Still Confused About Health Care Reform?

Majority of Americans Still Puzzled Over How Law Affects Them

Medically Reviewed by Laura J. Martin, MD on May 11, 2010

Public opinion remains divided about health care reform, but a majority of Americans, 55%, agree on one thing: They’re confused about the new law, according to a Kaiser Family Foundation poll.

Here are answers to frequently asked questions about the health overhaul and related issues that have many people scratching their heads.

What has triggered the public’s confusion?

Many people have stumbled over a central question: What does reform mean to me? “Even if they have a sense of what’s in the law, they don’t know what it will mean for them and their family,” says Mollyann Brodie, a Kaiser Family Foundation vice president.

The public confusion wasn’t helped by months of partisan debate and misinformation about the bill. Also, reform will affect people in different ways, depending on their circumstances: whether they are uninsured, have a government plan, or are privately insured; whether they’re buying coverage on their own or are part of a large employer plan; what their family income is; and whether they have a medical condition.

And the current health care system is confusing by itself. “It’s a big, complicated system, and a big, complicated bill,” says Donald Taylor, a Duke University health policy professor.

Polls show the public is divided about the new law. Are there any areas of agreement for most Americans?

The Kaiser Foundation poll in April shows large majorities support several provisions that will kick in this year. For example, 86% favor providing tax credits to small businesses that want to provide coverage for workers. Almost eight in 10 have favorable views of financial help for seniors who hit the gap in Medicare drug coverage known as the “doughnut hole.” The provision to allow young adults to remain on their parents’ health plan until age 26 is favored by three of four Americans. The young adult provision is “quite significant,” says Sara Collins, a Commonwealth Fund vice president. “In this economy, that will probably affect more young adults than it would have in the past.”

Many states don’t want to participate in the new “high-risk” insurance pools for people with pre-existing medical conditions. Are consumers in those states barred from joining these pools?

More than a dozen states, citing cost concerns, have said they would not operate these federally subsidized programs for uninsured people who have been denied health insurance. “It is creating an unfunded mandate on the states,” says Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation. But in those non-participating states, the federal government will step in to run the pools for residents until 2014, when insurers will be barred from discriminating against people with pre-existing conditions. The temporary state pools are expected to begin July 1 and will receive a total of $5 billion in funding, which many experts feel is inadequate to cover their long-range costs.

Attorneys general in several states have filed lawsuits against the law. Can those legal actions block reform?

The state lawsuits challenge the law’s requirement for individuals to buy health insurance. Moffit of the Heritage Foundation calls that requirement an unprecedented expansion of congressional power. Yet many legal experts think that the states’ suits have little chance of success. “A state cannot sue the federal government to have a federal law invalidated,” says Timothy Jost, a professor at Washington and Lee University School of Law. Individuals’ lawsuits over paying a penalty could get more traction. But Jost says that Congress “can do anything it wants as long as it’s regulating economic activity. This is clearly economic activity.” Mark Hall of Wake Forest University School of Law says, “There’s not a constitutional right to be uninsured. ... It’s hard to argue that Congress can’t regulate it in this way.”

Can reform be repealed if Republicans gain control of both houses of Congress?

It’s an uphill climb for reform opponents. First, they must seize control of both houses. Then, if the president vetoes a repeal bill - and President Obama assuredly will -- Republicans must command a two-thirds congressional majority to override the veto. But if a Republican wins the presidency in 2012 or in 2016, repeal of health reform becomes more possible. Under that scenario, they would need a filibuster-proof 60 votes to junk the law entirely. But short of 60, Republicans with a Senate majority could still cut off or delay funding for implementation of reform provisions. Reform opponents with a majority “can always make trouble for the president,” Jost says.

Will insurance premiums go up or down when reform is fully implemented?

It depends on who’s buying the coverage. People purchasing individual insurance may indeed face a higher cost when exchanges are launched four years from now. But they will receive much better benefits coverage, Duke’s Taylor says. Those already in large employer plans may not see much change beyond the current climb in their premiums related to rising medical costs, not reform, says Collins of the Commonwealth Fund.

Will illegal immigrants be given the opportunity to buy health insurance in the new exchanges?

Illegal immigrants will be barred both from getting subsidies to buy coverage and from participating in the new insurance exchanges that will begin in 2014, even if they pay the entire cost out of their own pocket. Undocumented immigrants will continue to get care at some community clinics and will still be able to receive emergency medical treatment at hospital ERs.

Does reform represent a government takeover of the health care system?

Certainly government will have a bigger role under reform. The law provides a large expansion of Medicaid, a government insurance program for the poor and disabled. And there is more government regulation of insurance in general. “It’s a remarkable expansion of federal power,” Moffit says. Still, it’s not a government-run system. The private insurance market will be preserved in the new insurance exchanges, and large employers will continue to run their own health plans. “People will have more protections,”says Collins of the Commonwealth Fund.

Show Sources


Kaiser Health Tracking Poll, April 2010.

News release, Kaiser Family Foundation.

Mollyann Brodie, vice president, Kaiser Family Foundation.

Donald Taylor, professor of health policy, Duke University.

Sara Collins, vice president, Commonwealth Fund.

Robert Moffit, director, Center for Health Policy Studies, Heritage Foundation.

Timothy Jost, Robert L. Willett Family Professor of Law, Washington and Lee University School of Law.

Mark Hall, Fred D. & Elizabeth L. Turnage Professor of Law, Wake Forest University School of Law.

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