10 Questions for … an Obamacare Expert


obamacareFew laws have generated as much opposition–or confusion—as the Affordable Care Act.

Since its stormy passage in 2010, polls have consistently shown that many Americans have major misconceptions about what the health-care law does, including the false notion that it replaces private coverage with a government-run insurance system.

Americans even have different opinions of the law, depending on what it’s called. According to a recent CNBC poll, more people are opposed to “Obamacare” than the Affordable Care Act—even though they are one and the same.

The health-care law’s supporters hope the confusion and hostility will begin to subside now that the exchanges, which launched October 1, are open for business. That said, according to a recent Kaiser Health Tracking Poll, about half of those surveyed said that they didn’t have enough information about the law to know how it would affect their families.

Don Silver, an attorney, was once one of those consumers who was desperate for more clarity. So he read through all 900-plus pages of the law (twice!)—plus around 15,000 pages of health-care regulations—and then wrote “The Best ObamaCare Guide.” Given his expertise, we asked Silver to separate fact from fiction—as well as share some little-known knowledge about the law.

LearnVest: What does the Affordable Care Act do?

Don Silver: The big picture is that the Affordable Care Act extends coverage, either through private insurance or Medicaid. It’s important to point out, however, that the law does not guarantee access to care. It also does not control medical costs. There is no real rate control on the federal level, although there is some in certain states.

Some new benefits that affect everyone: You cannot be turned down for insurance due to preexisting conditions, and there are also no longer any annual or lifetime caps on coverage. Additionally, 10 essential health benefits—including doctor visits, maternity care and hospital visits—are now required coverage.

Young adults can now stay on their parents’ plans until age 26, but there can be some downsides if kids live in a different area than their parents, in which case medical care might be all out of network and out of pocket. Women will also now pay the same premium rate for coverage as men, which has not been the case in most states. And the unhealthy will pay the same amount as those who are healthy, which also has not generally been the case.

The employer mandate—employers with 50 or more full-time and full-time-equivalent employees now have to provide insurance or pay a penalty—is also new, but that’s been delayed for one year.

RELATED: The 2014 Health Care Cost Forecast

  • OmnesLegal

    Great article. Lot’s of misconceptions going around.

    • glass

      actually this article isn’t truthful at all.

  • AS Smart

    Wonderful article. Seem like parents of those with autism will continue to be marginalized by lack awareness, and now lack of coverage in certain geographical areas. Thanks for spotlighting the situation.

    • ranavain

      To be fair, I’m not sure the ACA is changing anything on that front. It’s always been the case that some plans cover autism treatment and some don’t… in fact, I’d say this is probably a net positive for specific conditions like this, because it will now be much easier to compare plans side-by-side to see what is covered and what is not.

      I think this is also something that will improve as more and more companies join the exchanges.

      • kgal1298

        You’re right and a lot of people don’t actually check or call on the benefits of one provider for the other. If I had a serious illness that needed specific treatment it’s always best to see who will cover what, but I do like the exchanges for offering a side by side view.

    • glass

      Right, because PPACA reduces FSA levels which hurts chronic disabilities like autism and mental illness.

  • DC

    “I am a lawyer, but I offer a non-political perspective on a 1000 page law in 3 paragraphs or you can read my book.” The writer only covered one of ten sections in the bill. It is too big and encompassing to be successful. Much of the insurance reform could have been done in a brief bill and introduced as a pilot to avoid this polarized backlash.

    The U.S. chose to kick this reform off in a free market (not a single payer system) and now you will see that every NFL Superbowl advertisement will come straight from the taxpayers pockets, this competition will do nothing to lower the costs of healthcare.

    This is a huge money grab by insurance companies, brokers (Navigators), and attorneys.

    You don’t need a 1,000 pages to communicate any law and its definitions.

    • glass

      You forgot all the politicians who met with big insurance and big pharma when PPACA was a bill. Can you guess which ones? The corporations have no power unless the politicians are complicit and allow it. Corps do not vote in our government, our elected politicans, unvetted by a compromised media, vote on laws. Put the blame where it belongs. Everyone knows corporations are driven by profit motive, i can’t blame them for their transparent self-interest. it is the hidden, non-transparent, political dealings that need exposing and cleaning.

      • kgal1298

        Haha glass your right. The problem is we elect officials and allow them to take unlimited campaign contributions and many of those come with promises. Though with opposition you can imagine insurance companies aren’t happy about this. They don’t want to cover sick people they’ll lost more than they gain in that regard, but again the economic impact isn’t for certain so we don’t know. For all we know they will make a killing off of this it’s hard to say overall because we can’t see the future or what people will do.

        • DC

          There are many winners with ACA, but the insurance companies are one of the biggest. We are excited that on Jan 1, 2014, $80B in premiums will be added, that is twenty million brand new customers with a voucher worth $4-6k per year. That will be plenty to cover the high risk “existing conditions.”

          Insurance is a wonderful and humane thing to do, but can only happen through a law that ensures that all companies are playing to the same rules.

        • glass

          The insurance companies are not charities. PPACA guarantees and mandates access to insurance. Most useful idiots don’t understand that issue. So if you have a pre-existing condition, you can have access to insurance, but you are going to pay for it. PPACA doesn’t guarantee “affordable”, as “affordable” isn’t defined in the law. (However promises were made by PPACA supporters in the media like the cost will equal the average cell phone bill, which is 71 dollars a month, but I digress) For anyone $1.00 above subsidy level, insurance is costing more due to the guarantee requirements. You can than Nancy Pelosi, Harry Reid, and Barak Obama for the mess. No republican voted for it. It was passed with 0 votes. Enjoy your higher cost, mandated-fined, insurance (but not health care).

    • RS

      I agree with DC. There was a lot of hype in a large number of pages. I personally have seen medicare dollars reduced here in Florida at the beginning of 2013. Everyone was so eager to hear about Affordable Care Act. And in the end, employers will be forced to offer a plan which employees will be forced to pay for. And the rest of us may or may not get a subsidy on the premium. Much Ado About Nothing.

  • glass

    Actually, it was Jimmy Kimmel that asked the ignorant to decide between PPACA and 0-care. Try and get one fact correct. Also, a impact of PPACA is the reduction in FSA, and the removal of people from HSA eligibility. Shocked that HSAs are not made nonrestrictive to all income levels.

    Siebeus states in a John Stewart “interview” that the mandate only applies to the 15%. Do you think she’s correct?

    You are correct on one thing. PPACA does not provide health care. It provides an avenue of government filtered access to private insurance, and that is all it does. Having insurance does not mean you get access to a doctor, hospital, procedure, or care. PPACA does provide for the government layer. PPACA does not add one single nurse, doctor, surgeon, or dentist to the HC profession. PPACA is in violation of itself, and any changes to it without due process is in violation of the constitution and separation of powers. Since no budget has existed during the two terms of this administration, the appropriations are invalid as all funding comes from the house. Welcome to tyranny by the elite power structure and their process be damned implementation of their will on the people without following the law.

    • kgal1298

      Well they did the same thing with Social Security. I do believe in the implications here, but I also know that health care laws would have to change no matter the administration. Though this is turning into a lovely distraction from the Middle Eastern problems we have too. The fact is all of it even that is a corrupt system. At this point party doesn’t matter what needs to change is the corruption allowed by lobbyists as well as campaign contributors who make shady behind the door deals with the officials that we supposedly elect. A little I rub your back and you rub mine has always been standard in the good old boys club.

      • glass

        Right. LBJ opened SS to the general fund via a loop hole. This is why SS is going to go backrupt because the govt has been wink wink nudge nudge writing IOUs to SS. The same thing can happen to PPACA. It’s about getting control of the money. Otherwise, all those presidents-ALL- of them could have stopped the IOU writing at any time. But they did not, because money is power, and elections are immediate and not future based. Everyday I thank the law that there are term limits, but I dismay they are not extended to the house and senate.

        • LL

          There should be term limits for the Senate and the House. That is where a lot of this undermining of the best and highest good for all the people is sold daily.

      • LL

        kgal 1298 Well said!!!! I agree 100%