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:
- 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.
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.
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.