constitutionality of the individual mandate is one of the questions the Supreme Court will rule on, likely in the next two months.

But the 2,400-page law has many other pieces. Some highlights:

Insurance reforms

  • Insurers have to spend at least 80 percent of premium dollars on health care. In other words, no more than 20 percent can be spent on administration, advertising, CEO salaries, profits, and so on. For group policies, the figure is 85 percent.
  • Insurers can no longer drop people from coverage when they get sick; nor can they refuse to insure children under 20 years old because of pre-existing conditions (or adults, starting in 2014); nor can they impose annual or lifetime claim limits.
  • Insurers must allow children up to age 26 to be included on their parents’ family coverage plans.
  • All policies must pay for preventive medical services, such as immunizations, mammograms and colonoscopies, with no co-payments, co-insurance, or deductibles.

Medicaid expansion

In 2014, Medicaid — the government health insurance program for the poor — will expand to cover all those earning up to 133 percent of the federal poverty line. [That computes to about $15,000 a year for an individual, or $25,00 for a family of three.]

Employer incentives and penalties

Small employers that provide health insurance — particularly low-wage employers — get a tax credit reimbursing them for up to a third or half of what they pay.

Large employers that DON’T provide health insurance, starting in 2014, may pay an annual penalty of somewhat less than $2,000 per employee.

Insurance exchange

Starting in 2014, individuals who don’t otherwise have health insurance will be required to buy it on state-based insurance exchanges, or face a tax penalty that starts at 1 percent of income and rises to 2.5 percent by 2016.

Individuals will get access to subsidies through the exchange, and those earning up to four times the poverty level will get some amount of subsidy. The subsidies cap the premium as a percentage of income and also help with co-pays and deductibles. For example, a family of four with an income of $66,000 would pay a maximum premium of 9.5 percent of their income — $524 a month — and would get up to $1,500 in help paying for co-pays and deductibles.

SEE RELATED ARTICLE: What the health reform law means for union members


  1. My current physician is against the PPACA because he claims it will increase taxes. Whose taxes? How will taxes be increased? I am completely unable to find an authoritative and non-partisan assessment of how taxes, whose taxes, and which taxes are going to be negatively effected. I would greatly appreciate ANY (non-spun nonpartisan) clarification on these matters. FYI. It is personal to me because my sister is still struggling to hang on to her house after her husband’s unexpected brain hemmorage two years ago. They have two children.

    • Hi Elizabeth. Thanks for your question. It’s true that PPACA increases government expenditures, and it contains a variety of new taxes and tax increases to help pay for that.

      The biggest tax increase in terms of revenue raised is an increase in Medicare payroll taxes on high-income taxpayers. Starting 2013, individuals with over $200,000 in taxable income (that’s income after all the deductions and exemptions are subtracted), and couples filing jointly with over $250,000 taxable income, will pay an additional 0.9 percent on the income above those amounts. For example, a single filer with $500,000 taxable income would pay $2,700 a year more than they do now. But hey, they made half a million a year; what are they complaining about!? That’s for “earned” income, like a doctor’s salary. PPACA also imposes a 3.8 percent Medicare tax, for the first time, on what the IRS calls “unearned” income — things like capital gains, rents, dividends, and interest.

      Other taxes include annual fees on insurers, drug-makers, and medical device makers; a 10 percent tax on tanning services (which cause skin cancer); and a surcharge on so-called “Cadillac” health insurance policies, policies that cost more than $10,200 a year for an individual or $27,500 for a family.

      Except for the tanning tax, these new taxes affect only big business and the top 2 or 3 or percent of income earners. You can draw your own conclusion about your doctor’s concern about it, but I can’t see how these new taxes would harm your sister. If anything, it’s more likely she would benefit from the other parts of the law, such as subsidies for health insurance and limits on out-of-pocket medical expenses. I hope that’s helpful.

    • I recommend you read Landmark: The Inside Story of America’s New Health Care Law and What It Means for Us All – non-partisan assessment and a simple read. I read the book, the law, and other published materials. Here’s a short summary of a longer book review I wrote for a graduate public policy class:
      Landmark The Inside Story of America’s New Health-Care Law and What It Means For Us All – a collection of writings by Washington Post reporters who covered and analyzed the passage of the PPACA through Congress – first acquaints the reader with the historic bill by presenting a behind-the-scenes account of the many closed-door negotiations made, barriers faced, and compromises reached to make the law possible. Thereafter, understanding what the bill means for us all, its impact, and how it will work becomes the leitmotif of the next thirteen chapters. The chapters are written in straightforward language to make clear an otherwise technical language. According to William Schiffbauer, a Washington lawyer who represents health insurers, the change of a semicolon or a colon or a period in legislative language can make a substantial difference over its precise meaning and the PPACA contains more than 2,000 pages of punctuation marks (2000). It is in writing and illustrating the more than 2,000 pages of the PPACA’s legislative language, using straightforward language and simple figures, that the Landmark authors demystify this dense, complicated healthcare legislation and its impact on stakeholders.
      Hope this helps. Best of luck.


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