By Sarah Kliff
The Washington Post
— "Frustrating." A "debacle." That is how President Barack Obama's own secretary of health and human services, Kathleen Sebelius, has described the rocky launch of HealthCare.gov. Americans were supposed to begin shopping for insurance coverage on Oct. 1, but millions have been unable to log into the federal online exchange. Congress, meanwhile, shut down the government for 16 days in a dispute over whether to fund the health-care law. As the debate continues, let's look at some of the most persistent myths about the law — and some new ones that have cropped up.
1. Americans will be forced to buy health insurance.
The health-care law's individual mandate, despite its name, isn't meant to force Americans into health plans. Instead, it is supposed to encourage people to purchase coverage by giving them two options: Buy insurance or pay a fine. In 2014, that fine is $95 or 1 percent of an individual's income, whichever is higher.
The Internal Revenue Service is responsible for collecting this penalty from individuals who indicate on their annual tax filings that they have not purchased coverage. The agency can take the penalty out of a filer's refund, but beyond that, its ability to recoup those dollars is extremely limited. The IRS cannot, for example, send agents to people's homes or put liens on their houses. In the health-care law, Congress specifically curtailed the ability to enforce this penalty, giving the IRS fewer ways to collect it than there are for other tax fines.
2. If you like your health plan, you can keep it.
Obama has repeatedly made this key promise about his signature legislation. "If you're one of the more than 250 million Americans who already have health insurance, you will keep your health insurance," he said in June 2012, shortly after the Supreme Court upheld the law.
In truth, the health-care law makes a number of changes to the insurance industry that will affect the nearly 165 million Americans covered by private plans. For one, it requires all health plans to include a wider set of benefits, among them maternity care and mental health services. Employers have responded by increasing premiums by less than 3 percent, on average, to make up for the cost of these new benefits.
The individual market, where 15 million Americans buy their own coverage, will see even bigger changes. Experts estimate that insurers will discontinue at least half of these plans in 2014 because they do not cover the benefits that the Affordable Care Act requires. Some say the number could be even higher, around 75 to 80 percent.
CBS News has reported that more than 2 million people have already received word from their insurers that the health plans they have now won't be available next year. Customers who receive a cancellation notice will need to shop for new coverage. Those plans could have a higher price tag because they offer more benefits, although many people will receive financial help from the government to buy a new policy.
3. The exchange's big problem is that it's overwhelmed by traffic.
The federal exchange did get a lot of traffic at first; the White House estimates that 8 million people visited the site in its first four days To put that in perspective, as one Web developer recently did, that's more users in HealthCare.gov's first 24 hours than Twitter had in its first 24 months.
Traffic has decreased since then, and some people have successfully purchased insurance through the online marketplace. That's led insurance companies to discover another, even more serious problem with the exchange: It's sending inaccurate enrollment data to insurers. Companies are supposed to get a file from the exchange each time someone enrolls in one of their plans. These files include important information such as where the new subscriber lives and how many people are in her family. But insurers say these files are sometimes wrong, listing children as spouses, for instance, or including an address that doesn't exist.
Some companies have assigned employees to hand-check each file for errors. This works now because few people are enrolling through the exchange. But at some point, insurers expect that they'll receive thousands of files each week and won't have the manpower to check each one. If lots of people start signing up before the problem is fixed, insurers worry that they won't know who actually bought their plans. And without knowing who has subscribed, insurance companies won't be able to send out membership cards, for example, or begin paying claims for trips to the doctor.
4. The exchanges will transform the insurance industry.
While the federal exchange has gotten much attention in recent weeks, only a small fraction of Americans are expected to use the new marketplace to buy health insurance. The Congressional Budget Office estimates that, by 2023, 24 million people will buy insurance through the state and federal exchanges; that's about 7 percent of the population. It's telling that many of the large insurance companies, such as Cigna and UnitedHealthcare, have decided to participate in only a handful of the states' marketplaces. So far, they don't see this segment of the market as key to their growth.
The vast majority of Americans will still get their health insurance the way they did before the Affordable Care Act: through their employers or through a public program, mainly Medicare and Medicaid.
5. The health-care law will increase the deficit.
The Congressional Budget Office estimates that, over the next decade, the health-care law will reduce the deficit by $109 billion. That's because the Affordable Care Act includes new spending cuts and tax increases, which more than offset the cost of expanding health insurance to millions of Americans.
The law's new revenue sources fall into three main categories. First are cuts to Medicare providers, such as hospitals and doctors. Under the Affordable Care Act, the federal government will pay slightly lower rates.
Second are cuts to private health insurance plans, known as Medicare Advantage plans, that cover Medicare patients. The federal government has, in recent years, paid these private plans more to cover Medicare beneficiaries than it has spent on seniors who sign up for the traditional public program. The health law aims to reduce those differences by cutting Medicare Advantage payments.
Lastly, the law includes new taxes on a number of health-care industries, including hospitals, medical-device makers, insurers and pharmaceutical companies.
Kliff covers health policy for The Washington Post and writes for the Post's Wonkblog.