What exactly is Obamacare and what did it change?


What people call "Obamacare" is actually the Patient Protection and Affordable Care Act. However, people were calling it "Obamacare" before everyone even hammered out what it would be. It's a term mostly used by people who don't like the PPACA, and it's become popularized in part because PPACA is a really long and awkward name, even when you turn it into an acronym like that.

Anyway, the PPACA made a bunch of new rules regarding health care, with the purpose of making health care more affordable for everyone. Opponents of the PPACA, on the other hand, feel that the rules it makes take away too many freedoms and force people (both individuals and businesses) to do things they shouldn't have to.

So what does it do? Well, here is everything, in the order of when it goes into effect (because some of it happens later than other parts of it):


53 Responses:

  1. tjic says:

    > What people call "Obamacare" is actually the Patient Protection and Affordable Care Act.

    OK, what's the ACTUAL name of the Bush Tax Cuts?

    Don't know? Me either. And yet the term "Bush Tax Cuts" allows us to have a conversation and understand each other.

    What's the problem with using the vernacular instead of the designed-as-propaganda name that a law claims for itself?

    • tjic says:

      Btw, lest the above be taken as endorsement of Bush and Republicans: no.

      • Up until recently "Obamacare" was used exclusively in a derogatory manner, though. That's the difference between it and "Bush Tax Cuts", which was used happily by people who supported them (because, hey, Bush was Cutting Taxes) as well as opponents (who wanted a President to find other things to do than directly increasing the wealth of his buddies at the expense of the public purse).

        - Chris

        • tjic says:

          > Up until recently "Obamacare" was used exclusively in a derogatory manner, though.

          Not sure I agree with that. I read slightly left of center Slate and The Atlantic, and more left of center Salon, and they all use the term.

          Anyway, the core point is this: the style of argument "you're such an idiot to oppose { welfare | Star Wars | whatever } because there's no such thing; perhaps you are TRYING to refer to { Aid to Families with Dependent Children | the Strategic Defense Initiative | whatever}" is the political equivalent of a spelling flame.

          • jwz says:

            OMG, who fucking cares?

            The guy was trying to be precise by using the official name of the thing. The only "spelling flame" I see is going on right here, getting bogged down in the first sentence of the intro instead of, you know, reading the actual article which contains actually quite a bit more information than that.

      • miguel says:

        If the law ever goes into effect I think Republicans will eventually rue the day they started calling it Obamacare. As the law becomes integrated into our every day lives and HR departments are asking everybody about their Obamacare status we'll be reminded for decades about Obama's achievement. If Medicare was called LBJcare we'd all remember LBJ more fondly.

    • James says:

      Indeed, Wikipedia calls the two bills the Bush tax cuts.

  2. RyanE says:

    If they'd only called it the "Patient Protection Care and Affordable Care Act (PP-CACA)", no one would have called it ObamaCare.

    Childish yes, but I like it too!


    • Hey! Cut off two of your fingers, and stab yourself in the eye, then go get treatment for your injuries without being turned down for a pre-existing condition!

      (If you weren't actually quoting King Missile, please ignore this creepy reply)

  3. CJ says:

    I have to buy braces for one of my kids. The new limits on Flex Spending Accounts affects me and will make the braces cost me more than they otherwise would. We're a single-income family in the Bay Area, which means it's hard to keep up financially. Not exactly the "no one under 200K will see tax increases" that was promised. Not that we're poor; it's more of First World Problems and all.

    Since it's an issue that affects me, I looked it up on this summary.... which somehow fails to mention it.

    • Doug Orleans says:

      Do you mean this bullet? "Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them. ( Citation: Page 801, sec. 9005 )"

      • cthulhu says:

        that's the one; if you've got special needs kids, have a chronic health condition, etc., your out-of-pocket health care just went up substantially. I typically go through the $5k in about 9 months just doing what has to be done for my family (which includes the special needs kids, etc.). We've been told Obama was all about soaking the rich; this ain't it.

        • Doug Orleans says:

          Is it offset by this bullet? "The amount you can deduct from your taxes for medical expenses increases."

          • CJ says:

            I'm not an accounting-scientician, but don't you have to itemize to get that? Which means if the health expense is less than the standard deduction, you're farked. (Would be very pleased to be corrected a second time on this.)

            • Grey Hodge says:

              Do you realize you just said "If the total of deductions you've actually accrued is less than the fictional number you're allowed to claim, you pay more in taxes" which is perfectly wrong? If your actual deductions are less than your standard deduction, you're still paying less. If your actual deductions are more than the standard, then you're paying the fair number. So either you get off easy or you get what you are legally allowed. The only way you pay more is if your deductions are greater than the standard, but you don't bother to itemize, in which case you're lazy and that's the lazy tax.

          • cthulhu says:

            Not even remotely close.

        • James says:

          That is such bullshit. Single payer now!

      • CJ says:

        Yes. Thanks.

  4. aczarnowski says:

    One step down the polarizing topic ladder from the insurance mandate it appears we have a No Child Left Behind implementation for heath care. I'm sure this time the right people will be in charge and it will be awesome. /sarcasm

  5. After RTFA, I have to say it is excellent. Thanks for linking.

    It is hard to get over how weird and backwards all the discussion about Obamacare is. I've lived in Belgium, in NZ, in Argentina, and now reside temporarily in Florida. I have dealt with medical bureaucracy (and sometimes paid health insurance) under 4 systems. The US health system is seriously f**cked, colossally backwards.

    It truly boggles my mind _why_ are people so attached to it. Companies in the health sector that are creaming it and their lobbyists, sure. But why, oh, why, in a country with an incredible number of personal bankruptcies caused by healthcare costs... why would there solid support for the current system.

    Time to rename the Stockholm Effect, perhaps. Antiobamacare Effect.

    Healthcare sector pundits have succeeded... it is a strange twist to USA's social darwinist tendencies. If a large part of a mature society is prepared to follow these pied pipers off a cliff, should it be helped?

    • Kevin says:

      It is generally considered unpatriotic to admit that things in this country don't work perfectly.

      • generally considered unpatriotic to admit that things in this country don't work perfectly"

        Riiiiight. But maybe the national emotional IQ is high enough to say "we lead in A, B, C and D; pat in the back, USA!USA! Hmm, we're seriously lagging on E, won't hurt to quickly mimic someone who's doing better, we can refine it later".

        All nations have to overcome hurt pride before they leapfrog.

        • Kevin says:

          Is there anything we lead on?

          • rwatkins says:

            "We're seventh in literacy, twenty-seventh in math, twenty-second in science, forty-ninth in life expectancy, 178th in infant mortality, third in median household income, number four in labor force, and number four in exports. We lead the world in only three categories: number of incarcerated citizens per capita, number of adults who believe angels are real, and defense spending, where we spend more than the next twenty-six countries combined, twenty-five of whom are allies."

            or so they say on the fake TV news.

          • MattyJ says:

            We produce the best television in the world.

          • Chris says:

            My experience in hopping between a few science fields is that the US seems to do the most research of any country. Maybe not the most per capita or per some function of GDP, but most in absolute terms. Any time I write a review paper or do lit review for an experiment I find the major published authors are from 2-3 random countries and the US. It may be Japan, England, and the US in one area, then Canada, France, and the US in another.

            I think the absolute effort is something to be proud of.

            • Edouard says:

              Harvard's endowment fund is over 30 billion. Wikipedia shows 73 US universities and colleges whose endowments are larger than a billion.

              I remember being in the US a few years back and talking to some students from one of those universities who were in the music school. They started to explain the computing resources, and specialized hardware they had access too (running hundreds of audio channels over custom modified DVI links). Here they would just share a fucking piano or something.

              And, yes, the elite of the world's universities are in the US, with perhaps Oxford and Cambridge as the only contenders in the top 10 (or, probably, 20). You should not only be proud, but, oh, I don't know, somehow leveraging all that world class knowledge to make your society the envy of the world.

          • Leolo says:

            Number of patents?

      • ... unless you're a conservative complaining about the federal government.

    • Elusis says:

      Fewer than 25% of Americans have a passport. Most people don't access local health care when they travel. Thus, relatively few Americans have ever experienced health care in other systems. I'm an outlier - I had two emergency doctor visits within a 10 day window for similar bacterial infections (one in my ear, one in my bladder) but the first was in the US (while uninsured, even) and the second was in the UK. The main difference was that the US visit cost me $90 for the doctor and $50 for the medication, while the UK visit cost me $10 for the medication and $20 for the cab there and back.

      And of course relatively few Americans have direct experience with the business of being a health care provider, to understand how many employees and work hours exist solely for the purpose of navigating 50 different health plans and badgering insurers to pay what they actually owe you for work you've already done. Many Americans know the confusing mess that is the EOBs and invoices you get after being sick yourself, but the rise of HMOs means that many people are used to having health care without ever seeing an itemized bill to understand just what a clusterfuck of accounting it is to simply go to your doctor for your annual physical and some bloodwork and maybe get a re-fill on your cholesterol drug.

      People in the US have no idea how good it could be.

      • Nick Lamb says:

        To be fair, unless you've skipped some important parts of that story, you actually defrauded the British taxpayer. The NHS is only for permanent residents and although there's no mechanism for you to pay for a consultation with a GP (there is a mechanism to pay for hospital treatment) that doesn't mean you were entitled to it for free. Likewise, you were probably supposed to pay full retail price for the medication, but I doubt the average pharmacy in the UK has any idea whatsoever how to charge you retail price for prescription-only medicines, or even that they should. So the taxpayer gets a bill both times.

        But yes, single payer does work out cheaper overall which means on average it works out cheaper for everyone.

        • Don't sweat the small stuff. It leaks a few $50 dollar consultations? Pffft.

          There is no "pre-existing conditions, ha ha, I am a health insurer but I will let you suffer and die without treatment because you're expensive, and then my CEO will get millions in bonuses!" BS.

          Everyone is insured and NO PREEXISTING CONDITIONS COPOUT. It is a huge, gigantic, life-changing deal for a surprising number of people.

        • Elusis says:

          Actually I asked what I should be paying for, and the response was that since I was in the country for longer than two weeks, I was classified as a "temporary resident" and allowed NHS services for free.

          • Nick Lamb says:

            Well, lucky you I guess. GPs are given free rein to make this sort of decision as they see fit (they're obliged to enroll permanent residents from a catchment area, but they aren't forbidden from enrolling anybody else who is in the country). I don't begrudge you the free ride, honestly it'd be nice if one day the US gets something resembling single payer enough to enter the reciprocal arrangement like New Zealand where residents of one country can visit the other and get roughly the treatment they're used to at home.

      • nibot says:

        "Fewer than 25% of Americans have a passport."

        According the the U.S. State Department, there were 109,780,364 valid U.S. passports in 2011. Wikipedia gives the current U.S. population as 313,863,000. Therefore, about 35% of Americans hold U.S. passports.

        However, it is true that the fraction used to be much smaller: http://www.forbes.com/sites/andrewbender/2012/01/30/record-number-of-americans-now-hold-passports/

    • cthulhu says:

      No question the system prior to Obamacare was totally fucked. I have yet to see persuasive evidence (persuasive to me, crusty old one that I am) that Obamacare un-fucks it significantly; ISTM that it mostly just shifts who gets fucked. I'm naturally distrusting of a system that was substantially designed by the insurance companies because it gave them guaranteed customers (check out how many health insurance weenies / corporate officers were involved in and signed onto Obamacare).

      I'm also skeptical that systems designed for Europeans, who live in much smaller and much more homogenous countries and don't shoulder the global burden of health research (drugs, equipment, etc), will work here.

      This is not meant to say that I have a proposal to reform health care (not health insurance - IMHO we need to stop talking about them as if they were the same). Health care is way hard to deal with because it treads so strongly on our hottest button - are we and/or our loved ones gonna live or die? This really hoses up all of the price signaling etc effects that make a free market work, AND makes us naturally distrustful of other people, especially those faceless gummint bureaucrats, telling us what we can and can't do.

      Are we all depressed yet?

      • Tim says:

        I'm depressed that you have bought into some of the propaganda which keeps so many Americans from realizing that we can improve the system.

        For example, you repeated that old chestnut about European healthcare systems only working because the USA foots the bill for equipment and drug research. There are two things deeply wrong with that argument. One is that it smugly ignores the great contributions the rest of the world makes. It's completely ignorant to believe that progress in healthcare would stop if you set U.S. research output to zero.

        The second is that if you could wave a wand and switch the USA to a national single-payer system tomorrow, it would not torpedo our drug & equipment research. How you pay for care is not necessarily the same as how you pay for research. Even today. For example, a lot of "big pharma" R&D spending is focused on productizing the fruits of basic drug research carried out by public-funded academic institutions. Like all corporations, they don't want to pay for open-ended, high-risk research if they don't have to, even though that's what's required to find truly new things.

        Government grants have always paid for a large share of the medical research done in the US, and that is unlikely to change no matter how we choose to pay for care.

    • 205guy says:

      heh heh heh. He said "mature." Don't you people get it? the US is not a mature society. Nobody grows up and takes responsibility for themselves or others. Many just want to be entertained forever. Most have no self-control. That makes for a lot of obese sheeple consumers. A lot are bat-shit crazy about a guy who died almost 2000 years ago. Others are full-gonzo with their guns and delusions. A bunch of others are strung up on hard drugs. Not to mention the criminally bent portions of society doing the dealing and defrauding. There is no consensus, process, or will for raising children with love and turning them into adults with compassion, drive, motivation, and vision. The few good people who are reaching maturity being drowned in a sea of idiocracy.

  6. Where's that emotional IQ?

    Plenty to be proud of: airplanes/avionics, computer/hw design, software design, some healthcare tech, chemistry, tourism, and that's just the areas I am familiar with.

    Oh, and you have Paul Krugman, who's explained the whole mess from the beginning. PLENTY to be happy with, as long as your ego can coexist with a few other talented nations. Germans will make better cars, Airbus competes with Boeing, etc.

    The 2-country deathmatch of the cold war era is over.

  7. Pseudo-anonymous says:

    The pre-existing conditions cop-out doesn't just affect people with cancer and shit. It affects me. I left my job, which sucked royally and was basically driving me crazy, a month ago to become self-employed and discovered that I was "uninsurable". Why? I have naturally high cholesterol, which has been controlled with cheap medication for years, and I had the audacity to see a therapist about my mostly job-induced depression. That's apparently sufficient for the medical underwriters to shit-can you where I live. I am able and willing to pay for insurance and they won't let me.

    So here you have a system whereby a pretty damn healthy all things considered individual is unable to get insurance without being beholden to a corporation. Nice. Please bring on the "Obamacare", thanks!

  8. phuzz says:

    As a Brit I wasn't really familiar with the ins and outs of, oh hell, let's just call it ObamaCare. Most of it seems pretty obvious to me (once I get past what seems to be a common british view of "They have to pay for healthcare? That's barbaric!"), but I can see why the mandate part is so contentious. I can see why it's necessary, but it's not a very elegant solution (not that I can see a more elegant one, apart from single payer of course).

    Also, do chain restaurants not already have to publish the nutrition information on their food? McDonalds already do over here.

    • phuzz says:

      (Which is not to say that the NHS is without issues)

    • Ben Brockert says:

      Chain restaurants have to provide nutrition information, but that's typically in the form of a poster or booklet of small print somewhere in the store. Now they'll have to put the calorie counts on the menu.

      ..."offered for sale in a restaurant or similar retail
      food establishment that is part of a chain with 20 or more locations
      doing business under the same name (regardless of the
      type of ownership of the locations) and offering for sale substantially
      the same menu items,"

      "the restaurant or similar retail food establishment
      shall disclose in a clear and conspicuous manner—
      in a nutrient content disclosure statement adjacent
      to the name of the standard menu item, so as to be
      clearly associated with the standard menu item, on the
      menu listing the item for sale, the number of calories contained
      in the standard menu item, as usually prepared
      and offered for sale"

      • Lun Esex says:

        They should have to add the calorie counts to the receipts, with the sum total of calories for the entire purchase down at the bottom. Y'know, not just 'cos it adds up, but because average 'mericans can't do math.

        "Huh, lookit that, this $12 single-person fast food meal adds up to 5,000 calories..."

        Not that the majority of Americans eating in fast food restaurants are even going to know if that should be considered too much, or just about right, anyway.

        • Ben Brockert says:

          Not that the majority of Americans eating in fast food restaurants are even going to know if that should be considered too much, or just about right, anyway.

          "the restaurant or similar retail food establishment shall disclose in a clear and conspicuous manner—" [...] "a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu and designed to enable the public to understand, in the context of a total daily diet, the significance of the caloric information that is provided on the menu"

          • Lun Esex says:

            See, they're going to read that as closely as I did, in your previous post! :)

            Anyway, to put it in context it'd have to be printed at the bottom of the receipt next to the sum of the calories of the purchase.

            Along with a message: "Hey, dummy, you're about to eat enough calories in a single sitting for a family of six!"