The Patient Protection and Affordable Care Act, signed by Mr
Obama in 2010, is the largest overhaul of the US healthcare system since the
1960s.
What does the law do?
Its aim is simple: to extend health insurance coverage to
some of the estimated 15% of the US population who lack it. Those people
receive no coverage from their employers and are not covered by US health
programmes for the poor and the elderly. To achieve this, the law requires all Americans to have
health insurance, but offers subsidies to make coverage more affordable and
aims to reduce the cost of insurance by bringing younger, healthier people into
the health insurance system. It also requires businesses with more than 50 full-time
employees to offer health coverage, although this provision was delayed until
2015 to allow more time for compliance.
The law creates marketplaces - with websites akin to online
travel and shopping sites - where individuals can compare prices as they shop
for coverage. In addition, the law bans insurance companies from denying
health coverage to people with pre-existing health conditions, allows young
people to remain on their parents' plans until age 26, and expands eligibility
for the government-run Medicaid health programme for the poor. The law aims eventually to slow the growth of US healthcare
spending, which is the highest in the world.
What happened to the website?
Healthcare.gov is a federal website that serves as a
marketplace where individuals in 36 states can compare private insurance plans,
learn about available public subsidies, and sign up for a coverage. The
remaining 14 states and Washington DC have set up their own websites. The federal portal was plagued with technical glitches from
its roll-out on 1 October, including long sign-in wait times, log-in
difficulties, insurance account creation problems, slow page loads and outages. Exchanges run by individual states did not appear to have
the same problems. Enrolment figures for the first month were a fifth of what
the Obama administration initially projected.The White House has promised a "smooth experience"
for the "vast majority" of website users by the end of November.
Why were some Americans' plans cancelled?
In autumn 2013, insurance companies began announcing the
cancellation of millions of policies that do not meet the law's minimum
requirements, including coverage of a range of preventive and emergency
healthcare. Millions of Americans with individual plans were affected, despite
Mr Obama's oft-repeated promise that those who liked their plans "could
keep them". Mr Obama apologised to those whose policies had been
cancelled and then announced he would be giving a one-year reprieve from the
cancellations. But insurance firms have questioned whether the proposed fix is
workable.
Why do conservatives oppose the law?
Republicans say the law imposes too many costs on business,
with many describing it as a "job killer". They have also decried it
as an unwarranted intrusion into the affairs of private businesses and
individuals. The party and a veritable industry of conservative think
tanks and advocacy groups have fought the law since Mr Obama first proposed it
in 2009 at the start of his first term in office. After the law was passed in 2010, Republicans launched a
legal challenge, which ended in June 2012 when the US Supreme Court declared it
constitutional. It was also a central issue in the 2012 presidential election,
when Mr Obama won a second term in office.Meanwhile, the House of Representatives, controlled by the
Republicans, has taken dozens of symbolic votes to repeal the law and forced a
partial government shutdown over the issue. Republicans in state capitals have
also sought to undermine it in various ways.Democrats say Republicans are politically motivated to
attack Mr Obama's flagship domestic achievement in order to weaken him.
When do its elements take effect?
The law takes effect in several stages:
2010: Insurers were banned from denying coverage to children
with pre-existing conditions, adults under 26 years of age were allowed to
remain on their parents' plans, and insurers were barred from cancelling
coverage in some circumstances. Insurers were forbidden from imposing lifetime
limits on health coverage.
2011: The law expanded access to preventative health
services, and offered drug discounts for people in the Medicare programme for
pensioners.
2012: Provisions to encourage healthcare providers to lower
costs took effect.
October 2013: Consumer health insurance marketplaces go
online, and is plagued by snags and glitches.
2014: People without health coverage from the government or
their employers will be required to purchase it. The government Medicaid health
programme for the poor will be expanded to cover more people, tax credits will
subsidise individual and family purchases of health policies, and insurers will
be barred from denying coverage to those with pre-existing health conditions.
15 November 2013 Last updated at 01:55 GMT
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