ObamaCare at Year Three

With the exception of my uncle, who asks me about the health benefits of red wine (to get me to condone his drinking), people tend to only ask me one public health question: What do you think of ObamaCare? 

The Patient Protection Affordable Care Act (formerly known as PPACA, now known more commonly as the ACA, Health Care Reform, or ObamaCare) celebrates its 3rd birthday this week. As someone who majored in sociology at Bowdoin College, it’s been thrilling to have people take interest in what I study. I love talking about Health Care Reform.

(Pictured:  Found the knife and sticks in my room at my parents' house.  I think I wanted to whittle my own spear in middle school.)

I think of it like my little Swiss Army knife: a knife blade, a screwdriver, a nail file, a pair of scissors, a toothpick, and tweezer in one.  I’ve carried one around for years, though not the same one.   Most days, I forget that I have one— hence the many, many knives I’ve donated to the TSA.  And that time at nerd camp when I had to turn it in as "contraband."  But every once in awhile, when a package arrives or a Swedish bookshelf needs assembling, this little tool becomes very handy (see also MacGyver, Angus).  The ACA works the same way.  It doesn’t affect my life most days.  My relationships with my doctor and insurance company have not changed much in 3 years, nor the price I pay for these things.  But as I already know from the experience of my family and friends, it will be very handy when I need it.

If this analogy all sounds a lot like how we think of health insurance, it makes sense.  The main focus of the ACA was coverage expansion.  It was about allowing young adults to stay on their parents’ health insurance, about closing the ~$3000 coverage gap on medications for elderly people, helping people find and purchase insurance, and much more.  For more details, the Kaiser Family Foundation has the full deets on what’s in the ACA in both short and long form.

Though it can get you out of all sorts of jams, the Swiss Army knife is no panacea.  The little blade can cut through cardboard boxes, but it can’t chop down trees.  It’d be silly to expect it to.  Similarly, though the ACA has provisions that encourage efficiency, it won’t drastically reduce healthcare costs or trim our obesity rates.   And yes, there are bits that anger this group but pleases another, like the changes in how we pay some doctors, limits to how much insurance companies spend on non-medical expenses, and increase Medicare taxes for high-income earners.  Yet for the most part and for most people, the ACA hasn't and won’t affect your insurance status or fees.  It’ll just be there when you need help.