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Five Myths About Obamacare You Probably Believe

Health & Wellness  (tags: healthcare, government, health, prevention, medicine, risks, protection, treatment, society, family, children, disease, illness, safety, investigation, ethics )

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If you do, you're definitely not alone--it's easy to get confused by the changes that are coming with the Affordable Care Act. We sort through them to give you a bottom line.

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JL A (281)
Tuesday April 9, 2013, 5:12 pm

Five Myths About Obamacare You Probably Believe
If you do, you’re definitely not alone—it’s easy to get confused by the changes that are coming with the Affordable Care Act. We sort through them to give you a bottom line.
By Fran Kritz
April 3, 2013

Five Myths About Obamacare You Probably Believe

Does Obamacare feel like a confusing maze you'll need to navigate to get good, affordable insurance coverage? You're not alone in feeling that way, but the changes coming in January 2014 should help millions of Americans. (Colin Anderson/Getty Images)

Misconceptions and myths about the Affordable Care Act (ACA; aka Obamacare) abound. That’s not good, says Ron Pollack, the head of FamiliesUSA, an advocacy group based in Washington, D.C. That’s why Pollack’s group recently put together a list of myths, along with the correct information, about this important law and the changes it will soon bring:

A Quickie Guide to Obamacare: Four Big Changes You Need to Understand

Myth #1: Starting in 2014, everyone must either have health insurance or pay a penalty—no exceptions.

Truth: The following groups are exempt from the ACA requirement to have coverage:

People who are not required to file taxes are exempt.
People with a legitimate religious reason for not believing in insurance.
Members of Indian tribes.
People who go without coverage for less than three months.
People who truly cannot afford to purchase coverage. (Health insurance premiums cannot cost more than eight percent of a family’s income to be considered “affordable.”)
There is also a general hardship exemption that covers unusual circumstances. For example, a family with unexpected costs associated with a natural disaster could be exempt.

Also, you don’t have to have coverage through an insurance marketplace to fulfill the requirement. You could get your health insurance through public or private coverage, a job, the military if you’re enlisted, or a veterans’ plan.

10 Things Your Health Insurance Plan Will Soon Have to Cover

Myth # 2: If you’re insured through your employer, Obamacare won’t help you.

Truth: The healthcare law provides many new protections to those who already have health insurance through their jobs, and it also gives employers incentives to offer better coverage. Here are some of the things that are required, starting in January 2014:

No annual or lifetime limits on the dollar amount your plan will pay for medical care
Access to preventive health services with no cost-sharing (i.e., no co-pays)
Coverage for dependents under the age of 26 (on their parent’s plan)
The right to choose your primary healthcare provider and to see pediatricians and obstetricians/gynecologists without a referral
The right to appeal coverage denials to an independent reviewer outside your plan
Protection against unfair premium increases and rebates to you or your employer if your health plan spends less than 80 percent of premium dollars on healthcare services.
Access to summaries of your plan’s benefits and costs in simple, plain language to help you understand your coverage and compare coverage options.

Bad News: Obamacare Is Going to Make the Doctor Shortage Worse

Myth #3: All businesses will be required to provide health insurance to their employees.

Truth: This is simply not true. The “shared responsibility” requirements in the Affordable Care Act apply to employers with at least 50 full-time employees. These large employers may have to pay a penalty if they don’t offer coverage to their full-time employees. The majority of American small businesses don’t have 50 employees.

Smaller employers will have new opportunities to purchase health insurance for their workers, but they are not required to provide this coverage. Under the Affordable Care Act, businesses with fewer than 25 full-time employees may already qualify for a healthcare tax credit to help them with the cost of health insurance for their workers.

Myth #4: Undocumented immigrants will receive federal aid to buy health insurance.

Truth: Undocumented immigrants are not eligible for either Medicaid or the new tax credits that will help pay for private insurance.

Need Health Insurance? This is How You Get It Under Obamacare

Myth #5: My state isn’t setting up its own health exchange, so it’s exempt from Obamacare.

Truth: If a state doesn’t set up its own health exchange the federal government will ensure that consumers in that state still have a place to get insurance by setting up an exchange for the state.

All of the other important consumer protections in the Affordable Care Act—like the prohibition on discrimination based on pre-existing conditions; the option for young adults to stay on their parent’s plans until they turn 26; and access to recommended preventive services with no copayments—will still apply to that state.

“Health reform is such a contentious issue and so complex that it’s no wonder people fall prey to myths about the law,” says Carrie McLean, senior manager of customer service at “We talk to thousands of health insurance shoppers every day at our call center and we know they’re confused about who qualifies for coverage, how affordable it will be in 2014, and where they’ll be able to buy it.”

As 2013 moves along, you can expect to see more and more news stories, over every medium, about the changes that are coming with the ACA. And though you may be tempted to bury your head in the sand (we understand; it’s confusing), try to pay attention.

And since you probably don’t need to worry about smaller changes, here’s a timeline of the bigger ones you can tape to the fridge:

· July 1, 2013: State call centers open to answer your questions about health insurance options in your state.

· October 1, 2013: State health insurance exchanges in all 50 states begin enrolling new members,

· January 1, 2014: Health insurance coverage under the Affordable Care Act begins.

Of course, the law is not perfect. It’s complicated and some of the materials could definitely be more user-friendly. And there are some glitches in the way the law was written that could price some people out of the market for coverage, even though the whole goal was to not have that happen. (To change that provision, and perhaps some others, will require news laws to be passed by Congress.)

Why Panic and Greed Are Driving Up Your Health Insurance Costs

Thankfully, experts, including policy specialists at advocacy firms such as FamiliesUSA, are currently compiling lists of needed improvements to review with the Secretary of Health and Human Services (HHS will oversee the ACA changes).

And as imperfect as the law is, much of it does go far in helping provide affordable coverage to more Americans, in a fairly simple manner. “Each [state] marketplace will offer insurance shoppers a variety of tools, such as a consumer-friendly website, a toll-free hotline for assistance, and a network for one-on-one assistance—all intended to help the residents of that state find and purchase the quality, affordable health insurance policy that best suits their personal or family needs,” explains FamiliesUSA’s Ron Pollack.

Do you feel like you understand the Affordable Care Act? What do you find most confusing about it?

Fran Kritz is a freelance writer specializing in health and health policy and lives in Silver Spring, Maryland.

Arielle S (313)
Tuesday April 9, 2013, 5:45 pm
How nice to see facts, instead of distortions and half truths... Thank you JL!

JL A (281)
Tuesday April 9, 2013, 5:51 pm
You are welcome Arielle.

Tamara H (185)
Tuesday April 9, 2013, 6:02 pm
Thanks J L. This is very helpful.

JL A (281)
Tuesday April 9, 2013, 6:10 pm
You are welcome Tamara. You cannot currently send a star to Tamara because you have done so within the last day.

Barbara K (60)
Tuesday April 9, 2013, 6:22 pm
Thanks, my friend. I watch the Senate. I watched he hearings and then the debates and the votes on this Bill. It went thru many filibusters by the Rs, nothing new there, and then I watched when Senators Kennedy and Byrd were brought in by wheelchair as they wanted so much to vote for this Bill and were given standing ovations. You may remember that Sen. Kennedy was diagnosed with brain cancer while they were working on the Bill, and Sen. Byrd also was very ill. At that time the Senate did have the 60 votes to override the filibusters, etc, until they became ill, of course, and 2 Republicans joined in to pass the Bill. I know pretty much what is in it. Here is the address for more info and thanks, JL A: "".

Barbara K (60)
Tuesday April 9, 2013, 6:23 pm
Geez, JL, they won't let me give you a green star yet.

JL A (281)
Tuesday April 9, 2013, 6:33 pm
Thanks for the reminders on the legislation's history Barbara and additional resource url and I appreciate your desireto send me a star. I'm in the same boat so: You cannot currently send a star to Barbara because you have done so within the last day.

cecily w (0)
Tuesday April 9, 2013, 9:31 pm
Thank you, JL A--It's a relief to see that the facts are being distributed in plain English.

lee e (114)
Tuesday April 9, 2013, 9:44 pm
Thanks -- it is a program that has been started, but it must be improved - it's certainly not perfect - but I'm so grateful it ;has begun! -- It probably should become "single payer" - but we at least have a program which we can improve - over years! - and that thanks to Obama!

Billie C (2)
Tuesday April 9, 2013, 10:16 pm
well now it's gonna have major pieces that aren't going to be ready like the plans for small businesses to pick from. it's falling apart at the seams. that's what happens when you pass giant bills that haven't been read. try breaking it up into smaller pieces and the garbage could be weeded out. now we get the garbage with little bits of good. we were sold out to the insurance companies. thanks obama and the dems.

De D (96)
Tuesday April 9, 2013, 10:55 pm
Thanks for sharing this information about Obamacare. I do hope its not going to turn into a nightmare for some people. I'm not sure about prescriptions.....does it cover any?

Sherri G (128)
Tuesday April 9, 2013, 11:51 pm
It is a start that will benefit millions with a preexisting conditions or have been told they don't have any insurance left. It does still have a long way to go and definitely should be single payer. Let's face it the insurance companies are corporations whose primary goal is to make more money. Insurance companies are middle men and have no incentive nor do they feel a need to provide real care for Americans. Good to know the myths that are indeed myths. Thanks JL

Lynn D (0)
Wednesday April 10, 2013, 1:31 am
Thanks but, still not very helpful!

Gloria p (304)
Wednesday April 10, 2013, 3:07 am
I hope it's true because I absolutely cannot afford health insurance.

Gene J (290)
Wednesday April 10, 2013, 7:07 am
Sort of makes one wonder just what it is about this great beginning that red state governor's fear so much. Could it be decreased campaign contributions from the monolith that is for profit medicine now? Or from the mega plans that will now have to justify the obscenity that is their executive compensation plan while spending most of their money on actual health care? The truth is that this is just the beginning on the road to single payer health care, the option that costs the least, provides the best coverage and produces far better outcomes than our outmoded for profit system does now. People before dollars is what must become our national priority, if we do that, all else falls into place without bankrupting anyone. Not to mention it is the only option that truly gets coverage to all of us, especially those 50 million without any now.

Barbara K (60)
Wednesday April 10, 2013, 7:26 am
For those wondering about the costs. The insurance companies, under this Bill, cannot deny coverage for pre-existing conditions, and cannot drop you when you become ill with cancer, etc, as they were doing before. Then the cost. The insurance companies are not allowed to make more than 20% profit on you. So if you pay, say $1,000 for coverage and didn't need to see the dr that year, they must refund $800 of your premium back to you. If you did see the doctor, you receive the difference between what expenses you had and the 20% limit allowed for the insurance company to make. That is why the insurance companies fight this plan so much. They can no longer make large sums of money off you if you were not ill, nor can they drop you or deny you because you are ill. Yes, this Bill was considered a good beginning, as they couldn't get the Rs to go along with anything and didn't vote for any of the amendments; they wouldn't even read the Bill as they had no intention of voting for it in the first place. The Bill was online and anyone could have read it the entire time. It is still there now under "" to answer any questions you have and to show you what is covered (most everything is covered), but of course you choose your insurance coverage and insurance company, so you choose yourself what you want to be covered. Many people got lots of money back from the insurance companies as unused portions of their premiums. You may have heard about it on TV, etc. As Senator Kennedy said at the beginning when they realized they would get no help from the Rs for single payer, or anything else, "We will take half a loaf, and come back later for the rest". It is too bad he had to die, he worked his entire career trying to get us insurance coverage without all the costs and baloney the insurance companies were pulling on the patients. Also, if you cannot afford your insurance, the government will subsidize you.

JL A (281)
Wednesday April 10, 2013, 7:43 am
You are welcome Cecily, Lee, D.D., Sherri and Lynn.
ACA does cover prescriptions D.D. and gradually makes the Medicare Part D 'donut hole' smaller.
The universal coverage the DEMS gave up in negotiations for the GOP promised to support would've had all the advantages you describe Lee and Gene and at least less of the concerns Billie speaks of, which I believe he should blame the GOP for given the history.
You cannot currently send a star to cecily because you have done so within the last day.
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JL A (281)
Wednesday April 10, 2013, 7:45 am
You cannot currently send a star to Barbara because you have done so within the last day.

Arielle S (313)
Wednesday April 10, 2013, 7:51 am
"The insurance companies are not allowed to make more than 20% profit on you. So if you pay, say $1,000 for coverage and didn't need to see the dr that year, they must refund $800 of your premium back to you" Thank you for this, Barbara - I thought I understood the bill but I did not know this. There have been so many rumors and lies about Obamacare that separating the truth out takes some work....

JL A (281)
Wednesday April 10, 2013, 8:03 am
You cannot currently send a star to Arielle because you have done so within the last day.

Barbara K (60)
Wednesday April 10, 2013, 11:04 am
Yes, Arielle, the insurance companies put out all kinds of lies over this Bill, even had their employees going to Town Hall Meetings to raise a ruckus against the Bill and to get people all stirred up over it. It really is a good Bill. It can be improved upon when there are enough Dems in Congress to do it. But this was the best at the time, as they had to fight the Rs every inch of the way. That is why it took so long for it to go thru. I watched every day, every speech, every amendment, etc. Also, the Rs even "filibustered by amendment". That means that they put up so many amendments (totally ridiculous ones that had nothing to do with health care), but took time to debate and vote on them. It was quite a history lesson, and a lesson on government too.

JL A (281)
Wednesday April 10, 2013, 11:12 am
You cannot currently send a star to Barbara because you have done so within the last day.

Angelika R (143)
Wednesday April 10, 2013, 11:16 am
Now this is truly a very important and excellent post, thx JL! Though not applicable to me, I know that it is essential for all Americans to know the truth and debunk all the myths! There have been enough folks already riding on these myths and bashing the whole plan, incl. a certain D.O.! Nothing but spreading lies has been going on.
This ACA resembles our system in many ways, plus it has some previleges that only our private health insurances offer: the REFUNDS of premiums if you made no use of doctors (including dentists etc) visits.

Trouble point will likely be the employers, now seeking to some way change their businesses /staff size.

JL A (281)
Wednesday April 10, 2013, 11:35 am
Thanks for highlighting the premium refund aspect with proven success in Germany Angelika. Business adjustments may prove tricky. Small businesses have tax incentives helping underwrite cost and the insurance industry tends to charge less per person to employers with larger numbers of employees covered. In addition, the business owner's own insurance is less costly when a group plan than individual private insurance for the same benefits to self and family. Primary risks are probably big businesses/corporations approaches.
You cannot currently send a star to Angelika because you have done so within the last day.

Angelika R (143)
Wednesday April 10, 2013, 11:54 am
I could imagine you will need MANY advisers to explain the system to patients, wonder if that turns into job creation, offered by private sector or state/federal ? These people need to be schooled real well and I cannot imagine that it will be left up to the American people all alone to get informed about this ACA. They are not all (unfortunately) like Barbara K! :-)

Barbara K (60)
Wednesday April 10, 2013, 12:26 pm
Oh, yes, should have mentioned, that the employers get good-sized tax breaks for offering insurance to their employees. Don't let them fool you, they won't go broke covering employees. Some places are making up lies about how it is driving them out of business, and some have threatened and some have closed down. It is disgusting that they care so little for humanity or their employees that they would close down instead of giving them insurance. At the same time, it is my belief that they were broke and going out of business anyway, just needed to blame it on the ACA. The Koch Bros pay people to come on these sites and take opposing sides on anything, including the ACA. Remember, we were warned about it nearly 2 years ago. So you know who people like DO are working for. Anyway, everything about the Bill is on the internet and can be seen by anyone.

JL A (281)
Wednesday April 10, 2013, 12:34 pm
From the article regarding accurate information and jobs creation Angelika:
"· July 1, 2013: State call centers open to answer your questions about health insurance options in your state."
Thanks for sharing your expertise and responding to others' questions Barbara!

Lin Penrose (92)
Wednesday April 10, 2013, 12:52 pm
Thanks J.L. Very a informative in understandable (mostly) post. I think one of the major problems is going to be the lack of Doctors available for the numbers of patients. Several in my local area are upset with some of the Medicare changes. Now (?). Many Doctors are in patient treatment of various types. Most are just like the rest of us, trying to make a living. When you consider the costs that all Doctors had to fork over, and Still are paying off Student Loan debts for their education &abilities. Also, they must to pay very hefty insurance costs (i.e. malpractice). They are between ''rocks and harder places'. Altruism of physicians can only go so far. So, now more people are able to get medical help, but what if there are not enough Doctors to fill the demands? Some very serious consequences in some form or another will appear. Can the Government force Doctors to accept patients and to work regardless if working at a deficit?

The insurance companies are terrified. Refunds of premiums for unused medical treatment? Darn- sure wish they would. I will definitely look into that!


Birgit W (160)
Wednesday April 10, 2013, 1:23 pm
I do not believe anything anymore what politicians or corporations want me to believe.

JL A (281)
Wednesday April 10, 2013, 1:41 pm
You are welcome Lin. Excellent points.
For starters, we could reinstate the federal incentives for med students to pursue specialities with scarcities and those to medical schools to admit more students to meet the demand.

Those that serve underserved communities for at least three years get student loan forgiveness. I believe that is also true for other health professionals (PT, OT, etc.).

Fred Krohn (34)
Wednesday April 10, 2013, 2:24 pm
Here's something that's not a myth: PPACA is unconstitutional! Let's hope we get this piece of congressional cow flop shovelled into the compost heap or incinerator where it might actually be of some use!

Judith Hand (55)
Wednesday April 10, 2013, 2:55 pm
Noted. A relative in MA sent me a video on a woman who was beyond grateful for the plan that - of all people. Mitt Romney - had initiated there. She had serious illnesses that she could not afford or address, but the health plan did. My thinking is that at least those people who haven't insurance will get it. And those who are very ill will have a chance. I'm having problems with my President these days, but not with the healthcare plan that Romney once paraded then chose to bash.

JL A (281)
Wednesday April 10, 2013, 3:20 pm
The constitution gives SCOTUS the authority to determine what is or is not constitutional and SCOTUS ruled ACA is constitutional.

S S (0)
Wednesday April 10, 2013, 3:23 pm
Thank you.

JL A (281)
Wednesday April 10, 2013, 4:06 pm
Excellent example of the benefits of ACA Jude! You are welcome Shanti.

Jeremy S (3)
Wednesday April 10, 2013, 5:40 pm
Thank you for this accurate description, and discussion, of the ACA. I only hope the President is remembered for this, which is his signature work, rather than the political infighting that took place because people refused to accept that he had been elected legally, twice. As he was.

Now we just have to trust Congress won't slap on to legislation a number of useless gobbledygook amendments that serve their own constituencies rather than the American people... But I'm not holding my breath.

Michael M (5)
Wednesday April 10, 2013, 5:43 pm
It's easy to lie to faux news watching lemmings as they are unwilling to believe Obamacare is actually going to save their pathetic lives.

reft h (66)
Friday April 12, 2013, 11:05 pm
good post, thanks for the info

Connie O (44)
Monday April 15, 2013, 8:28 am
excellent points... I have been awaiting this plan for sometime...being self employed and having to pay outrageous insurance premiums, it will be very cost saving.

DaleLovesOttawa O (198)
Monday April 15, 2013, 8:50 pm
Interesting to see the debates going on in the States about healthcare. Am grateful for universal healthcare.

JL A (281)
Monday April 15, 2013, 8:51 pm
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