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Still don’t understand the Affordable Care Act? You’re not alone.

“On Tuesday, March 23, 2010, several hundred people crowded into the East Room of the White House to witness President Barack Obama sign into law the Patient Protection and Affordable Care Act. The mood was exultant, and the President was interrupted ‘repeatedly with cheers, applause and standing ovations’ from more than 200 House and Senate members [and] regular citizens who had experienced first hand the travails of the nation’s patchwork system of health care coverage.

“In the President’s words on that Tuesday in the East Room, ‘the bill I’m signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see,’ enshrining ‘the core principle that everybody should have some basic security when it comes to their health care.'” –Lawrence R. Jacobs and Theda Skocpol, Health Care Reform and American Politics

That was well over a year ago, and yet many Americans still don’t fully understand what the Act says or means. (This, of course, has not stopped certain people from shouting opinions in the streets and posting their thoughts on picket signs.)

The Patient Protection and Affordable Care Act is the first of two pieces of legislation making up the 2010 health care reform. The second piece of legislation passed was the Health Care and Education Reconciliation Act. For simplicity, it’s common for both pieces of legislation to be called the Affordable Care Act, or ACA.

I recently stumbled across the site Act of Law, on which an anonymous woman is reading the entire ACA aloud. “I will read the law for two hours each week and post videos of each reading here on this site,” she writes. “It is 906 pages long (table of contents included) and I estimate that it will take about 60 hours to read.”
The most recent video she posted covers hours 23 and 24 of this project. It appears below with permission.

So what’s really between the pages? This is where the book Health Care Reform and American Politics: What Everyone Needs to Know comes in handy. Affordable Care promises key changes in a complex, expensive, and fragmented set of U.S. arrangements for paying for health care. Especially notable are popular new benefits:

• For some thirty-two million Americans who currently lack insurance–working-age men and women and their children–the new law expands access to medicaid (the federal-state insurance program for low-income people) along with subsidies to help small businesses  and individuals with modest means purchase reasonably priced coverage on state-run “exchanges” offering comparison shopping among private plans.

• For older people on Medicare, the new law promises free preventative checkups and more complete subsidies for prescription drug coverage.

• For individual purchasers as well as some 176 million Americans who already have health insurance via their employers, the new law promises key regulatory protections: By 2014, private insurers will no longer be able to avoid or cut people with serious “preexisting” health conditions, and as of fall 2010 they had to cover children, regardless of health problems, and allow young adults to remain on parental insurance plans until age 26.

Beyond these subsidies and protections for ordinary people currently with or without health insurance, the new law seeks to correct for rising economic inequalities and aspires to trim total national health care costs. Most New benefits promised by the Affordable Care Act will go to lower and middle-income Americans–the people whose employers do not provide health insurance, yet who are not poor or old enough for existing federal programs, and these expanded benefits are slated to be paid for primarily by higher taxes on wealthier citizens and by fees assessed on parts of the health care industry. This is why New York Times columnist David Leonhardt calls Affordable Care “the federal government’s biggest attack on economic inequality” since the late 1970s. In addition, the Congressional Budget Office projects that cost-control provisions will gradually reduce the nation’s overall health care bill and shrink the federal budget deficit.

Health Care Reform and American Politics is an incredible and accessible primer on this topic. If you’re interested in better understanding the legislation, I highly recommend you pick up a copy. Until then, Act of Law still has over 30 hours to go, so that should keep you busy.

Lawrence R. Jacobs is the Walter F. and Joan Mondale Chair for Political Studies and Director of the Center for the Study of Politics and Governance in the Hubert H. Humphrey Institute and Department of Political Science at the University of Minnesota.

Theda Skocpol is the Victor S. Thomas Professor of Government and Sociology at Harvard University, a member of the National Academy of Sciences, and past president of the American Political Science Association.

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