Explaining Health Care Reform

As Republicans continue their assault on patients' rights one year after the historic passage of the Affordable Care Act, Ezra Klein details how provisions of the law work for the American people:

So this is my birthday present to the [health care] legislation, and those who are befuddled by it: some clarity on what it does, and how it does it…

In 2019, once the law has been fully implemented for five years, it is expected to cover about two-thirds of the uninsured, to cost about 4 percent of what the health-care system spends in any given year and to cut the federal deficit by less than 1 percent. If you obtain insurance from your employer, Medicare, Medicaid or the veterans system — and that describes most Americans — you probably won't notice the legislation at all.

Nevertheless, the Affordable Care Act, once it kicks in fully in 2014, is expected to do four things: provide coverage; remake a small slice of the private insurance market; pay for itself; and try to control costs…

The law has two main mechanisms for covering people: Medicaid — which is a government insurance program that focuses on the poor — and subsidies to help people afford private insurance. The split is expected to be almost even: Of the 32 million people the law is expected to cover by 2019, 16 million will be on Medicaid and the rest covered by private insurance...

Transactions will happen on the new "exchanges" — a place that will, in effect, be a Web site where people can compare plans and choose the one that will serve them best…the exchanges offer another layer of consumer protection: Just as Amazon.com would stop carrying a toaster that routinely exploded when customers plugged it in, if an insurer repeatedly misbehaves, regulators can kick it out of the exchange…

All in all, the legislation is expected to save or raise about $100 billion more than it spends in the first 10 years…

Is it a perfect piece of legislation? Not even close. Will everything work as expected? Almost certainly not. But for all its flaws, it's a good law, which is why Republicans have had so much trouble coming up with state plans that could cover more people at a lower cost. And it's worth trying.

So happy birthday, Affordable Care Act. Here's to many more.

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Democrats remain committed to creating jobs, strengthening the middle class and reducing the deficit—as the Affordable Care Act does.