WEDNESDAY, March 23, 2011 (HealthDay News) -- The Affordable Care Act turns 1 year old on Wednesday, and the health-care reform package -- the centerpiece of President Barack Obama's first term in office -- remains as controversial as the day it was signed into law.
"The worst law ever enacted in the United States," said Greg Scandlen, director of Consumers for Health Care Choices, a national nonprofit group that says it seeks to "empower health-care consumers to preserve individual freedom and the quality of care in America's health-care system."
Scandlen believes most people should provide for their own health insurance, preferably with money from their employer and money they set aside for themselves.
On the opposite side of the fence is Kathleen D. Stoll, director of Health Policy at Families USA, who acknowledges that "we do have this debate about the Affordable Care Act and its merits, [but] people need to understand what is coming in 2014 and, if they do, they are really going to be happy about it."
"A lot of this is electoral rhetoric," said Stoll, who doesn't think Republicans in Washington can make good on election day pledges to repeal the law -- at least as the current Congress is constituted with Democrats in charge of the Senate and the GOP controlling the House of Representatives.
Although the full impact of the law won't be felt until 2014, legal challenges are keeping federal appeals courts busy and the legislation's ultimate fate will probably be decided by the U.S. Supreme Court.
Much of the controversy surrounding the law, which was designed to bring affordable health insurance to most Americans, centers on the so-called "individual mandate," which requires all Americans not already insured to purchase health insurance or face a fine.
Only 22 percent of Americans support the provision, according to a March 1 Harris Interactive/HealthDay poll.
The poll also found that Americans remain sharply divided over the merits of the law, with 39 percent of respondents opposed to it, 34 percent in favor of it, and 27 percent still undecided. Predictably, the division reflects respondents' political viewpoints, with 72 percent of Republicans wanting to repeal all or most of the legislation, compared to 15 percent of Democrats.
But a December Harris Interactive/HealthDay poll revealed that people found much to like in the health-reform package. Two-thirds of the respondents said they like the fact that the law prevents insurers from denying coverage to people with pre-existing medical conditions. Another 60 percent want to keep the provision for tax credits so small businesses can afford coverage for employees. Fifty-five percent like the idea that the law allows children to stay on their parents' insurance plans until they are 26. And just over half support the idea of new insurance exchanges where people can shop for insurance.
Stoll said much of the confusion stems from the fact that many "people are struggling to understand what the act means for them and their families today, and what it means for them when it is fully implemented in 2014."
For example, people who have insurance now will see no difference when the individual mandate takes effect in 2014, she said.
Stoll said there are parts of the law that have already kicked in that people support -- such as preventing insurers from denying coverage for pre-existing conditions and allowing parents to keep their children on their plans until age 26.
Also, reforms to Medicare will help seniors through the "doughnut hole" -- when they temporarily lose prescription drug coverage -- with lower prices. Some will even be receiving $250 rebates this year, she said.
And seniors are eligible for free preventive care services such as colonoscopies, mammograms and flu shots, Stoll said.
Stoll thinks people are naturally leery of change, but in time they will view the Affordable Care Act the same way they view Medicare and Social Security, two programs now considered untouchable by most Americans. "But we aren't there yet," she said.
But Scandlen -- who finds the scope of the law "breathtaking, every citizen is affected by it, unlike Social Security or Medicare" -- denounces the legislation as a "federal takeover of the health insurance industry." He said it would be impossible to pick out the few parts of the law that are worthwhile before scrapping the rest.
Among his targets of criticism: the individual mandate, and the way waivers or exceptions for the law are being handed out "on a whim" by the Secretary of Health and Human Services, Kathleen Sebelius.
One part of the law that Scandlen likes is having the government subsidize low-income people to help them buy health insurance. "Only the federal government had the resources to make that happen," he said.
He also supports the beefing up of Medicaid, the insurance program for lower-income Americans. "There is a portion of the population that can't handle any kind of insurance contract. They're dysfunctional, illiterate, they can't read a contract, they have bad impulse control, they can't plan ahead. That is a significant problem. They need direct provision of services like free clinics," he said.
Scandlen believes there's a small window to repeal or change the law, adding that, when the law is fully enacted in 2014, it will be too late.
"But at some point it will have to be changed, because it is going to collapse. They are building a structure that cannot be sustained," he said.
More information
For more on the Affordable Care Act, visit HealthCare.gov.
