The Affordable Care Act is here and the sky has not fallen

The Affordable Care Act was enacted all the way back in 2010. But, even before then, critics were asserting that this new law would more or less destroy the American economy, insert Uncle Sam squarely between patients and providers, and initiate the end of freedom as it ushered in socialized medicine. That was nearly 4 years — and 40 repeal attempts — ago, and yet, the sky remains intact above us.

Sure, there have been some major bumps in the road along the way. No one, including perhaps most of all the president, was thrilled to receive cancellation notices in the mail from their insurers after being told they could keep their plans if they liked them. Others, particularly if they — or those they work with — are young and healthy, have seen some increases in their insurance premiums, and have attributed those increases to the new law, as if insurance premiums weren’t on a steady upward trajectory well before anyone ever heard the name Barack Obama.

And, of course, the infamous Healthcare.gov website was a tremendous embarrassment in the early days, threatening to derail enrollment efforts critical to the functioning of the new health insurance exchanges. Most of this has been, or is currently being, addressed by the Obama administration. And, it is helpful to keep in mind that this new law represents an enormous undertaking. Health care represents 18% of the American economy. Changing something that large takes time and is certainly prone to mistakes along the way. Similar efforts, like the implementation of Social Security and Medicare were also beset with more than their fare share of problems.

But now that we’re into the real heart of the ACA, with the most key provisions now implemented as of January 1, 2014, what has really changed? Has the government prevented you from seeing any doctor you wish? Have your taxes gone up exponentially? Are you now paying more for health care and getting less? Has a “death panel” convened to decide your fate? Or has life, somehow, gone on much as it did before? Some of you may say, “Yes, my taxes increased.” or “Yes, my health insurance premiums have increased.” For some, that is inevitably true, and I would not disagree.

But, for others, the world is a much brighter place as of January 1, 2014. The phrase “pre-existing condition” is no longer a part of insurance companies’ vocabulary. That means that the middle-aged woman with breast cancer who was unable to buy insurance because she was already sick, is now able to get covered and receive the care she desperately needs.

In many states, Medicaid has been expanded to everyone with incomes up to 138% of the federal poverty level. That means that the childless adult who works full-time for minimum wage is now able to have health insurance for the first time. And, across the country, the health insurance exchanges are open for business and subsidies are available for those with incomes between 100% and 400% of poverty. That means that a father or mother with a family of four, who works for a small business that doesn’t offer insurance benefits, can get federal assistance to buy insurance as long as they earn less than $94,200.

These changes are real and they are positive. And, I would contend, not only has the sky not fallen, but for many it also looks to be a brighter shade of blue. But, we are just getting started, and 2014 is full of new opportunities and challenges, as these experts predict.

Brad Wright is an assistant professor of health management and policy, University of Iowa who blogs at Wright on Health.

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