Discussing the Pros and Cons of ObamaCare

What are the pros and cons of ObamaCare? The ObamaCare pros and cons mirror the complex nature of the new health care law. ObamaCare (the Affordable Care Act) contains many benefits, especially for low and middle income families and businesses. ObamaCare also contains some obstacles for high earners, larger firms that don’t insure their employees, and certain sectors of the healthcare industry.

The Affordable Care Plan contains some negatives, but we need to ask ourselves this question: Do the costs outweigh the benefits? The average American has a lot to gain and little to lose. Those making more, including larger firms and consequently their employees, may see negative financial effects. While some groups benefit more than others, most Americans will benefit from the new rights and protections like guaranteed coverage of pre-existing conditions and the elimination of gender discrimination. Your health insurance costs may go up in the short run, but the quality of your insurance just got a lot better. Below we will also discuss the pros and cons of ObamaCare in regards to the economy, healthcare costs, and the healthcare industry in general.

This video does a good job at explaining ObamaCare as a whole and what you need to know about the program. Watching this will make understanding the pros and cons of the Affordable Care a lot easier.

ObamaCare Pros and Cons List

Here is a quick list of the Pros and Cons of ObamaCare. Remember that you will need to either Get Coverage and maintain it throughout the year or get an exemption – you can do this through your State’s Health Insurance Marketplace.

ObamaCare doesn’t create insurance; it regulates private insurance to ensure you get more rights and protections, and in doing so, helps tens of millions get access to high-quality Affordable Health Insurance. Of course, health care reform is not without its costs. Below are just a few of ObamaCare’s pros and cons:

ObamaCare Pros ObamaCare Cons
Tens of millions of uninsured people will get access to affordable, high-quality health insurance through Medicaid expansion, their employers, and the Health Insurance Marketplace. In order to get the money to help insure all these people, there are new taxes (mostly on high-earners and the healthcare industry). The taxes that may affect you directly are the individual mandate and the employer mandate.
Over half of uninsured Americans can get free or low cost health insurance, and some can get help on out-of-pocket costs using their state’s Health Insurance Marketplace. The individual mandate says all Americans who can afford health insurance have to obtain health coverage, get an exemption, or pay a fee. That creates an extra complication with regards to filing taxes. Some folks who just barely miss the Federal Poverty Level limit of 400% are hit the hardest as they don’t qualify for assistance. Those who do get cost assistance will need to adjust tax credits on the 8962 – Premium Tax Credit form.
Over 20 million will be exempt from the fee by 2016. Those with exemptions can often still get cost assistance. Exemptions also qualify you for special enrollment. In order to get many of the exemptions, you’ll need to submit a form to HealthCare.Gov or file the 8965 – Exemptions form.
There are now more private coverage options than ever, and all major medical coverage options must provide minimum essential coverage. More options mean more complicated shopping for coverage. Keeping a private health insurance system means that shopping for health insurance can be confusing, and consumers risk over-buying or under-buying. Coverage options also, by nature, create a tiered healthcare system where more money equates to a better quality of care. However, in that respect, nothing has changed.
ObamaCare’s many protections ensure that you can’t be dropped from coverage when you get sick or make an honest mistake on your application. You also can’t be denied coverage or treatment for being sick or get charged more for being sick. Additionally, you can’t be charged more for being a woman. Other protections ensure that you have the right to a rapid appeal, that health insurance companies can’t make unjustified rate hikes, and that these companies must spend the majority of premium dollars on care, not paying executives. Insurance companies must cover sick people, and this increases the cost of everyone’s insurance. In order to ensure people don’t just buy coverage when they need it, most people must obtain coverage or pay a per-month fee. Also, coverage can only be obtained during annual open enrollment periods. One can owe the fee due to forgetting to pay a premium, and then not be able to get coverage until next open enrollment. Some people, like men in good health with no pre-existing conditions, who were not responsible for anyone but themselves, and who remained healthy, were benefiting from being in a low risk group. They may have had cheap limited coverage before the premium hikes took place in 2014.
All major medical coverage must count as minimum essential coverage. Generally, this means that coverage must offer ObamaCare’s protections, cover essential health benefits such as free preventative services, limit deductibles and out-of-pocket-maximums, provide minimum actuarial value, and not have annual or lifetime dollar limits. Minimum essential coverage can only be obtained during open enrollment unless you qualify for a special enrollment period. Those who don’t understand how to compare plans or didn’t have coverage before the ACA may be shocked by how cost sharing works on higher deductible plans. Also many may get non-minimum essential coverage like short term because of their confusion.
ObamaCare includes a number of cost curbing measures, which have led to health care spending growing at the slowest rate on record (since 1960) in 2014. Meanwhile, health care price inflation is at its lowest rate in 50 years. Unfortunately, even though the costs are increasing more slowly than they might have, health care costs are steadily increasing.. The law also includes spending. Upfront spending and more regulation is required in order to realize long term cost curbing measures.
Medicaid has expanded to cover up to 15.9 million men, women, and children who fall below 138% of the poverty level. Medicaid expanded using Federal and State funding. Not all States have to expand Medicaid.  The states that have chosen not to expand Medicaid leave 5.7 million of our nations’ poorest people without coverage options.
CHIP has expanded to cover up to 9 million children. CHIP also uses Federal and State funding.
The employer mandate says that, starting 2015/2016, businesses with the equivalent of more than 50 full-time employees must provide health coverage. In anticipation of the employer mandate, some businesses have cut employee hours. This adds extra operation costs to businesses that did not provide health insurance. Many lower wage employees will find health insurance unaffordable and end up with no affordable options due to having been offered coverage through work (see below).
Small businesses with less than 25 full-time equivalent employees can get tax credits for up to 50% of their employees’ health insurance premium costs. Employee health benefits can be expensive. Lower wage workers may end up getting better value through the marketplace, but having employer-sponsored coverage means that they can’t get cost assistance. Also, dependents of employees with coverage are unable to use the marketplace.
Young Adults can stay on their parents’ plan until 26. 82% of uninsured adults will qualify for free or low-cost insurance. Insurance helps everyone get lower prices on healthcare and protects them in an emergency. Young people tend to be healthy and to not need coverage as often as older Americans. However, due to low premiums and the benefits of having a plan, young people have some of the best deals of everyone under the ACA when purchasing care.
Medicare has improved for Seniors by measures that eliminate the donut hole, keep rates down, cut wasteful spending and fraud, and expand free preventive services. Some Medicare payments to doctors and hospitals have been limited; Medicare pays doctors more than any other type of coverage, and these rates have led to very complex problems that are driving the costs of health care up for everyone. In addition, retaining supplemental Medicare options means confusing options for seniors. The unfounded death panel rumor led to cutting out an important provision in the law that would have provided end-of-life counseling.
ObamaCare retains a free market and allows our $3 trillion dollar healthcare industry to thrive. Retaining a for-profit healthcare system has economic benefits, but it also means that every aspect of the system requires profit. Americans have higher healthcare costs than other countries, which have more “universal” healthcare systems.

Why Create This List of ObamaCare Pros and Cons?

This ObamaCare pros and cons list is meant to give you an idea of the most praised and most controversial aspects of the 1000-plus page bill. Many online sources only want to give you one side of the story – we aim to bring you an unbiased look at both the negative and positive aspects of the Affordable Care Act. Let’s continue by discussing the ObamaCare pros and ObamaCare cons for majority groups of Americans. Then we will go through some specific points of the law that are commonly thought of as pros or cons.

ObamaCare Facts

Pros and Cons of the Health Insurance Marketplace

The health insurance marketplace is your state’s website for health insurance. The marketplace allows you to apply for federally subsidized insurance and to find out if you qualify for Medicaid. The marketplace is your best choice for insurance if you qualify for cost assistance. To find out if you qualify for cost assistance, you can go to your state’s marketplace, or a local broker or provider outside of the marketplace.

If you don’t qualify for cost assistance, you may Find That Using Any Major Broker is the way to go as only certain plans from certain providers are offered in some states through the marketplace. A quality broker can offer you plans, both on and off the marketplace, from all providers in your state. Insurers have to deal with subsidies and an extra tax for plans they sell on the marketplace, and some insurers may not offer plans in your region at all.

Cost assistance makes the marketplaces attractive, while having a wider choice makes shopping outside of the marketplaces attractive. The drawback to shopping outside the marketplace is that we have a very segmented private health insurance system, which can easily lead to people over-buying or under-buying health insurance policies. Also, insurers can still sell types of coverage that won’t protect you from the fee outside of open enrollment. Additionally, some shady, lead-generating sites have used websites that look like official sites to collect information, and then re-sell your consumer information. (We have done a lot of work to ensure those shady sites don’t advertise with us).

No matter what plan you get, you’ll pay the same premium (before subsidies) the insurance company pays broker fees and your state controls insurance prices in your region. Regardless of what option you choose to obtain private insurance, make sure you inquire about cost assistance before choosing a plan. Learn more about ways to buy insurance.

You need to enroll in a plan during each year’s annual open enrollment period to avoid the fee and get cost assistance. Don’t wait until the last minute to get covered!

Marketplace Cost Assistance and Choices Outside the Marketplace

Healthcare.gov is the official Health Insurance Marketplace, and is the only place where you can get cost assistance.  Qualified Brokers can help you shop for marketplace plans and you can shop around for quotes outside the marketplace too.  Know your options and get the best coverage at the best prices.

The Pros and Cons of ObamaCare for the Average American

The Average American – those making under 400% FLP – have a lot to gain and little to lose under the new law. The average American family is likely to see a reduction in their insurance premiums, and 30 million of the 44 million currently without insurance will gain access to coverage due to expanding coverage via employer mandate, the health insurance marketplaces, Medicare, or Medicaid/CHIP.

ObamaCare offers a number of protections and benefits to all Americans. Beyond the 10 essential health benefits mandated by ObamaCare, there are additional benefits that range from working toward eliminating the penalty for having a pre-existing condition to expanding health services. Overall, the quality of health care is increased, and the cost, in theory, will be reduced.

Lower income Americans making below 138% of the Federal Poverty Level (FPL) may qualify for Medicaid under Medicaid expansion.

Middle income Americans (those making between 133% – 400% of the federal poverty level) and employees will be able to use tax credits and out-of-pocket subsidies on the exchanges to save up to 60% of the current cost of premiums, thus making insurance affordable for up to 23 million Americans.

Affordable insurance is defined as costing less than 8% of your annual income. Tax credits cap cost at 9.5% for sliver plan for those making between 300 – 400% FPL. If insurance is unaffordable or you had another hardship, you may qualify for an exemption.

During open enrollment 2014, 85% of the 8 million enrollees got cost assistance to help reduce premium costs and out-of-pocket expenses.

One of the cons of ObamaCare is that, since many Americans work for larger employers, some employees may have the new costs involved with insuring their workforce passed onto them. Other workers will see a decrease in the quality of plans offered by employers, who are trying to avoid paying an excise tax on high-end health insurance plans. These negative outcomes will affect less than 1% of businesses, and only a small fraction of these companies are expected to deal with the new challenges by cutting worker hours and benefits or by not hiring new workers. Get more information on the impact of the Affordable Care Act on jobs here.

ObamaCare Facts

The Pros and Cons of ObamaCare for Women

When it comes to women, ObamaCare offers many pros and few cons. 47 million women will gain access to women’s health services, including preventive and wellness services. Many of ObamaCare’s new benefits for women are required by law to have no out-of-pocket payments. Also, insurers can no longer charge women more than they charge men.

There aren’t many ACA cons that are unique to women; however, there is the issue of contraception and its availability. ObamaCare expands contraception coverage, but this “mandate” is one of the most contested aspects of the new health care bill and, depending on your viewpoint, can easily be seen as a con.

ObamaCare Pros and Cons for Low-Income Americans

Low-income Americans will enjoy more ObamaCare pros than cons. This is especially true in states that expanded Medicaid eligibility. Since ObamaCare works on a sliding scale, most low-income Americans, especially those without insurance, will see nothing but benefits. Medicaid expansion will cover over 15 million previously uninsured low-income individuals and families below the 138% FLP mark.

The cons of ObamaCare for low-income Americans are that some states, despite 100% federal funding for the first year and 90% thereafter, have decided to opt out of coverage for their poorest thereby leaving 5.7 million without coverage. In some cases, rejecting Medicaid Expansion isn’t just about saving money. In fact, the studies on whether or not states save at all by opting out have come up with inconclusive results. It’s often accused of being a politically driven move to “break” ObamaCare. The opt-out is projected to leave 2 to 3 million low-income Americans without coverage.

NOTE: The accusations that some state representatives are trying to “break” ObamaCare isn’t something that we are speculating or have made up. It’s readily available information on many of the more conservative blogs. It’s no secret that a portion of the GOP wants to repeal ObamaCare. They have a strategic plan of non-cooperation that includes “breaking” the Exchanges and Medicaid Expansion. ObamaCare isn’t just going to go away, but while the battle goes on, Americans continue to be caught in the crossfire. It’s also worth noting that the number of uninsured, Medicaid-eligible Americans differs from state to state. Some of the states opting out of expansion have a greater number of uninsured and, therefore, would both pay more and cover more of their constituents. Their cost would be greate, as would the payment by this insurance to healthcare providers, who may otherwise have to provide services for free.

ObamaCare Pros and Cons for Seniors

ObamaCare’s pros and cons for seniors include unprecedented reforms to Medicare, such as closing the “donut hole”, and expanding both benefits and coverage options. Millions of seniors have already saved money or taken advantage of the ACA-created absence out-of-pocket costs for wellness and preventive visits.

Some of the reforms to Medicare include reductions to Medicare Advantage, home health care payments, and Medicare hospital payments. Some Medicare reforms have had or may have negative impacts on some seniors and doctors who work with Medicare patients. Oversight was included in the law. An oversight committee is in charge of making sure that the potential pitfalls in Medicare reform don’t hurt seniors or the Medicare industry.

Under ObamaCare Part B, Medicare policyholders saw a reduction in Part B premiums, and the deductible went down for the first time in Medicare’s history. However, high-income seniors may pay more due to both the way the Part B formula works and the new taxes that affect some high earners..

Pros and Cons of ObamaCare for Businesses

Small Businesses will only see the pros of ObamaCare while firms that don’t already provide their employees with health insurance will have to deal with readjustment. However, only .2% of firms with over 50 employees currently fail to provide insurance to their full-time employees. A big pro of ObamaCare is that it provides millions in tax credits to small businesses with fewer than 25 employees. These tax credits help offset the cost of buying health insurance for their employees. Small business has historically struggled to provide benefits to workers and half of America’s uninsured are small business owners, workers, or dependents.

Unfortunately, one of the biggest cons of the ACA is that many families are finding employer-sponsored plans to be affordable for the employee but unaffordable for dependents. This has led to a family affordability glitch. Instead of supporting repeal of the law, we suggest supporting a provision for the families of millions of hard working Americans that would allow them to shop on the Marketplace.

obamacare benefits

More Information About ObamaCare Pros and Cons

More About the Pros and Cons in ObamaCare: Some people oppose ObamaCare as a whole, but considering the 1000-plus pages of complex legislation contained within the Affordable Care Act, it’s hard to justify a total repeal of the law. Here are some of the things ObamaCare does right and a few that may have a negative impact on America.

Pros of ObamaCare

Most of ObamaCare’s 1000-plus pages are filled with really impressive and long-overdue reforms to the $2.6 trillion dollar health care system. ObamaCare gives 30 million of 44 million uninsured Americans access to health insurance. Tens of millions of Americans have already benefited from ObamaCare’s improved health care services, and last year alone, the average family saved thousands on health care costs.

Here are some of the benefits of the healthcare law:

Important New Healthcare Benefits

ObamaCare gives Americans access to hundreds of new health care benefits. However, these benefits (excluding those mentioned elsewhere on this page) include: No annual or lifetime limits; children can stay on their parents plans to 26; the FDA can approve more generic drugs, thus driving prices down and breaking monopolies; and protections against discrimination for gender, the disabled, and victims of domestic abuse. Check out our ObamaCare Health Care Reform Timeline for a comprehensive list of reforms.

ObamaCare Pros: Preventive and Wellness Services

Millions of Americans now have access to preventive and wellness services at no out-of-pocket cost. Specific benefits can be found on our Benefits of ObamaCare page.

New Consumer Protections

In what’s commonly referred to as the “rate hike” review, ObamaCare regulates insurance providers with the “80/20” rule. This forces health insurance providers to either spend at least 80% of their income on health and marketing expenses or return the unspent remainder to their customers as rebates. Furthermore, Americans no longer have to worry about being dropped from their coverage for being sick or being denied new coverage due to a preexisting condition. ObamaCare has a long list of other protections that are serve all Americans.  For example, to promote wellness, it even includes a mandate that fast food restaurants to display calories.

New Cost Assistance for the Middle Class and Small Business

Those earning under 400% of the federal poverty level (roughly 88k for a family of four) could save up to 60% on their premiums via tax credits and subsidies on the health insurance exchanges. Small businesses with less than 25 full-time employees have this advantage as well.

Important Medicaid Expansion

In states that have not opted out of Medicaid Expansion, those under 133% of the poverty level will be covered due to ObamaCare’s expansion of Medicaid to low-income Americans. In the past, many of these low-income Americans were left with too much income to qualify for Medicaid but without enough to afford insurance.

ObamaCare Pros: Improvements to Medicare

ObamaCare does a lot for Medicare. For the most part, these changes are a great improvement, and they have already benefited tens of millions of seniors. ObamaCare closes the Medicare drug ‘donut hole’, provides improved preventive and wellness services with no out-of-pocket cost, and reforms aspects of Medicare to improve overall care for seniors.

The Debate of Quality Over Quantity

Doctors and hospitals will be moved to a system where they will be rewarded for focusing on quality of care rather than quantity of care. Many of the provisions that enforce this do so by punishing high turnover rates. However, this has some unintended consequences; although the overall reform will create a better health care system for all Americans, some doctors and health care institutions are being hit hard.

ObamaCare Pros: Oversight Committees

159 new boards, agencies, and programs are created by ObamaCare to oversee spending and to ensure that ObamaCare is working correctly. Though sometimes listed as a con, having oversight on a reform of this size is necessary to ensure that that the program works. It’s important to note that ObamaCare doesn’t ration healthcare; rather, it regulates the health insurance industry, which has been rationing our health care for years. Your health care is still between you and your doctor and is determined by your private insurance.

Cons of ObamaCare

Although ObamaCare does a lot right, it also has consequences that affect specific groups of Americans. ObamaCare has hurt a small number of small businesses, has negatively impacted insurance premiums, and has enacted reforms that hurt some medical industries and workers.

Here are some of the cons of the healthcare bill:

ObamaCare Cons: Taxes on Small Business

.2% of firms in the US have over 50 full-time employees and will have to either insure full-time workers or pay a fine. To avoid this, some businesses will cut employee hours or hire fewer new workers. It’s worth noting that the fine isn’t paid for your first 30 workers. Also, many businesses are coming up with solutions that don’t hurt the workforce, such as passing the extra costs onto consumers. Please be aware that, when politicians say “small business,” they are also referring to the top 3% of small businesses; this includes some very wealthy Hedge Funds, which use tax loopholes to pass as small businesses.

ObamaCare Cons: Religious Beliefs

There is some argument over ObamaCare funding women’s health services like contraception. There are exceptions built into the law allowing businesses to refuse to provide these services to women based on religious grounds; nonetheless, this issue has been causing problems in the political arena and the courts.

ObamaCare Cons: Rising Premiums

ObamaCare itself doesn’t raise premiums; in fact, many of its reforms to the insurance industry are intended to drive down costs, to make the quality of insurance better, and to prevent insurance company abuses. Unfortunately, many of ObamaCare’s consumer-protecting provisions weren’t enacted until 2014. In the meantime, premium rates rose at alarming rates. ObamaCare’s only guards against this by allowing states to enact provisions against price gouging. Many States are enforcing this, but others are not. For more information on this problem, see our ObamaCare Insurance Premium Rate Hikes page.

ObamaCare Cons: ObamaCare Insurance Exchanges

Another con of ObamaCare is that 26 states have opted out of the State Run Exchanges or plan to do so. These states then let the federal government run their exchanges for them. Many states claim that this is a cost-cutting measure, but the truth is much more complicated. The Medicaid-expanding provision was meant to be in the bill, but it is being used to avoid providing subsidies to low and middle income Americans. This forces the Federal taxpayers to take care of the constituents of states that did not create their own exchanges. This has also resulted in a 3.5% fee, paid by the insurance provider, on policies sold on the federal exchange. Learn more about the State Run Insurance Exchanges.

ObamaCare Cons: Tax for Not Buying Insurance

As of 2014, you must purchase insurance or pay a “penalty income tax”. The first year it is $95 or 1% of your income. Ideally, for the program to work optimally, everyone would have insurance. This would result in affordable, high-quality insurance for all. Since this is unrealistic, the tax is in place to help make up for the estimated 6 million people who will choose not to get covered.

ObamaCare Cons: Big Business Taxes

Medical device taxes and “drug innovator” taxes dig into the profits of some of the powerhouses in their respective industries. These taxes are a reaction to the large profit margins these companies benefit from and the often-monopolistic hold they have on their industries. These companies drive up the cost of health care, so they are taxed to help finance health care reform. However, taxes on large businesses may have unintended consequences on the job market and on some aspects of the health care industry. At the present, we’ve yet to see conclusive evidence on the effects of said taxes.

ObamaCare Cons: Taxes on the 2%

The top 2% of American businesses and individuals will pay some extra taxes. You could argue that it’s actually those earners falling just outside of the top 2% who will get hit the hardest – despite having less disposable income, they still face a significant new tax burden. However, the most vocal opponents of the ACA (the ones who fund the anti-ObamaCare campaigns) are big businesses that oppose regulation, entitlement programs, or any tax or program that affects their bottom line.

ObamaCare Cons: ObamaCare Hurts Medicare

Although ObamaCare has helped tens of millions of seniors save money on medications and get access to better health care, there are some caveats. ObamaCare cuts $716 billion from Medicare and reinvests the money back into the program. Since there is such a big overhaul, ObamaCare set up a committee to oversee spending and effectiveness. Due to the sheer volume of the reforms, some of them, while well-intentioned, will inevitably have unintended consequences that warrant adjustment.

ObamaCare Cons: ObamaCare Cost

ObamaCare is projected to cost $1.36 trillion over the next ten years, and in order for the program to work as intended, this is going to require funding from both the tax payers and the States. However, the end result of ObamaCare’s spending is a $200 billion reduction of the deficit over the next decade. Also, states receive between 90 – 100% of the necessary funding for most ObamaCare-related programs that they set up. A few states, including Nevada and Michigan, have done studies showing that states can save billions with ObamaCare. Despite a loss on per-plan profit, health insurance companies stand to make billions by insuring millions of newly-insured Americans.

How to Move Forward with The Pros and Cons of ObamaCare

Fixing the parts of ObamaCare that don’t work isn’t as simple as “repealing” ObamaCare (an action that would cost tax payers billions). Dealing with the pros and cons is something that is already built into the law via oversight committees and other such forward-thinking provisions. With so many aspects of the Affordable Care Act still in the initial stages of growth, only time will tell how ObamaCare will truly impact America.


ObamaCare Pros and Cons