The public remains sharply divided toward President Barack Obama's historic health care reform legislation, according to polls that show few are undecided. Most people think they know whether they like or dislike the law. But when it comes to knowing what's actually contained within this mammoth retooling of our health insurance system, most of us may not be smarter than a failing fifth grader.
A recent online quiz on the main provisions of health care reform by the Kaiser Family Foundation found that participants, on average, answered just 5 out of 10 questions correctly.
It's understandable. The ambitious law runs to 2,700 pages, some of its regulations have yet to be written, and the benefits that have already taken effect have been overshadowed by the recently resolved Supreme Court challenge. The barrage of political advertising surrounding November's presidential election has further clouded, rather than clarified, things.
Now that the Supreme Court has upheld the health care overhaul law, perhaps it's time to acquaint ourselves with the changes that have already occurred and those soon to come.
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Here are the facts to dispel eight fictions that have grown up around the Affordable Care Act.
1) Mandate muddle
Fiction: Everyone must purchase health insurance beginning in 2014, no exceptions.
Fact: While most uninsured Americans will be required to buy health insurance or pay a penalty (or tax, if you like) beginning in 2014, several groups are exempt from the so-called individual mandate.
They include those whose income is so low, they don't file federal tax returns; anyone who would have to spend more than 8 percent of their income on health insurance; undocumented immigrants; people who are incarcerated; members of Native American tribes; and those who qualify for a religious exemption.
There's also one other large set of people who won't need to buy health insurance.
"Everybody who is eligible for Medicaid or Medicare does not have to purchase additional coverage," notes Deborah Chollet, a senior fellow at Mathematica Policy Research in Washington, D.C., who is helping states set up the new health exchanges where consumers will shop for insurance.
Private researchers have found that only a very small percentage of Americans will be subject to the individual mandate penalty, maintains Kathleen Stoll, director of health policy for the health care consumer group Families USA.
2) Misplaced worker apathy
Fiction: If you're insured through your employer, health care reform won't affect you.
Fact: On the contrary, many new consumer protections under the Affordable Care Act are already benefiting people with job-based health insurance.
For example, the health care reform law bars insurers from placing lifetime limits on what they will pay for a worker's medical care, plus there are new restrictions on annual benefit limits, says Brian Chiglinsky, spokesman for the Centers for Medicare & Medicaid Services. "Insurers are no longer able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud," he adds.
Other new features for job-based policies include: no more copayments or deductibles for preventive health services, including cancer screenings; the right to see obstetricians and gynecologists without a referral; better access to out-of-network services in an emergency; protections against unfair administrative fees; and the right to keep dependents younger than 26 on your policy.
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3) New government insurance?
Fiction: The Affordable Care Act creates a new government-run insurance plan.
Fact: The health care reform law includes no such provision.
Rather than centralize health insurance, health care reform accomplishes many of the goals of so-called universal coverage through its interwoven expansion of the existing Medicaid program, increased federal regulation of the health insurance industry and tax credits to make private insurance more affordable.
The law does call for the creation of new insurance plans, but the government won't run them, Chollet says. "The federal Office of Personnel Management is required to contract with at least two private insurance carriers, including at least one nonprofit, to offer coverage in every market nationwide," she explains. "They can contract with more than two, and some of these nonprofits are consumer-owned and operated health plans called co-ops."