Republicans have voted more than 40 times to repeal President Obama’s health care law. The Affordable Care Act, often referred to as Obamacare, has so divided the nation that it has led to a government shutdown.
But why are Americans so divided over a law that experts say will extend health insurance to more than 30 million citizens? Is Obamacare really that bad?
Even though the Patient Protection and Affordable Care Act (ACA), as it is officially known, has been the law of the land since March, 2010, it is still a mystery to most Americans. It's “something like 32,000 or 64,000 pages [long],” a young man told DW.
Kavita Patel of the Brookings Institution in Washington says many of the misconceptions plaguing Obamacare are due to a “failure to break it down and have people understand how it will affect them.”
About 80 percent of all workers in the United States are already insured through their employers. According to Gallup, 8 out of 10 Americans love their current health care, but the problem is that millions were losing their homes or going broke, because they couldn't afford skyrocketing insurance costs or out-of-pocket fees.
The underlying philosophy of the health care reform is for every American to have access to health care. Under the old system, many young adults decided to forego buying health insurance – both because of the high costs, and because they felt less likely to get sick and need it.
Under the new law, individuals will be required to get insurance, meaning that every tax-paying citizen will chip in – young and old, healthy and sick.
Inevitably, many young people that are currently uninsured, but healthy, will experience this mandate as a financial burden.
To increase pressure on people to sign up, the law imposes a penalty on those who decide not to have coverage: a $95 tax penalty.
The main goal is to drastically bring down the high number of uninsured Americans – about 60 million, or 20% of the population. To do this, the law expands free or low-cost health care to families making less than $31,000 a year through the government-run Medicaid program for the poor. Patel estimates this will cover about 17 million of the uninsured.
Key point of Obamacare
The crown jewel of the Affordable Care Act is the newly created online health insurance exchange, launched on October 1. Here, millions of Americans who don't qualify for Medicaid, but are either uninsured or get their insurance through private companies, can compare and shop among a slew of insurance policies.
There are four tiers of health plans: A "Bronze" plan will cover 60 percent of a patient's health costs, whereas the "Silver" covers 70, the "Gold" 80, and the "Platinum" plan 90 percent. There's also a bare-bones option for under-30-year-olds, who tend to be healthier, but earn less. And because out-of-pocket expenses have proved ruinous in the past, Obamacare caps these at $6,350 for individuals and $12,700 for families.
Companies employing more than 50 full-time workers will face a penalty if they don't provide health insurance. However, they will be able to apply for tax credits to cover up to 50% of the premiums for low to moderate wage employees.
Still, critics say the employer mandate will hurt job creation. And already some companies have begun employing people part-time, or even banning employees from working more than 29 hours a week to avoid crossing the 30-hour threshold that would require them to provide full health benefits.
Experts worry that this could add to the almost 30 million people, who won't have access to insurance, despite the new law. Some are undocumented immigrants, but, according to a new analysis in the journal Health Affairs, most will be Americans who live in states that refuse to expand Medicaid – an opt-out made possible by last year's Supreme Court ruling.
So far, 26 states — all with Republican governors or Republican-controlled legislatures – have taken that route, leaving up to 8 million people out of Obamacare's reach. Only 16 states and the District of Columbia have worked with the White House to set up their own health care exchanges.
Obamacare has created a seemingly unbridgeable gulf between Democrats and Republicans. This has created a toxic political climate that has many doubting whether Obamacare can work.
A Real Clear Politics poll average shows that 51 percent of Americans oppose the new health care law, with just 40 percent in favor.
According to Gallup, 44 percent of Americans believe Obamacare will make the healthcare situation worse, while only 35 percent think it will make it better.
“It's a train wreck,” one man told DW, “all of the new taxes, the federal government basically mandating to the entire country what they can have and can't have. It's just a disaster.”
Many worry that the law will add to the national deficit. According to the non-partisan Congressional Budget Office (CBO), Obamacare will cost the federal government an estimated $1.4 trillion over the next decade. It also raises taxes on investment income for high-income earners, as well as on health care industries, such as hospitals and insurance companies.
But, as long as Democrats rule the Senate and Obama runs the White House, chances that the law will actually be repealed are slim to none.