Health Reform One Year Later: The Haves and Have-Nots — So Far

Americans don’t know much more about the Affordable Care Act today than they did when President Obama signed it into law a year ago, on March 23, 2010. A Kaiser health-tracking poll released last week found that 52 percent of the public admits to not knowing enough about the law to assess how it affects them personally — compared with 56 percent who said that a year ago in the same poll.

So in honor of the law’s first birthday, we decided to provide a rough scorecard of who’s been helped so far by the law, and who hasn’t.

Who’s been helped?

Medicare recipients. While seniors view the law less favorably than the population as a whole, Medicare recipients actually have gained the most from the new law. This year they’re getting free coverage of preventive services and an annual wellness visit, and, most notably, major help in paying for prescription drugs in Medicare’s notorious doughnut hole. Predictions of drastic cutbacks in private Medicare Advantage plans, whose subsidies are being reduced by the law, turned out to be wrong.

Young adults. The law allows parents to keep children on their health plans until they turn 26, even if they’re not in school or even living at home. Federal officials estimate that this year, more than 1.2 million young adults will benefit from this change.

Small businesses. Most of the non-Medicare subsidies in the new law won’t start until 2014. One exception is small businesses, which have historically had the hardest time finding and affording group health insurance. Businesses with fewer than 25 employees and average wages (not counting the owner’s) of less than $50,000 are now eligible for tax credits of up to 35 percent of the employer’s premium contribution. The subsidies and the number of eligible small business will both increase in 2014, but the Commonwealth Fund, a non-partisan health care research organization, estimates that between now and then firms employing about 3.4 million workers will have already been helped.

Some early retirees. A little-known subsidy in the health-reform law helps early-retiree insurance plans with expenses for retirees who develop costly health conditions. Consumers can’t apply for this program on their own so even those being helped by it may not know it. But according to the most recent federal update more than 5,000 plans from every state are participating in the program.

Who’s still waiting

People ages 55 to 65. People this age who lose access to group health coverage often find themselves in a world of financial pain if they have a pre-existing condition. We frequently hear from people in this predicament (examples here, here, and here), and frankly there’s not much help for them until 2014, when health reform’s major changes kick in.

At that point, they’ll be able to go to their state’s health-insurance exchange and buy a comprehensive policy without fear of being turned down or charged an arm and a leg because of their pre-existing condition. It’s true that the health-reform law established subsidized Pre-existing Condition Insurance Plans in every state, but you have to be uninsured for six months to be eligible, and even then the premiums can run more than $500 a month. Perhaps that’s why only 12,000 people had signed up by February, 2011.

Lower-income and unemployed adults. Nearly one in four adults — an estimated 43 million people — said they or their spouse had lost a job in the previous two years, and nearly half of those said the job had been their household’s source of health insurance, according to a recent Commonwealth survey. Of those, 57 percent became uninsured as a result. Twenty-six million people said they’d tried to buy insurance on the individual market, but 60 percent said it was “very difficult or impossible” to find coverage they could afford, and 35 percent said they were turned down, charged more, or had certain coverage excluded because of a pre-existing condition.

In 2014, such problems will cease to exist. Pre-existing conditions will no longer be a factor, and income-based subsidies will help low-income or unemployed adults pay for comprehensive coverage. Until then, there’s not much help available, which goes a long way towards explaining why 52 million working-age adults went without health insurance at some point last year.

Nancy Metcalf, senior program editor at Consumer Reports , where this post first appeared, also writes the Consumer Reports blog Ask Nancy

Take Action: Know the facts about the new health care law.

Photo by ProgressOhio
written by Nancy Metcalf


Linda Robinson
Past Member 6 years ago

As a 60 year old with a preexisting condition who is self-employed in the arts (EEK!), 2014 is a land far away. For those who are willing to face the bureaucracy, there's Medicaid. There are millions of us: many have dropped off the planet of statistical analysis, and landed on the planet of no doctor visits. It's a national disaster, and a legislative shame.

Patricia S.
Pat S6 years ago

James J,
How right you are. There have been so many waivers given to companies. Let's give them to all.

Patricia S.
Pat S6 years ago

Health insurance costs were supposed to go down, from what obama said. Instead they have risen!

6 years ago


Sound Mind
Ronald E6 years ago

Affects me not, but I support it 101%.

Archer Jordan
Archer Jordan6 years ago

As a health insurance broker/agent I applaud the efforts to achieve universal healthcare. be honest I would have preferred a single payer system or failing that at least a public option. I think the thing that people really object to is the mandate requiring people to buy their coverage from private insurance companies. If it had been up to me I would not require people to buy coverage but would impose a reasonable waiting period like 6 months for pre-existing conditions if people didn't have continuous coverage as mandated by HIPAA, that is no more than a 62 day lapse. In that way insurers would be protected from people waiting to buy coverage when they get sick or need a proceedure.

I work very hard to help my clients find and access health insurance. There is a provision called MLR (medical loss ratio) that requires insurers to spend at least 80% for individual and small group or 85% for large group benefits. But my commissions are not considered benefits. This causes insurers to slash commissions and market plans directly without the public having the benefit of independent agents working for them. The agents commissions should be counted as benefits to the policy holders not as overhead of the insurance companies. H. R. 1206 would amend this oversight.

Luis L.
Luis L6 years ago

The biggest flaw in the ACA is that the vast majority of those who would benefit still have not been affected by it. I think it makes it hard for people to support this bill when they won't see any benefit for another 3 years. By then any support it may have had will have long disappeared. It left this bill without a constituency that can rally behind it.

carlee trent
carlee trent6 years ago


Bon L.
Bon L6 years ago

Thanks for the info.

Liberty G.
Liberty Goodwin6 years ago

Liberty G: Little Star in the other health article makes one critical point - a devastating fact about the Health Care "Reform" bill is that large numbers of uninsured people simply can't afford to pay premiums. And, "subsidies" will be offered to only a tiny percentage of those. And, even if the premiums are covered, co-pays and deductibles will prevent these folks from actual access to care.

The second elephant in the room is - it is all very well to say that there shouldn't be limits on paying for needed care, but - where is all that money coming from? Since many of those mentioned in my first paragraph will only pay a small yearly fine, and the government is broke - who can doubt that premiums for the rest will soar?

The bottom line - we won't have universal health care until:
1. We take the profit motive out of the system.
2. We include affordable & effective alternative medical options in the mix (as do other countries with lower costs & better health results).

The best possibility that was floated during the debate was the idea of regional or state consumer health care cooperatives. These would be directly run and controlled by the people themselves, eliminate the middle man ("insurance"), allow choice to participants and deny big bucks to corporate entities.