Reality is the leading cause of stress among those in touch with it.” When American writer and director Jane Wagner wrote that line she was being much more serious than most of the comedy routines she helped to craft with her partner Lilly Tomlin, and she most certainly was not thinking about health care reform. Yet it seems a more perfect observation could not be penned for post-PPACA America in early 2015.

There are more than enough stressors to go around. Most imminent among them is the upcoming Supreme Court hearing in King vs. Burwell. Plaintiffs contend that the law is clear and replete with consistent references that subsidies would not be made available to those states choosing to refuse to setup their own exchanges in favor or allowing the federal government to step in.

Defendants point to the enormous (some say “catastrophic”) effects of a ruling that upholds the law as written. Interestingly, most of the coverage over the last couple of months has focused on such table pounding rather than pounding the facts — an age-old lawyer’s dictum for what to do when the facts don’t favor your argument. Hopefully the Court will focus on what the law (and only the law) is — or is not.

If that stressor doesn’t do it for you, how about a law that was (in part) sold as something that would help the middle class and that has created a totally predictable burden instead? LifeHealthPro.com reporter Allison Bell recently cited a Gallup study on how Americans view their financial challenges.

The number of respondents reporting “health care costs” as their top problem increased from a year ago. Moreover, this worry concerned people in the middle-income category ($30,000 to $74,999) more than other surprisingly steep deductibles and overall out-of-pocket costs. A recent Kaiser Family Foundation survey found that out-of-pocket costs are often five times what the average person with employer-based coverage paid last year. Another group with major PPACA stress: the more than 300,000 individuals who have lost or are about to lose their coverage because they failed to prove legal residency. Last year (according to the Centers for Medicare & Medicaid Services) 112,000 such individuals were dropped from plans.

This year, they expect another 200,000 to follow suit. However tough it is to be without coverage, it just has to be worse to have it and then have it yanked away. Stress? You bet. But wait! There’s more! Our last bite at the stress apple even comes with a sinister-sounding name: The Clawback.

According to a study from the University of California, Berkeley (supporters of the health care law), 40 percent of PPACA participants may discover they owe their rich uncle in Washington as much as $11,200 in undeserved subsidies they have received.

Richard Pollock, writing at The Daily Caller says, “The idea that struggling, low-income Obamacare enrollees would have to repay the government for subsidies has been a dirty little secret that has always been a part of the Affordable Care Act.” The report’s authors warn that the repayment feature could kill future support for Obamacare. You think?

Yes, as reality intrudes so rudely into the panacea that was sold to Americans, it is like the Lilly Tomlin routine where she plays 5-1/2-year-old Edith Ann, who has just made a sandwich with all kinds of unsavory items from the kitchen and then tried to convince her dog to eat it. The items sounded OK individually, but her dog didn’t like the final product. Apparently, the final PPACA sandwich might not be as appetizing as some had hoped. To quote Edith Ann, “… and that’s the truth!”