WASHINGTON (AP) — Three years ago, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA), activating a plan for extending coverage to more than 30 million uninsured people.
“This is what change looks like,” he exulted.
Today, Obama’s message about PPACA boils down to this: Be patient, not yet, adjust your expectations.
Here’s a look at how the scope of the Patient Protection and Affordable Care Act of 2010 (PPACA) has narrowed in recent years:
Public option? Never mind.
Obama once trumpeted the idea of providing a public option in health care, in essence a government-run plan that would be one of many choices for people seeking affordable care. That idea, popular with liberals but opposed by conservatives and many moderates, never made it into PPACA. In the quest for a workable compromise, Obama deemed it expendable.
A related program — the basic health option program — seems to be in regulatory development limbo.
Long-term care insurance? Buh-bye.
When the president signed his health-care plan into law, it included the CLASS Act, a proposal to provide basic long-term care insurance at an affordable cost. Before the program ever got off the ground, though, the administration ditched it last spring for fear it would turn into a financial drain. It could take be years before lawmakers to tackle the issue again.
Coverage for the needist? Not in every state.
PPACA envisioned millions of the neediest Americans gaining health insurance by enrolling in Medicaid, with coverage starting in January. But the Supreme Court threw a wrench in that plan last year when it gave states the right to opt out of the Medicaid expansion plan. Because of Republican opposition in many states, it looks like nearly 2 in 3 of those who would qualify for new Medicaid coverage may be out of luck because their state lawmakers have not agreed to expand the program.
What about the workers? A longer wait.
PPACA requires companies with 50 or more workers to offer affordable coverage to full-time employees or risk a series of escalating tax penalties. Originally, that requirement was supposed to take effect on Jan. 1, 2014. But now the administration is pushing that requirement back a year, citing the complexity of the undertaking. Most medium and large business already offer health insurance. Those most likely to be affected by the delay: low-wage workers at hotels, restaurants and stores.
What’s left? For now, at least, plenty.
Under the current timetable, starting next year individuals will be required to carry health insurance or face fines.
People who are uninsured will be able to shop for affordable coverage through exchanges, or online marketplaces.
Middle-class people who don’t have coverage through their jobs will use the marketplace to apply for tax credits to help pay their premiums. Low-income people will be steered to the Medicaid expansion — if their state participates. Insurance companies will be required to accept people regardless of their medical problems.
A number of other changes already have taken effect, including a provision that allows young adults to stay on their parents’ insurance until age 26 and a ban on lifetime limits on insurance coverage.
Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.