There is a lot of confusion about the Affordable Care Act (ACA), largely caused by a campaign of misinformation led by talking heads on the far right of the political spectrum. This has led to an ignorant public, who say they like the Affordable Care Act and its elements when it is presented by its real name and the elements are listed one by one, but react negatively when asked about "Obamacare." A video demonstrating this ignorance would be funny were the situation not so serious. I'm writing this post to explain the act, why it has the mandate that every American have insurance, what the health insurance marketplaces do, and what the ACA will do for each one of us.

First, let's explore the need for a mandate. The mandate states that all Americans must have health care coverage, and specifies that employers with more than 50 full time employees must provide it for their employees. Other Americans must buy it for themselves, and older citizens will continue to be covered by Medicare. There are penalties for not having coverage that increase over the next several years. The aspects of the ACA that people say they like depend on the mandate, because it would not be economically possible for the private insurers (who will continue to provide our health care coverage) to offer the more generous terms without a larger pool of people to cover. It is especially important to have more healthy young people in the pool, as that brings premiums down and reduces risk. The second reason to like the mandate is that it distributes the expense burden more rationally across the system. This is because uninsured people often use the emergency room at local hospitals for medical care. This is among the most expensive of places to deliver care, and when the uninsured cannot pay for the treatment they receive, the expense is absorbed by the institution and passed along to either other paying patients or the taxpayer. Insuring the uninsured will also help them get the care they need in more appropriate settings than the emergency room, and provide continuity of care by helping more people have a primary care physician who knows them. The mandate is central to making our system work better and more fair.

Health insurance marketplaces are exchanges where consumers can shop for health insurance plans that satisfy the requirements of the mandate. The governments (federal or state) running the exchanges are not providing the coverage, but aggregating information about private insurers to allow consumers to shop for policies. Think of what Travelocity or Expedia do for airline tickets and hotels and you get the idea. The original goal was to have each state run its own exchange, but right-wing politicians in 27 states refused to do so, so the federal government is operating their exchanges. Many people are confused that the exchanges are government insurance, and we hear a lot of crazy talk about it being socialized medicine. This is not the case - they don't fundamentally change the variety of models of insurance we have in the US. The marketplaces are simply one-stop shopping exchanges for insurance.

Finally, let's look at the benefits of the ACA to the average citizen. Here are the provisions it contains.

The ACA eliminates lifetime and annual limits on coverage. Prior to the ACA, if you have a serious disease and reached your lifetime limit, the insurer no longer had to pay. You had to cover expenses yourself until you had exhausted your resources, and then apply for Medicaid to pay for care.
The ACA requires insurers to cover dependent children until age 26
The ACA eliminates pre-existing condition exclusions starting in 2014. Prior to the ACA, if you had a chronic disease and bought coverage, your policy could be written to exclude paying for that disease.
Insurers won't be allowed to charge women or people with medical problems higher rates.
The ACA limits deductibles in the small group market to $2,000 for individuals and $4,000 for families. Prior to the ACA, plans could have extremely high deductibles, placing a strain on families in the event of a serious illness.
The ACA requires health plans to report the percentage of premium dollars spent on actually providing care, and to provide rebates to their customers when that figure falls below 80-85 percent.
Premiums of older people can’t be more than 3 times the cost of those of younger people
The ACA makes coverage portable
The ACA limits waiting periods for coverage to start to 90 days. Prior to the ACA, long waiting periods could be in place, meaning you could be paying for insurance that wouldn't be available if you needed it during the waiting period.
The ACA standardizes the terms explaining the benefits and limits of a plan, which makes it easier to compare options.

The ACA is a step in the right direction for our country. Like any legislation, it isn't perfect. The Republican party would better serve our nation, and their constituents, if they stopped the campaign of misinformation, confusion, and obstruction and started working to help ensure the system works for all Americans.