national LIVE
Updated 4:24 PM  |  January 25, 2017

Back to
Obamacare is the Affordable Care Act: So what’s in it?

Not everyone realizes that Obamacare and the Affordable Care Act are the same thing. The 2010 law created insurance exchanges — that is, marketplaces — for people to buy private health insurance if they couldn’t get affordable coverage through work. Critics initially used the term “Obamacare” in a disparaging way. But in 2011, President Barack Obama embraced the nickname, saying “I have no problem with people saying Obama cares. I do care.”

For the health plans sold through these marketplaces, the law provides people the first subsidies the government has ever given to help them pay for private insurance. Presumably, both the marketplaces and the subsidies would be dismantled under any legislation to repeal the ACA.

Besides setting up the exchanges, the law has other parts that affect insurance requirements and try to foster innovation in the way health care is delivered. It requires health plans sold to individuals and small businesses to include a set of “essential health benefits.” One popular provision allows young adults to stay on their parents’ plan until age 26. Trump has said he likes that idea, but it isn’t clear how he would implement it because neither his administration nor Congress’s Republican majority has produced its own health-care plan.

Deductible, co-payment, coinsurance: What they mean

Deductible: The amount consumers must pay for health care services before the insurance plan begins to pay.

Co-payment: The fixed fee a patient must pay for a service after the deductible is met — for example, $20 for a doctor’s visit.

Coinsurance: The percentage of costs a patient must pay for a service after the deductible is paid — for example, 20 percent of a hospital stay.

What do people mean when they say universal access or universal coverage?

This may sound like a small semantic difference, but the distinction is a big one. The ACA has a goal of covering everyone with health insurance. And while it hasn’t achieved that goal, the years since the law passed have coincided with a major drop in the ranks of the uninsured. Under the law, about 20 million people have gained coverage, according to the best estimates, leaving about 9 percent, or 27 million people, still uncovered.

In contrast, many Republicans say they have a goal of “universal access.” That would mean that everyone would be offered a chance to buy some form of insurance, but not necessarily that everyone will get it.

What is Medicare?

The federal insurance program for older and disabled Americans is another enormous entitlement program whose future shape is now in question. Some Republicans, including Trump’s HHS nominee, have long favored changing Medicare from a system of “defined benefits” to a “defined contribution” in which the government would give beneficiaries a certain amount of money to help them buy private health plans.

Proponents argue that some people on Medicare already belong to a version called Medicare Advantage that is built around such private plans and that people who will be elderly in the future will be accustomed to picking health plans. Critics fear that, if the government no longer provides the insurance and sets benefits, coverage and older Americans’ ability to afford it could eventually erode.

During his campaign, Trump promised not to touch Medicare. More recently, he has said he favors “modernizing” he program but has not defined what he has in mind.

What is the ACA Medicaid expansion?

The original idea for expanding coverage under the ACA was that about half of the newly insured would gain private health plans through the marketplaces and the other half would become eligible for Medicaid under a major expansion of the 1960s-era program that has been a joint responsibility of the federal government and states. Instead of the patchwork of eligibility rules that existed around the country, there would be national standard in which anyone with income up to 138 percent of the federal poverty level could qualify.

That expectation ended in 2012, when the Supreme Court, as part of a ruling that upheld the law’s constitutionality overall, gave each state the latitude to decide whether to participate in the ACA Medicaid expansion. As of now, 31 states and the District of Columbia have. For states that expanded Medicaid, the federal government paid 100 percent of the cost for newly eligible enrollees for the first few years, and the federal share is now ratcheting down to an eventual 90 percent.

While some states with Republican governors have expanded Medicaid under the ACA, the Trump administration and many GOP leaders in Congress oppose it. The president has recently indicated that he supports an idea, long popular in conservative circles, that would fundamentally change Medicaid, transforming it from an entitlement (meaning that everyone who is eligible can get into the program and the government spends whatever is needed to provide its benefits) to a program of block grants, in which the government allots to each state a fixed amount of money each year and frees states from many of the program’s rules about what health services must be covered.

Block grant proponents say that they would give states more flexibility to run their programs as they see fit; detractors say they are a smokescreen to curb federal spending and ultimately would hurt poor people.

What is a health savings account?

Health savings accounts, which have long been a staple of Republican health proposals, allow individuals to save money tax-free to pay their medical bills. They are typically linked to high-deductible health plans. HSAs exist already, under the ACA and even before that, and it is unclear exactly how Republican plans would expand their availability. Some evidence suggests that these arrangements primarily help more affluent people who have enough money to set aside for future medical expenses.

The Obamacare debate: Defining key terms

Understanding health-care lingo can be challenging enough. But when you add political spin, you have a recipe for mass confusion, if not migraines. Here is a glossary of basic terms to help decode the debate.