Stephen Lam/Getty Images
President Obama encourages people to sign up for health insurance exchanges in San Jose, Calif., on June 6.
President Obama encourages people to sign up for health insurance exchanges in San Jose, Calif., on June 6. Stephen Lam/Getty Images
Call it the Affordable Care Act, call it Obamacare, call it whatever you want — it's coming. And soon. In less than four months people without health insurance will be able to start signing up for coverage that begins Jan. 1.
A lot has been said about the law, most of it not that understandable. So starting now, and continuing occasionally through the summer and fall, we're going to try to fix that.
Let's stipulate right now that there are lots of things about the health law still in dispute and a matter of intense political debate. But given that the law has not been repealed after numerous attempts, and that major pieces of the law are about to take effect, we thought it would be helpful to try to explain what's coming as dispassionately as we can.
So we'll begin with the biggest question of all — who's affected?
For the answer, let's go right to the top — President Obama himself:
"What is left to be implemented is those provisions to help the 10 to 15 percent of the American public that is unlucky enough that they don't have health insurance," Obama told reporters at a news conference in April.
That 10 to 15 percent includes more than 30 million people. Some are adults with pre-existing medical conditions who have been turned down for coverage. Some may be working at jobs at small businesses that can't afford to offer health coverage. Or they may have jobs that do offer coverage, but they don't work enough hours to qualify.
All that stuff you've been hearing about state-based insurance exchanges and marketplaces? Here's how the president explains what's going to happen for those 30 million Americans:
"What we're doing is we're setting up a pool so that they can all pool together and get a better deal from insurance companies," Obama said. "And those who can't afford it, we're going to provide them with some subsidies."
Of course it's nowhere near that simple. There are going to be a lot of details: different plans to choose from with different premiums and copayments. Some people will be eligible for various subsidies depending on the plan they choose. And some will be eligible for Medicaid, if their state decides to expand it.
There are also big worries that enrollment information might not get where it needs to go, at least not at first, and that people then might have trouble getting treatment if government and insurance company computer systems that need to be linked end up talking different languages.
Now, what about people who already have health insurance? President Obama says that's not what this year is really about.
"For the 85 to 90 percent of Americans who already have health insurance, this thing has already happened," he said. "And their only impact is that their insurance is stronger, better, more secure than it was before. Full stop. That's it."
By that, the president means many of the benefits of the law have already taken effect for those with insurance.
For example, "insurance companies can't drop them for bad reasons," Obama said, like because they made a mistake on their insurance application.
And noting one of the most-used provisions now in effect, "kids are able to stay on their [parents'] health insurance until they're 26 years old," the president said. More than 3 million young adults are taking advantage of that opportunity.
All this is not to say that nothing will change or that everything will be great for people with employer-based health insurance. The law hasn't actually reduced premiums, particularly the share workers pay. And while most employers who offer insurance now are expected to continue to offer it in the future, some may drop coverage and send workers to the health exchanges instead.
But for now, the focus is on the uninsured and getting them coverage.
Do you have a question about how the Affordable Care Act will work, or how it might affect you? Email your questions to MorningEdition@npr.org.
We'll answer questions in upcoming segments.