Okay, explained like you’re a five year-old (well, okay, maybe a bit older), without too much oversimplification, and (hopefully) without sounding too biased:
What people call “Obamacare” is actually the Patient Protection and Affordable Care Act. However, people were calling it “Obamacare” before everyone even hammered out what it would be. It’s a term mostly used by people who don’t like the PPACA, and it’s become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.
Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn’t have to.
So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):
Already in effect:
- It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)
- It increases the rebates on drugs people get through Medicare (so drugs cost less)
- It establishes a non-profit group, that the government doesn’t directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( Citation: Page 665, sec. 1181 )
- It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( Citation: Page 499, sec. 4205 )
- It makes a “high-risk pool” for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of “pre-existing conditions” altogether. For now, people who already have health issues that would be considered “pre-existing conditions” can still get insurance, but at different rates than people without them.
- It renews some old policies, and calls for the appointment of various positions.
- It creates a new 10% tax on indoor tanning booths. ( Citation: Page 923, sec. 5000B )
- It says that health insurance companies can no longer tell customers that they won’t get any more coverage because they have hit a “lifetime limit”. Basically, if someone has paid for health insurance, that company can’t tell that person that he’s used that insurance too much throughout his life so they won’t cover him any more. They can’t do this for lifetime spending, and they’re limited in how much they can do this for yearly spending. ( Citation: Page 14, sec. 2711 )
- Kids can continue to be covered by their parents’ health insurance until they’re 26.
- No more “pre-existing conditions” for kids under the age of 19.
- Insurers have less ability to change the amount customers have to pay for their plans.
- People in a “Medicare Gap” get a rebate to make up for the extra money they would otherwise have to spend.
- Insurers can’t just drop customers once they get sick. ( Citation: Page 14, sec. 2712 )
- Insurers have to tell customers what they’re spending money on. (Instead of just “administrative fee”, they have to be more specific).
- Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they’re turned down.
- New ways to stop fraud are created.
- Medicare extends to smaller hospitals.
- Medicare patients with chronic illnesses must be monitored more thoroughly.
- Reduces the costs for some companies that handle benefits for the elderly.
- A new website is made to give people insurance and health information. (I think this is it: http://www.healthcare.gov/ ).
- A credit program is made that will make it easier for business to invest in new ways to treat illness.
- A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they’re not price-gouging customers.
- A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn’t paying for the Aspirin you bought for that hangover.
- Employers need to list the benefits they provided to employees on their tax forms.
- Any health plans sold after this date must provide preventative care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.
- If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word “tiny”, a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we’re talking about people in the top 5% of earners.
This is when a lot of the really big changes happen.
- No more “pre-existing conditions”. At all. People will be charged the same regardless of their medical history.
- If you can afford insurance but do not get it, you will be charged a fee. This is the “mandate” that people are talking about. Basically, it’s a trade-off for the “pre-existing conditions” bit, saying that since insurers now have to cover you regardless of what you have, you can’t just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you’ll have to pay the fee instead, unless of course you’re not buying insurance because you just can’t afford it.
- Insurers now can’t do annual spending caps. Their customers can get as much health care in a given year as they need. ( Citation: Page 14, sec. 2711 )
- Make it so more poor people can get Medicaid by making the low-income cut-off higher.
- Small businesses get some tax credits for two years.
- Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
- Limits how high of an annual deductible insurers can charge customers.
- Cut some Medicare spending
- Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them.
- Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.
- Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won’t be footing their health care bills any more than any other American citizen.
- A new tax on pharmaceutical companies.
- A new tax on the purchase of medical devices.
- A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they’ll get taxed.
- The amount you can deduct from your taxes for medical expenses increases.
- Doctors’ pay will be determined by the quality of their care, not how many people they treat. Edit: a_real_MD addresses questions regarding this one in far more detail and with far more expertise than I can offer in this post. If you’re looking for a more in-depth explanation of this one (as many of you are), I highly recommend you give his post a read.
- If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers).
- All health care plans must now cover preventative care (not just the new ones).
- A new tax on “Cadillac” health care plans (more expensive plans for rich people who want fancier coverage).
- The elimination of the “Medicare gap”
Aaaaand that’s it right there.
The biggest thing opponents of the bill have against it is the mandate. They claim that it forces people to buy insurance, and forcing people to buy something is unconstitutional. Personally, I take the opposite view, as it’s not telling people to buy a specific thing, just to have a specific type of thing, just like a part of the money we pay in taxes pays for the police and firemen who protect us, this would have us paying to ensure doctors can treat us for illness and injury.
Plus, as previously mentioned, it’s necessary if you’re doing away with “pre-existing conditions” because otherwise no one would get insurance until they needed to use it, which defeats the purpose of insurance.
Obamacare has death panels!: That sounds so cartoonishly evil it must be true, right? Well, no. No part of the bill says anything about appointing people to decide whether or not someone dies. The decision over whether or not your claim is approved is still in the hands of your insurer. However, now there’s an appeals process so if your claim gets turned down, you can challenge that. And the government watches that appeals process to make sure it’s not being unfair to customers. So if anything the PPACA is trying to stop the death panels. ( Citation: Page 23, sec. 2719 )
What about the Independent Medical Advisory Board? Death Panels!: The Independent Medical Advisory Board is intended to give recommendations on how to save Medicare costs per person, deliver more efficient and effective care, improve access to services, and eliminate waste. However, they have no real power. They put together a recommendation to put before Congress, and Congress votes on it, and the President has power to veto it. What’s more, they are specifically told that their recommendation will not ration health care, raise premiums or co-pays, restrict benefits, or restrict eligibility. In other words, they need to find ways to save money without reducing care for patients. So no death panels. In any sense of the (stupid) term. ( Citation: Page 407, sec. 3403 )
Obamacare gives free insurance to illegal immigrants!: Actually, there are multiple parts of the bill that specifically state that the recipient of tax credits and other good stuff must be a legal resident of the United States. And while the bill doesn’t specifically forbid illegals from buying insurance or getting treated at hospitals, neither did the laws in the US before the PPACA. So even at worst, illegals still have just as much trouble getting medical care as they used to. ( Citations: Page 122, sec. 1402, Page 123, sec. 1411, Page 125, sec. 1411, Page 132, sec. 1412 )
Obamacare uses taxpayer money for abortions!: One part of the bill says, essentially, that the folks who wrote this bill aren’t touching that issue with a ten foot pole. It basically passes the buck on to the states, who can choose to allow insurance plans that cover abortions, or they can choose to not allow them. Obama may be pro-choice, but that is not reflected in the PPACA. ( Citation: Page 64, sec. 1303 )
Obamacare won’t let me keep the insurance I have!: The PPACA actually very specifically says you can keep the insurance you have if you want. ( Citation: Page 55, sec. 1251 )
Obamacare will make the government get between me and my doctor!: The PPACA very specifically says that the Secretary of Health and Human Services (who is in charge of much of the bill), is absolutely not to promote any regulation that hinders a patient’s ability to get health care, to speak with their doctor, or have access to a full range of treatment options. ( Citation: Page 165, sec. 1554 )
Obamacare has a public option! That makes it bad!: The public option (which would give people the option of getting insurance from a government-run insurer, thus the name), whether you like it or not, was taken out of the bill before it was passed. You can still see where it used to be, though. ( Citation: Page 92, sec. 1323 (the first one) )
Obamacare will cost trillions and put us in massive debt!: The PPACA will cost a lot of money… at first. $1.7 Trillion. Yikes, right? But that’s just to get the ball rolling. You see, amongst the things built into the bill are new taxes – on insurers, pharmaceutical companies, tanning salons, and a slight increase in taxes on people who make over $200K (an increase of less than 1%). Additionally, the bill cuts some stuff from Medicare that’s not really working, and generally tries to make everything work more efficiently. Also, the increased focus on preventative care (making sure people don’t get sick in the first place), should help to save money the government already spends on emergency care for these same people. Basically, by catching illnesses early, we’re not spending as much on emergency room visits. According to the Congressional Budget Office, who studies these things, the ultimate result is that this bill will reduce the yearly deficit by $210 billion. By the year 2021, the bill will actually have paid itself and started bringing in more money than it cost.
Obamacare is twice as long as War and Peace!: War and Peace is 587,287 words long. The Patient Protection and Affordable Care Act, depending on which version you’re referring to, is between 300,000-400,000 words long. Don’t get me wrong, it’s still very long, but it’s not as long as War and Peace. Also, it bears mention that bills are often long. In 2005, Republicans passed the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users, 2005, which was almost as long as the PPACA, and no one raised a stink about it.
The people who passed Obamacare didn’t even read it!: Are you kidding? They had been reading it over and over for a half a year. This thing was being tossed around in debates for ages. And it went through numerous revisions, but every time it was revised, it was just adding, removing, or changing small parts of it, not rewriting the whole thing. And every time it was revised, the new version of the bill was published online for everyone to see. The final time it was edited, there may not have been time to re-read the entire thing before voting on it, but there wasn’t a need to, because everyone had already read it all. The only thing people needed to read was the revision, which there was plenty of time to do.
Pelosi said something like, “we’ll have to pass the bill before reading it”!: The actual quote is “we have to pass the bill so that you can find out what is in it, away from the fog of controversy”, and she’s talking about all the lies and false rumors that were spreading about it. Things had gotten so absurd that by this point many had given up on trying to have an honest dialogue about it, since people kept worrying about things that had no basis in reality. Pelosi was simply trying to say that once the bill is finalized and passed, then everyone can look at it and see, without question, what is actually in the thing (as opposed to some new amendment you heard on the radio that they were going to put in).