Still confused about the ACA, also known as Obamacare (or Romneycare!)?

Here's a an expansion of primer I wrote for Twitter, covering some of the basics. To get specific questions answered, go to the website listed below for instant chat or call the toll-free number, 24/7. 

Obamacare 101

Q. I get insurance at work. What do i need to do per new law? 
A. Absolutely nothing! You are already insured. Stay well!

Q. I am on Medicare. What should I do on October 1? 
A. Enjoy a good walk in the park. You are already insured.

Q. I just changed jobs and my new boss doesn't offer insurance. What to do?
A. Buy discounted insurance through your state exchange. Or, see if you can join an association that will insure you. 

Q. I'm a cancer survivor with no insurance. What can I do? 
A. Starting January 1, 2014, insurers cannot turn you down. Get insurance now through your state exchange Oct 1, for coverage beginning Jan 1, 2014. If you need help before then, there is a bridge-program designed for such situations. Ask an exchange navigator for more information. 

Q. I'm insured but my 20 year old son needs insurance and can't afford it. 
A. Insurers now must let him stay on your policy until age 26

Q. I heard insurance rates are going to sky rocket. 
A. So far, that is not the case. See
 for sample costs. (Note: If you haven't shopped for insurance lately, these prices may seem high, but they are discounted compared to today's premiums. Also, like all insurance, the broader the coverage, the higher the premium. You might be able to get away with a cheaper plan to start with, then upgrade next year when enrollment re-opens in the fall. 

Q. What happens if I don't take out health insurance? Can they make me? 
A. You'll pay a penalty when you file your next income tax. That penalty will increase every year you are not insured. 

Q. Where are these state exchanges? 
A. Online or through your state offices. See
 for more info.

Q. I don't make much and need insurance. Can I get Medicaid? 
A. A state insurance exchange navigator can tell you if you qualify.

Q. I'm on Medicaid. What do I do? 
A. If you still qualify, you will stay on Medicaid.

For answers to your own questions about Obamacare, see
or call 1-800-318-2596, for live responses in many languages, 24/7.

Feel free to share.

State-by-State Premiums Under the Health Care Law
New data from the Department of Health and Human Services outline how much monthly health care premiums will cost for individuals and families buying insurance through new exchanges in 36 states.

It's hard to believe, but today marks the third anniversary of the passage of the Affordable Care Act, better known as health care reform. Thank you, Barack Obama! Thank you, US Congress! Thank you, Nancy Pelosi! Thank you, Harry Reid! Thank you, Supreme Court! 

Here's hoping we have many, many more years to watch this fledgling law grow. As it evolves, we expect the ACA to greatly improve the lives and overall health of everyone in the US. 

Confused about health care reform?

Here's a write-down of something I wrote for my local newspaper, the KevinMD blog and this blog in 2009. It's about Romneycare, the Massachusetts version of the Affordable Care Act. Except for some minor updating, everything still holds: 

We weren’t sure we liked the idea of mandatory universal health care when it was first presented to the people of Massachusetts. We worried about reduced care, higher bills, and all the other things you worry about when you’re facing change. 

Here’s what has happened to us as a result of mandatory, universal health care: 
• We are still on the same insurance plan. 
• We still go to the same doctors. 
• We’re still on the same medications. 
• We still use the same pharmacy.
• All other medical facilities we use – imaging labs, hospitals, blood testing labs, physical therapy -- have not changed. 
• As far as we can tell, our insurance premiums have not changed or have changed slightly ($5, maybe, per month).
• We both have increased our weekly exercise, in part, because our insurance now encourages prevention by paying a nice benefit for going to the gym. 
• We feel more comfortable being in crowds at the grocery store, movie theaters, or in close quarters at the barber shop and hair salon, knowing everyone there has access to health care. That means everyone we deal with is less likely to be spreading infectious disease than they were three years ago.
This program has been in effect almost three years. As far as we can tell, the world has not come to an end. 

And that’s the truth.

See today's New York Times for the truth behind claims about Obamacare. 

February 3, 2011
The New York Times 

For Tucson Survivors, Health Care Cost Is Concern

TUCSON — Seconds after gunfire erupted outside a supermarket here last month, Randy Gardner, one of those struck during the barrage, said another looming crisis immediately entered his mind.

“I wondered, ‘How much is this going to cost me?’ ” he said. “It was a thought that went through my head right away.”

Tucson’s medical system quickly swung into action after the shootings, with ambulances and medical helicopters rushing victims to hospitals where trauma specialists awaited them. The life-saving treatment the victims received over the ensuing days carried a heavy cost though, and the bills — the costliest of which may be in the hundreds of thousands of dollars for Representative Gabrielle Giffords— are still being tallied.

For the full story, see:

For those who haven’t had a chance to read the particulars of the new health care reform law, here it is in several formats. (Thanks to Don, Erin and Diane for the links.)

First, a CliffNotes version from the folks who brought you the whole thing. Second, a handy plug-in that explains exactly how you’ll fare, no matter what your circumstances. (There’s no law that says you can’t try several different scenarios.). Third, a more robust analysis by a staunchly non-partisan organization. And finally, a spotlight on a section overlooked by most media, i.e., changes in the way we will care for people when they need it most. 

1. Here’s a write-down of each section of the entire law, as passed. It’s short and fairly easy to understand.

2. The Washington Post has a cool interactive site. Fill in a couple of particulars (male, 57, NY, employer-provided insurance) and it will call up all the elements of the law that will pertain to your situation.

3. The Kaiser Family Foundation is a leader in health care information. Here is their summary of coverage provisions in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

4. The blog Cab Drollery cites an interesting opinion piece in the Los AngelesTimes, which outlines some of the benefits seniors will reap related to changes in Medicare that promote more home-based, long-term care. The plan is to move away from the nursing-home model to group- and home-based models for care. I bet many seniors will appreciate this.

Thanks, Bill Campbell of The Tome of the Unknown Writer, for sharing this.

Kevin Pho, M.D., has a surprising take on the health care reform bill, as passed by the House Sunday night:
Kevin and numerous guest bloggers (including this one) have written extensively about this legislation on, read by almost 30,000 people daily. In addition to publishing his medical blog, this primary care physician maintains a lively Facebook page and Twitter voice, and contributes often to the editorial pages of USA Today. 

What will health care reform mean to you and your family?

Here's a section-by-section analysis of the bill, to date:

What does the health care reform bill do for seniors?

Here’s a timely video sent to Birds readers by the office of Senate Majority Leader Harry Reid: 

Let’s suppose you live in a city with a 35% (!) unemployment rate and you lose your job. 

And let’s suppose your region isn’t the only one suffering from extraordinarily high unemployment. Unemployment is rampant, but unevenly distributed. You just happen to live in one of the worst places.

To help people like yourself, Congressman Smith from another state is sponsoring the New Jobs for America Bill  (NJAB) to stimulate job growth and provide benefits to the unemployed until the economy picks up.  

Would you expect your own Congressperson to vote YES on the NJAB? Or would you be happier if he or she said, “Hell, no, we don’t want no stinking new jobs in our area,” then votes NO and proposes his own We Don’t Want Your Stinking Jobs Bill?

Well, about 100 members of the House of Representatives did exactly that in the health care reform arena, voting against help for those without insurance, in spite of constituencies with 1-in-3, 1-in-4 and 1-in-5 uninsured. Most were from districts in Florida, Texas and California, as well as other parts of the south and west. Almost all were Republican. 

To add to the craziness, minutes after the bill was signed into law, Virginia, Idaho, Florida, South Carolina, Nebraska, Texas, Utah, Pennsylvania, Washington, Alabama, Michigan, and South Dakota filed lawsuits against the federal government to prevent it from providing health insurance to large numbers of their uninsured. What? 

Remember what John Boehner (Rep, 0H-8) said just before the vote about how important it was to listen to and represent the needs of one’s constituents, not just vote the party line?  He told them he was listening to them, probably in reference to the Tea Party slogan, "Listen to Me!"

To be fair, Boehner doesn’t have an unusually high number of uninsured in his district --only 12.40% -- but he did receive $2,728,844 in campaign contributions from the health care industry.  Which constituency was he listening to when he voted NO? 

Boehner isn’t the only one beholden to the industry, however. There are plenty sitting on both sides of the aisle.

(On the other hand, Charles Rangel (Dem, NY-15), from a district with 18.20% uninsured,  accepted $3,867,249 in contributions, but voted YES. Go figure.) 

Why would voters keep returning people to Congress to vote against their best interests? Does this make any sense? 

Here are a few names from the list of NO voters representing districts with high percentages of uninsured. You might recognize he name of a few who have been in Congress for many years.  

Joseph Barton                     TX-6                23.20% uninsured
Roy Blunt                              MO-7              19.50%
Lincoln Diaz-Balat               Fl-21               31.30%
Mario Diaz-Balat                 FL-25              31.30%
Kay Granger                        TX-12              25.70%
Ron Paul (!)                          TX-14              24.00%
John Mica                             FL-7                20.70%
Connie Mack                        FL-14              26.10%
Darrell Issa                           CA-49              21.90%
Charles Young                      FL-10              22.70%
Pete Sessions                     TX-32               35.70%
John Deal                             GA-9                 23.20
Virginia Brown-Waite          FL-5                 24.80%
Michael Conaway                TX-11               27.00%
Mary Bono Mack                  CA-45              24.10%

And the list goes on.

For a complete look at how members voted, how much they received in campaign contributions from the industry, and how many in their district are uninsured, see: 

In case you missed this in the NYT
Republican lawmakers stir up the 'tea party' crowd

By Dana Milbank
The Washington Post, Monday, March 22, 2010; A01

The Democrats were blamed for many horrible things -- tyranny! socialism! corruption! -- as they marched toward Sunday night's passage of health-care legislation, but nobody ever accused them of making health reform look easy.

It all began 14 long months ago, when Ted Kennedy was still alive and everybody, Republicans and Democrats alike, seemed to agree that the nation's health-care system needed change. Then came the town hall meetings, the death panels, the granny killing, the images of Nazi concentration camps, the Cornhusker Kickback, the Louisiana Purchase, Joe Wilson's "You lie!" moment, the middle-of-the-night and Christmas Eve votes, the Massachusetts special election, the Stupak Amendment, the Slaughter Plan, the filibusters, the supermajorities, the deeming and passing.

It was one of the ugliest and strangest periods the American legislative process has ever experienced. And Sunday was no different. The day's debate on the House floor was in its early moments when two men, one smelling strongly of alcohol, stood up in the public gallery and interrupted the debate with shouts of "Kill the bill!" and "The people said no!" As the Capitol Police led the demonstrators from the chamber, Republicans cheered -- for the hecklers.

Rep. Barney Frank (D-Mass.), who for the second day in a row had homophobic epithets hurled at him by demonstrators, called his Republican colleagues "clowns" for this display. But the circus was just beginning.

As lawmakers debated their way to a vote on the legislation, dozens of GOP lawmakers walked from the chamber, crossed the Speaker's Lobby, stepped out onto the members-only House balcony -- and proceeded to incite an unruly crowd.

Thousands of conservative "tea party" activists had massed on the south side of the Capitol, pushing to within about 50 feet of the building. Some Democrats worried aloud about the risk of violence, and police tried to keep the crowd away from the building.

But rather than calm the demonstrators, Republican congressmen whipped the masses into a frenzy. There on the House balcony, the GOP lawmakers' legislative dissent and the tea-party protest merged into one. Some lawmakers waved handwritten signs and led the crowd in chants of "Kill the bill." A few waved the yellow "Don't Tread on Me" flag of the tea-party movement. Still others fired up the demonstrators with campaign-style signs mocking House Speaker Nancy Pelosi.

Click "Read More" for the rest of the piece.