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What does Obamacare do?

Two main things: expand access to health insurance and change the way the federal government pays doctors.

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Obamacare does two main things: expand access to health insurance and change the way the federal government pays doctors.

Over the next decade, federal budget forecasters expect that 25 million people will gain health coverage because of Obamacare. And about 17 million people have so far become insured since the expansion started in 2014.

The number of people with insurance is rising because of three main provisions in the law.

  1. The expansion of Medicaid, a federal program that provides health coverage to low-income Americans.
  2. The creation of insurance exchanges, online portals including Healthcare.gov where Americans can shop for coverage — some with financial help from the federal government.
  3. The the individual mandate: The requirement that nearly all Americans carry health insurance coverage or pay a penalty. This is meant to encourage people to take advantage of the two insurance expansions above.

That’s the part of Obamacare that most people know about. But there’s a whole other half of the Affordable Care Act that launches dozens of experiments in how Medicare pays doctors, trying to tether the money physicians get to whether they improve patients’ health. The hope is, when the federal government starts paying for the most valuable care, it will tamp down on unnecessary care that doesn’t make people any healthier, and reduce medical spending in the process. That’s the goal, at least. Whether it will actually work is a subject of fierce debate among health economists.

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