MONEY Health Care

The Hidden Health Care Subsidy for the Rich

Waiter holding silver platter
AndyL—Getty Images

If a recent appeals court decision holds up, many middle-class families will lose federal subsidies to buy insurance. But high-income families can still get help.

A recent decision by a federal appeals court has put an essential feature of the Affordable Care Act, better known as Obamacare, in danger. That ruling may not stand up in the next round of appeal. But if the court’s decision survives, it will create a troubling—and, I would argue, outright perverse—inequality.

The quick backstory: Opponents of the new health care law argued in court that a strict reading of the law doesn’t allow the federal government to subsidize individual insurance premiums in states that have not set up their own “exchanges,” online marketplaces where people can go to buy coverage. The D.C. circuit court agreed, while another court the same day reached the opposite conclusion, setting up a likely showdown in the Supreme Court next year. If the ruling stands, millions of people in up to 36 states could lose federal tax credits that helped make insurance affordable.

What’s so perverse about this is that while many low-income and middle-income people would no longer get help from the federal government to buy insurance, loads of affluent people still will.

Here’s why: Even before Obamacare, the federal government played a big, but hidden, role in funding the private health insurance of most working-age people. When you get insurance at work, the money your employer pays for your premiums isn’t included in your taxable compensation. That’s a valuable tax benefit to you, but that lost revenue costs the government just as much as if was cutting a check.

This system has done a lot to encourage companies to offer health insurance, which is a good thing. But it also had a surprisingly backwards effect. Affluent people are more likely to have coverage (and costlier coverage, too). And because they face higher tax rates, they benefit more from tax breaks. As a result, you get more from this hidden subsidy the more you earn. The Tax Policy Center recently estimated that the average benefit of the health-insurance tax break is about $800 for a household in the middle 20% of earners. For people in the top 20%, it’s $3,400.

Prior to the Affordable Care Act, tax subsidies for health care you bought for yourself were much stingier. One of the points of the law was to address this gap. Families earning less than 400% of the poverty line—as high as about $95,000 for a family of four—currently get a tax credit when they buy coverage on a state exchange or the federal Healthcare.gov. Now that particular subsidy is under threat in some states. But the tax break for employer insurance will still be around for those fortunate enough to have an employer who pays up for premiums.

Of course, if this happens—and I should stress if—it wouldn’t exactly be new. This is how health insurance worked everywhere in the country before the ACA. But people on both sides of the political spectrum knew that was a crazy system. And now, the difference would be all the more glaring, since some Americans buying their own insurance would still get help, and others wouldn’t—all based on the technicality of whether their state set up a website.

TIME

Uninsured Rate Dropping Faster in States Embracing Obamacare Provisions

A new Gallup poll finds that states where a Medicaid expansion has been implemented and a state marketplace to buy coverage has been established are seeing their uninsured rates drop quicker than states that haven't yet done so

States that have implemented core functions of the Affordable Care Act have seen a faster decline in the rate of uninsured residents compared to those that haven’t done so, according to a new Gallup poll.

In states that implemented a Medicaid expansion and a state marketplace, the rate of uninsured dropped 2.5 percent since 2013, down to 13.6 percent from 16.1%. Meanwhile, in states that did not apply the measures, the rate of uninsured people dropped 0.8 percent, hitting 17.9 percent, down from 18.7%.

21 states and the District of Columbia have implemented both Medicaid expansion and a state health insurance marketplace. 29 states, including Texas, Florida and Mississippi have applied one or neither of the Affordable Care Act’s central mechanisms.

The nationwide rate of uninsured, meanwhile, has dropped to 15.6 percent, its lowest level since 2008. The rate of uninsured peaked at 18.0 percent before the health exchanges opened in the third quarter of 2013.

TIME Health Care

What Sebelius Left Undone

Health and Human Services Secretary Sebelius takes her seat to testify before a House Energy and Commerce Committee hearing about issues and complications with the Affordable Care Act enrollment website, on Capitol Hill
Health and Human Services Secretary Kathleen Sebelius takes her seat to testify before a House Energy and Commerce Committee hearing about issues and complications with the Affordable Care Act enrollment website, on Capitol Hill in Washington, October 30, 2013. Jonathan Ernst—Reuters

The resignation of Health and Human Services Secretary Kathleen Sebelius leaves her expected successor Sylvia Mathews Burwell with a lot on her plate, with the implementation of the Affordable Care Act still incomplete

Kathleen Sebelius may have launched the Affordable Care Act, bungled its rollout and managed the subsequent repair effort, but she is leaving the Obama Administration long before the full effects of the law are known or felt by the vast majority of Americans. Sylvia Mathews Burwell, the director of the Office of Management and Budget, is expected to be nominated to replace Sebelius, who will officially resign on Friday. If confirmed by the Senate, Burwell will be tasked with turning the page on the Administration’s embarrassing early implementation of the ACA while managing the critical next steps in the effort to reform the U.S. health care system.

“Secretary Sebelius has soldiered through, but now really is a good time for somebody new who can say, ‘That was then. This is now,’” says Gail Wilensky, an economist, health policy expert and former official under Presidents George H.W. Bush and George W. Bush. “Now we are really getting ready for round two.”

The top agenda item for Round Two is preparing for the next open enrollment period on the insurance exchanges, which begins this fall. More than seven million Americans signed up for private insurance during the enrollment period that began in October 2013 and ended in March, but the Congressional Budget Office estimates 24 million Americans will get coverage this way by 2017.

Overseeing the exchange program and the federal subsidies to blunt the cost of coverage for millions of Americans will fall squarely on Burwell’s shoulders. She will need to enforce regulations intended to ensure the networks of doctors and hospitals included in future health plans sold through the exchanges are adequate. And Burwell will be in charge of guiding ACA programs designed to keep insurance premiums stable in the coming years, which is crucial to keeping coverage affordable for Americans who do not receive insurance through employers or government programs.

Burwell’s top priority, says Wilensky, will be “trying to ensure the next enrollment is nothing like the last enrollment period.” Computer software problems with the ACA’s federal exchange hobbled enrollment last fall and drew criticism that Sebelius and the entire Obama Administration were incapable of managing the ACA, the most significant and sprawling piece of health legislation since Medicare became law in 1965.

Also on Burwell’s plate are a number of critical ACA provisions not yet in place. The employer mandate, which was originally supposed to go into effect this year, has been put off until 2015. Insurance exchanges for small business owners, which were also originally planned for a 2014 launch, are still not operational. The so-called Cadillac tax, a fee to be levied against high-cost health plans, is scheduled to fall into place in 2018.

In addition to implementing provisions of the ACA, Burwell will also need to do some finessing and negotiating. The expansion of the Medicaid program, a primary way the ACA was expected to reduce the number of Americans without insurance, has only happened partially—so far. About half of all states have opted not to expand eligibility for the program, forgoing billions of dollars in federal funds, because their political leaders oppose the ACA. But behind the scenes, Sebelius had been cajoling a number of red-state governors to try to get them on board with creative compromises that would allow expansions of their programs without whole-heartedly endorsements of the ACA’s approach.

“There are a lot of Republican governors who have indicated an interest,” says Wilensky. Burwell will no doubt continue this effort and may have more success than Sebelius by the end of this year. “After the 2014 election cycle, it could be a lot easier for some of the state legislatures,” says Wilensky.

Unlike Sebelius, who oversaw HHS while the ACA was being written and debated, Burwell will take the reigns at a time when the health reform policy-making is largely over and pure management experience is more in demand. This is a role Burwell, a veteran of the Clinton administration and Bill & Melinda Gates Foundation, is well suited for, says Jonathan Gruber, a professor at MIT who worked as a paid consultant to the Obama Administration on the ACA.

“I know lots of people who think incredibly highly of her. She’s not really a health person, but she’s a manager’s manager,” says Gruber. “Right now, we need to just manage that policy and and I think she’s a great choice in that sense.”

And finally, Burwell will walk into her first day of work at HHS surely wanting to improve morale at the Department of Health and Human Services, where bureaucrats have fallen under heavy and relentless criticism in the past six months.

TIME Health Care

Jindal Floats Obamacare Replacement Plan With Eye on 2016

Governor Bobby Jindal of Louisiana speaks during an address to delegates at the Conservative Political Action Conference, National Harbor, Maryland, March 6, 2014.
Governor Bobby Jindal of Louisiana speaks during an address to delegates at the Conservative Political Action Conference, National Harbor, Maryland, March 6, 2014. Trevor Collens—Alamy

The Louisiana governor nibbles but doesn’t take a bite out of health care reform, by proposing his "Freedom and Empowerment Plan," as he seeks to position himself from repeal-only Republicans more than two years before the presidential election

Louisiana Gov. Bobby Jindal on Wednesday unveiled an alternative to replace President Barack Obama’s health care reform law, seeking to distinguish himself from a Republican Party more known for its insistence on total repeal of the Affordable Care Act.

“Repealing all of Obamacare is a good and necessary step—but not one sufficient by itself to achieve the real health reform America needs,” Jindal said in the introduction to the plan, entitled “The Freedom and Empowerment Plan, The Prescription for Conservative Consumer-Focused Health Reform.”

Jindal mocked the “liberal shibboleth of ‘universal coverage,’” saying his plan is more focused on “containing the rising tide of health costs.” Indeed, his plan would expand coverage to less than 10 million Americans, far fewer than the 30 million people Obamacare aims to cover by 2022. There are currently an estimated 50 million people in America without health insurance.

Jindal’s 26-page plan nibbles at the edges of health care reform without ever taking a bite. It doesn’t tackle the long-term issues of Medicare and Medicaid insolvency. It hardly mentions either program, which make up the backbone of U.S. health care coverage. Instead, it rehashes old Bush administration ideas and cherry picks from the best of Obama’s politically divisive reform law, without taking a serious whack at the harder stuff like how to defray risk without a mandate that Americans buy insurance.

The plan does, though, hit on all the feel good conservative touchstones: insurance plan and doctor choice, empowering markets, Obamacare repeal and preserving anti-abortion policies. It is notable that Jindal, who became secretary of the Louisiana Department of Health and Hospitals in 1996 and later served as President George W. Bush’s assistant secretary of Health and Human Services, chose to tackle health care as one of his first issues on a national stage. Given his resume, one might have expected a more comprehensive plan. But this was a plan with a specific audience in mind: Republican primary voters. Last month, Jindal formed a PAC and a conservative policy group called America Next—signs pointing to a possible bid for the presidency in 2016.

The Freedom and Empowerment Plan would create a standard deductible for all health insurance plans, whether provided by an employer or bought by an individual. This was a change first proposed in 2007 by Bush, though it failed to garner congressional support. According to one study at the time, the voluntary program would lead to about 9.2 million people buying health insurance. Those who don’t make enough to buy plans and don’t get them from their employers would get a subsidy from the government that Jindal estimates would cost $100 billion over 10 years.

Jindal also would require insurers to guarantee renewability in spite of pre-existing conditions, something they already do under Obamacare but with the incentive that the individual and employer mandates are forcing healthy people into the system, which helps mitigate the costs and risks of taking on already sick people. To address that issue, Jindal suggests “a high-risk pool, a reinsurance fund or some other risk transfer mechanism.” A similar idea, put forth by Republican Sens. Orrin Hatch, Richard Burr and Tom Coburn in their Obamacare replacement plan in January, was met with resistance by insurance companies.

Jindal would also expand health savings accounts, crack down on medical malpractice lawsuits, allow health insurance to be sold across state lines and allow groups to pool together for cheaper coverage—all Bush-era ideas. As in Obamacare, the plan would also incentivize healthy behavior, crack down on fraud and require more price transparency in the system.

TIME Health Care

White House Embraces March Madness To Sell Obamacare

President Obama And First Lady Speak at Miami High School
Larry Marano—WireImage/Getty Images

The Obama administration is banking on the popularity of the NCAA men's basketball tournament to sell the Affordable Care Act to young Americans by using athletes, coaches and sports celebrities to encourage more youth to sign up

The Obama administration is getting a case of March Madnesss for its latest effort to reach young and healthy consumers who have been slow to sign up for insurance under the new health care reform law, two weeks before a critical enrollment deadline.

The administration has marshaled athletes, coaches, and sports celebrities to help sell the law to the so-called “young invincibles,” whose participation is vital to the success of the insurance marketplaces, according to a White House official who described the blitz. Just 25 percent of enrollees are aged 18-35, well below the administration’s target.

The field of teams in the college basketball tournament was set to be chosen on Sunday, also known as “Selection Sunday.” On Monday, the White House will release a “16 Sweetest Reasons to Get Covered” bracket listing the top reasons to get health insurance, along with a new web video featuring top college basketball coaches. The bracket will be updated all week to reflect the results of an online survey. The bracket is timed to coincide with the release of President Barack Obama’s selections for his own NCAA tournament bracket on Wednesday, the White House official said.

Additionally, ads paid for by the Department of Health and Human Services featuring LeBron James, Magic Johnson and Alonzo Mourning will air during March Madness games and on ESPN, ABC, TNT and NBAtv, while the agency is targeting digital ads to basketball supporters. Administration officials including Chief of Staff Denis McDonough and Senior Advisor Dan Pfeiffer have called into sports radio stations across the country to promote insurance enrollment.

The effort follows Obama’s appearance in a Funny Or Die Web video, “Between Two Ferns,” as well as a call-in to Ryan Seacrest’s radio show.

Last week the administration announced that 4.2 million Americans have enrolled in coverage through federal and state health care exchanges, well below the initial seven million projection and the revised six million projection from the Congressional Budget Office. The White House has said that the final weeks of the enrollment period are when they expect to see a surge in enrollment, particularly among young people, to avoid the law’s tax penalty for not having coverage.

More from a White House official on the latest enrollment push:

Building on our efforts to reach young consumers where they are during the final weeks of open enrollment, next week the Obama administration, well-known athletes, coaches, and other influencers are launching a push around March Madness to encourage tournament fans young and old to sign up for insurance by March 31. This effort will feature PSAs from athletes and coaches, new digital engagement tools and social media blitzes, and targeted interviews on sports radio, including Spanish Language sports radio, throughout the week. Officials from the White House and across the Administration, including many who are former basketball players, will participate in various ways, including White House Chief of Staff Denis McDonough, White House Senior Advisor Dan Pfeiffer, White House Senior Advisor Phil Schiliro, and Secretaries Sebelius and Duncan.

For example, on Monday morning, the White house will release a “16 Sweetest Reasons to Get Covered” bracket listing the top reasons to get health insurance. To introduce the bracket, the White House will release a new online video featuring two of the most recognized coaches in college basketball, talking about the importance of getting health insurance and making sure consumers know about the upcoming March 31st deadline.

Each day the ACA bracket will be updated based on the “winning” votes from online users. On Wednesday, when the President’s NCAA bracket is released, it will be incorporated into the 16 Sweetest Reasons to Get Covered bracket webpage on WhiteHouse.gov. The release of the President’s NCAA bracket last year got over 280,000 views, and was the most popular blog of the year on WhiteHouse.gov.

Next week, a new CMS ad featuring LeBron James will begin airing during March Madness games, as part of the agency’s existing ad rotation running on ESPN, ABC, TNT and NBAtv. LeBron’s ad joins similar 30 second spots CMS has been airing that feature Magic Johnson and Alonzo Mourning sharing their compelling health care stories and highlighting the importance of getting covered, even for young folks who may think they’ve invincible.

HHS and Healthcare.gov social media channels will be promoting enrollment by joining the online conversation during the NCAA tournament with graphics, posts and paid promotion targeted to basketball fans. Secretary Sebelius, a big college basketball fan, will be tweeting about the tournament throughout the tournament, especially about the Kansas Jayhawks.

On Thursday, athletes involved with the ongoing health care enrollment campaign being spearheaded by Gameplan4me.com will help drive a social media day of action, pushing out #GetCoveredNow messages to drive traffic to their site, which links to HealthCare.gov. GamePlan4Me.com is a unique partnership between the sports industry and athletes like Kobe Bryant and Victor Cruz, that encourages young people to make healthy decisions about their future, which includes signing up for health insurance.

On Monday, Univision Radio’s Locura Deportiva will air an interview with President Obama. Additionally, the ESPN Deportes network will air an interview with White House Chief of Staff Denis McDonough on its syndicated network of stations, which include Miami, Houston, Dallas, and Phoenix. And ESPN Deportes will also air a PSA featuring Secretary of Labor Tom Perez, will air 25 times each week between now and the March 31st enrollment deadline.

And throughout next week, Secretary Duncan, Denis McDonough, and Phil Schiliro will conduct interviews on several sports talk radio stations across the nation to discuss the importance of getting covered ahead of the March 31st deadline. On Monday, March 17, Dan Rooney, Chairman of the Pittsburgh Steelers will be interviewed by a leading Pittsburgh radio station to discuss the importance of having health care coverage.

Next week’s push builds upon the Administrations already extensive outreach to sports radio stations across the country. Since February 27, Denis McDonough and Dan Pfeiffer have done interviews with sports talk stations in major enrollment media markets to highlight the importance of health care coverage, reaching listeners in Atlanta, Austin, Cleveland, Detroit, Houston, Miami, Nashville, Oklahoma City, Philadelphia, and Tampa.

This effort also builds on the innovative strategies the Administration and stakeholders have been using to reach young people where they are, including by appealing to them through their mothers, who are often are the primary influences in the health care decisions of their adult children. Last week, Funny or Die released an interview of the President on Between Two Ferns, which as of Friday had over 15 million views and linked to HealthCare.gov. On Friday, an interview the President did with WebMD aired on the platform’s website, which has 156 million views per month – over 60 percent of which are women. And on Friday, a new online video campaign, YourMomCares, was launched by outside organizations, featuring the mothers of celebrities like Jonah Hill, Adam Levine, Jennifer Lopez and Alicia Keys, and the First Lady, all talking about the importance of getting covered.

TIME 2016 Election

Clinton Docs Reveal Staffers Plotting Political Theater

Hillary Clinton At George Washington University
Then First Lady Hillary Clinton speaks at George Washington University, Sept. 10, 1993 in Washington, DC. Diana Walker—Getty Images

The latest batch of documents released by Bill Clinton's presidential library show how staffers planned a public hearing for the purpose of "political inoculation" ahead of the health reform debate

In the run up to a 1993 Clinton administration public hearing on health care reform, staffers had some seemingly cynical advice for then-First Lady Hillary Clinton. The “primary goal,” of the hearing, they wrote in a memo, was not to gather a variety of perspectives before fashioning government policy, but to give the Clintons political cover from charges that they didn’t gather other perspectives.

That’s according to the latest round of newly disclosed Clinton-era documents, 4,000 pages of which were released Friday by the National Archives and the Clinton Presidential Library. The first release—3,500 pages unveiled in February—included, among other interesting tidbits, insights on how Hillary Clinton’s aides advised her to “be real” as she embarked on her own political career in the late 1990s. The document releases are being closely watched for any impact they could have on a potential 2016 Hillary Clinton presidential run.

The health care reform hearing memo is dated Feb. 10, 1993, early in the Clinton presidency. Just a few days later the president would deliver his first-ever televised address from the Oval Office, in which he would ask Americans to accept a tax hike in his ultimately successful effort to balance the budget. The administration was also preparing to make its ultimately-doomed push for national health care reform, a cause championed by the First Lady. In the memo, administration staffers Alexis Herman and Mike Lux offer Hillary Clinton their vision for a public hearing on health care issues to be held in March.

In the first line of the document, they get right to the point.

“As we discussed,” the memo reads, “the primary goal for this two day hearing would be to inculate ourselves from charges that we are refusing to listen to all those groups out there that want input.”

Later, they do make allowances for the possibility that someone might actually learn something at the hearing.

“Even though our primary goal is political inoculation,” they write, “we should not lose the opportunity for some public education. Some testifiers should be average people with horror stories, middle class families worried about the future, and senior citizens.”

But, they say, “these average people should testify during those periods when we believe more people will be watching.”

TIME Health Care

Jonah Hill’s Mom Wants You to Get Obamacare

Jonah Hill Mother
Healthcare.gov

The Obama administration aims to get so-called "young invincibles" to sign up for health insurance by March 31 with a new video that includes the mothers of celebrities like Jonah Hill, Alicia Keys, Adam Levine and Jennifer Lopez

Add a group of celebrity moms to the list of Obamacare boosters.

The White House continued its push Friday for Americans to enroll in new health insurance under the Affordable Care Act, with a video featuring the mothers of famous celebrities like Jonah Hill, Alicia Keys, Adam Levine and Jennifer Lopez.

“Jonah was a prankster,” Sharon Feldstein, Hill’s mother, says in the video released Friday encouraging Obamacare enrollment, which is branded as part of a campaign called #YourMomCares. “Jonah flooded the elementary school. Jonah would lie on top of my dashboard, and literally not get off.”

“Trust me, us moms put up with a lot,” Feldstein says. “But one thing we should never have to put up with is our kid not having health care.”

The messaging comes ahead of a critical March 31 open enrollment deadline, and at a time when the Obama administration is increasingly turning to comedy to drive Americans to sign up for new health insurance. The White House credited President Barack Obama’s appearance on the Funny or Die series Between two Ferns this week with driving significant traffic to the Healthcare.gov federal insurance exchange website.

The latest campaign, which includes a message from First Lady Michelle Obama, is targeting the so-called “young invincibles” — younger and healthier Americans whose relatively low health care costs are needed to make insurance affordable for the larger population of uninsured Americans.

“Seriously, do you want your mothers to have a nervous breakdown?” Feldstein says in the new video. “You need health insurance, it’s imperative that you have health insurance. Taking care of yourself so you mothers can sleep and have a nice life after all they’ve done for you is not too much to ask in my opinion.”

Michelle Obama closes the new video by imploring: “We nag you because we love you.”

The new ad campaign was produced with Droga5, the award-winning advertising agency and creators of The Great Schlep, the famous 2008 ad campaign in which comedian Sarah Silverman implored young Jews to go to Florida and convince their grandparents to vote for Obama.

See the video below:

-with reporting from Mark Halperin

TIME Health Care

Obamacare Enrollment Up To 4.2 Million

President Barack Obama
President Barack Obama delivers remarks on the quality of education at Coral Reef High School on March 7, 2014 in Miami, Fla. Larry Marano—WireImage/Getty Images

Enrollment in health insurance through Affordable Care Act exchanges is rising slowly, but total sign-ups are unlikely to meet the administration's targets

About 4.2 million Americans chose a new health insurance plan through the new health care reform law between Oct. 1 and March 1, according to a new government report Tuesday, but the pace of enrollments has slowed ahead of a critical March 31 deadline.

Since an open enrollment period started last fall, some 2.6 million Americans have chosen health plans through the federal exchange HealthCare.gov, while another 1.6 million have signed up through exchanges run by states. More than 80 percent of those who have selected plans are eligible for federal subsidies through the Affordable Care Act to reduce the cost of premiums.

Although the Obama administration is expecting a rush of sign-ups just before open enrollment closes March 31, total sign-ups are unlikely to reach seven million, the figure predicted by the Congressional Budget Office last year. Just 943,000 people enrolled in the health insurance marketplaces last month, down from about 1.1 million in January. In February, the CBO reduced its projection to six million.

The Obama Administration is making a strong push to publicize the open enrollment deadline and urge uninsured Americans to sign up. Americans who do not have health insurance by March 31 could be subject to federal fines. The effort is particularly aimed at young people, whose relatively healthy status helps mitigate the cost of covering older and sicker Americans. Of the 4.2 million who have signed up for private health plans through Obamacare so far, about one-third are over 55. Twenty-five percent are under 35.

In an effort to reach uninsured consumers the Administration calls “young invincibles,” 20-something Americans who don’t believe benefit of health insurance is worth the financial cost, President Barack Obama appeared in an episode of comedian Zach Galifianakis’ web interview show “Between Two Ferns” posted online Tuesday. White House senior communications adviser Tara McGuinness later said the video had driven large traffic numbers to the healthcare.gov site.

But Republicans said the apparent lack of interest in the law’s healthcare exchanges among young adults proved the law had failed to work as planned. “It seems the president’s push to enroll young adults is far too little, too late,” said Brendan Buck, spokesman for House Speaker John Boehner. “Young adults – those who the White House repeatedly said are critical – are deciding the health care law is a bad deal. Now, millions stand to be forced to pay a new tax because of this law. Given these dismal enrollment numbers, the president needs to work with Congress to get rid of this year’s individual mandate penalty.”

MONEY

Just How Big Is the Health Care Reform Law?

True to the cliche, it makes a pretty good doorstop:

Whenever big legislation that changes the tax code is passed, the nice folks at CCH send MONEYa bound copy of the new law, along with their explanation of how it will work. The Patient Protection and Affordable Care Act is long enough to require two volumes, one for the law itself (plus a committee report) and another for CCH’s explanation.

The length of this bill became an argument against it. So for context, I’ve put a third volume in the picture: On the bottom is CCH’s copy (with explanations) of the 2008 bill that created the TARP. I used to also have copies of the volumes on each of the past two major tax-cut bills; if memory serves, they were about the same size as the TARP book. So there you go: The PPACA is really long and complicated, even for federal legislation. But federal legislation is routinely long and complicated.

How is a citizen supposed to make an informed decision about a bill this long? Well, you could rely on a journalist’s analysis, like the one I wrote with my colleagues Amanda Gengler and Michelle Andrews. But if you want something more unfiltered, go to a good plain-language summary, like this one from the Kaiser Family Foundation. I’ve read the law — to the extent that this is possible for a layman (more on that in a second) — and as far as I can tell, the folks at KFF play it perfectly straight. They haven’t left anything important out, and it takes a lot less time to read the KFF’s version than the actual law.

With any piece of legislation, reading the bill itself is usually as helpful in understanding the law as reading computer code is to learning how to use an iPhone app. Okay, that’s overstating it; the law is written in English, more or less. But like computer code, legislation is really just a detailed set of instructions, in this case for a machine made of lawyers and administrators. A lot of stuff you’d just take for granted (like, say, what a health insurance plan is) has to be spelled out explicitly, whereas a lot of the stuff you really want to know is dispatched with a quick reference to another section in the legislation or in another law. The results can be confusing. Reading the bill, I was shocked to discover that the “public option” government-run insurance plan, which had been dropped from the health care reform package, was actually still in the final legislation. I knew I couldn’t possibly have a scoop here — someone at The Washington Post, the Republican caucus or Joe Lieberman’s office would surely have noticed — but it sure was baffling. That section of the bill, it turns out, is dropped from the law by a single line that shows up about 2000 pages later.

The lesson: You can’t read most modern legislation in raw form without a trustworthy guide. But there are a lot of good people who do that kind of guidance for a living, and the web has made them easier to find.

Follow MONEY on Twitter at http://twitter.com/money.

MONEY

What Health Care Reform Means to You

During the many months of talking, yelling, finger-pointing and partisan spinning about the best way to reform our health care system, it was hard for Americans to actually understand exactly how any sort of overhaul would affect them. Given how often things were moving and changing, even this blogger — who covers health care as one of her beats — found it difficult to stay on top of what the various bills meant to consumers, and what provisions were in or out.

With all that noise finally behind us, it’s now possible to focus in on how the newly-definitive details will affect Americans. So here’s a look.

Most of the major provisions of the legislation, including a requirement that most Americans purchase insurance or pay a penalty, do not go into effect until 2014. Yet there are a few big benefits that will kick in this year. Here are three of them:

  • Many young adults will be allowed to remain on their parents’ health insurance plan until age 26.
  • Senior citizens who fall into the Medicare “doughnut hole” will get some help in paying for their prescriptions.
  • People with pre-existing medical conditions that left them struggling to find affordable coverage in the past may now be able to get it through a government program.

For more details, Kaiser Health News has published two clear stories of what health care reform means to you, both immediately and down the road.

Follow MONEY on Twitter at http://twitter.com/money.

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