What Obamacare Is Really About, From One Who Knows

I hate Obamacare. That is not a political statement; it's a journalistic one. The complex, 800-plus-page law is an explanatory nightmare, and every time I think I really understand it, my clarity slips away.

So I'm always grateful when John McDonough weighs in. A professor at the Harvard School of Public Health and author of a definitive account of the law -- Inside National Health Reform — he's a leading (and openly partisan) Obamacare expert. His new piece -- Obamacare 101: Promises, Pitfalls and Predictions —  is the first in a new series run by WBUR's opinion page, Cognoscenti. Called Policy for a Healthy America, it will look at "the challenges and opportunities facing the U.S. health care system."

Among the future questions the series will address: Why is tackling the nation’s obesity problem so difficult? How is technology changing health care delivery? Is a single-payer system the answer?

Here's a bit from today's piece by John McDonough:

The biggest changes will transform people’s ability to buy health insurance. An insurance concept known as “guaranteed issue,” set to take effect on the first of the year, bans the practice of “medical underwriting” and the imposition of pre-existing conditionexclusions. The individual responsibility provision, called the individual mandate, will impose a new tax penalty on individuals who do not buy health insurance and who can afford to do so. A new set of tax subsidies will make health insurance affordable for many uninsured Americans. And consumers in every state will be able to purchase coverage through exchanges or market places — some run by states and some by the federal government.

And an optimistic ending:

My expectation is that once the ACA is successfully and fully implemented early next year, most opposition will melt away. Beginning in 2015, Congress will resume its customary and necessary role of providing vigorous oversight and reforms to the ACA.

By 2020, I believe that most states will have expanded Medicaid to cover most of their low-income residents. And the reforms embedded in the ACA that aim to lower costs and improve the quality, efficiency and effectiveness of care will grow stronger and deeper.