SURVEY SAYS: What's Your Take on the PPACA One Year Later?

March 23, 2011 ( - A year ago today, President Obama signed into law the Patient Protection and Affordable Care Act.   

We’ve had a year to get more familiar with its provisions, to implement some of them, and to begin laying the groundwork for changes that are slated to become effective over the next several years under the provisions of the PPACA.  We’ve also had a chance to see a growing number of states challenge the law in court, and a mid-term election that some would suggest was, at least partially, a referendum on that legislation.

This week, I asked readers the question I asked a year ago – what you think of the PPACA – what you think about the projected costs – what you think it will all mean for YOUR health care costs – and how you feel about that today compared with a year ago?

Well, a year ago 37.4% saw “lots of bad” in the legislation, and this year just 32.9% felt that way (still the most common response), while in this year’s survey 29.4% saw “some good, lots of bad”, pretty much the same as a year ago when 29.8% felt that way (see SURVEY SAYS: What Will Health Care “Reform” Mean?). 

Moreover, 9.4% of this year’s respondents saw “lots of good”, whereas last year just 6.4% were of that opinion.  Similarly, 12.9% of this year’s respondents saw “some bad, lots of good” in the PPACA, compared with 13.5% of that opinion in last year’s polling.  The number that had no real idea (2.4%) or saw “not much change (1.2%) were also pretty consistent with the 2010 results. 

The “other” category drew slightly more (11.8%) than it did a year ago (8.2%), and while most of those were in the “lots of very, very bad” camp, several lined up with the “some bad, some good” perspective (and a couple though the law didn’t go far enough to create a single-payer system). 

As you might expect from those results, just over half (53.6%) of this week’s respondents said they felt pretty much the same about the legislation this year as they did a year ago.  On the other hand, though the results above would suggest a slight moderation of bad feelings, a full 29.8% of this week’s respondents say they feel worse about the PPACA than they did a year ago.  Only 8.3% felt better than they did in 2010, while the remaining roughly 8% weren’t sure.

Speaking of a year ago, the Congressional Budget Office (CBO) had taken a stab at estimating the cost of this bill - and has revisited those calculations a couple of times since.  As for what readers now thought about the projected costs of the health care reform package:

60.7% - Likely to run MUCH higher than expected (versus 68.4% in 2010)

 9.5% - Likely to run higher than estimated (versus 9.4% last year)

 9.4% - Probably as accurate as they can be

 8.3% - Doesn’t matter, this is just the first step in reform

 6.0% - Likely to be less than anticipated

 4.8% - No idea

 1.2% - Likely to be MUCH less than anticipated 

As for the impact on their health care costs:

36.9% - Likely to run MUCH higher

31.0% - Likely to run higher

14.3% - Likely to be about the same

  4.8% - No idea

  1.2% - Likely to be less

The rest said they either wouldn’t be affected, or they didn’t really have any idea.

And then, of course, there were the usual fine assortment of verbatim comments.  One year on, it seems that the split on health care remains “spirited.”  So, wherever you are on the issue, you’ll find some who are with you – and some who aren’t:

The worst piece of legislation in our history.  It will break us if not repealed.  I heard that the first year estimate for Medicaid was $1 Billion, projected to grow to $10 Billion in 10 years.  10th year actual was $112 Billion.

A good and much needed law.  The changes it is bringing about are long overdue.

REPEAL is not the answer, because our elected officials have no positive solutions. The court should put PPACA on hold, since the most important issues for congress is the Budget, and  the additional Debt to finance O'Bamacare, and the many on-going crises at home and abroad.

The CBO projections were for the government cost.  Its likely this cost will be much higher.  And the cost for individuals with insurance will certainly go up - it has too.  The law added additional mandated coverage which costs additional money.  Unfortunately, it was a lost opportunity to bring an out-of-control system back to reality.

The exception list is getting to be, well, like proverbial rabbits. Seems to lend credence to the saying it's not what you know but who you know that counts. When does kool-aid merely become colored water.

"Unless we get the recipients of health care to shoulder some of the burden, we cannot bring down the cost.  If you ""give it away for free"" there is no incentive NOT to use it.  Why not set up something similar to the high-deductible plans?  That's what we have now.  Our incentive to stay healthy is there because ""well visits"" are 100% covered.  But we pay for everything else out of our Medical Savings Account contributions or out of pocket up to a deductible (about $2K per person and $4k per family). 

Although for THREE YEARS straight we made that deductible thanks to ER visits and one week long hospital stay for both kids, we STILL saved money over a ""regular"" plan.  And Obamacare wants to do away with all of that.  We LOVE our current plan as it cost us less than $100 a month in premiums for a family of 4 but buys us so much coverage. We have to actively manage our health, but the government is not interested in that.  Obamacare is just a way to get more folks dependent on the federal government."

“The most important thing in communication is hearing what isn't said.” - - Peter Drucker 

I have 2 big problems with the legislations.  1 is the mandate that everyone purchase insurance.  I don't believe that the federal government should have the right to mandate that an individual purchase a product.  #2 is the cost.  Most government programs end up costing much more than anticipated.  And I think this one will as well.  What happened to individual responsibility?

Health care reform succeeded in expanding coverage but did nothing to control the escalating cost of health care.

The bill is not perfect, but is a first step toward reducing health care costs.  The real problem is chronic disease, which accounts for 70% of health care costs.  If we want to see significant reductions in health care spending, people need to be healthier (exercise to reduce heart disease, stop smoking to avoid cancers, eat better to avoid obesity and diabetes).

It's still too early to predict where specific plan costs will head. We hope that the preventive care benefits will be utilized effectively by plan members, resulting in long-term cost savings. Unfortunately, it's like determining if the elephant repellent worked! There's no elephants but...why?

We need to control health care costs and that doesn't happen by only expanding coverage.  You can't expect the government to control costs - they never have and probably never will.

This bill is already costing us plenty in increased attorney fees for amendments, advice, etc. not to mention the cost of education, not only for those of us who administer the plan but also for plan members.  Add that to the fact that we are covering adult children who choose not to work and have serious addiction issues, we are seeing even higher medical claim costs and don't see an end in sight.

As the law stands right now, we are probably in for some nasty surprises when it comes to cost.  This law does not address the underlying problem of cost escalation.

Good intentions, woefully misplaced. The government has no business in health care - just look at how they screwed up Medicare!


Good intentions, woefully misplaced. The government has no business in health care - just look at how they screwed up Medicare!

PPACA is an ill-designed program which treats only minor symptoms of the real disease with no more than band-aids.

The features that tax employers for providing "Cadillac" benefits are counter-intuitive, and have nothing to do with providing benefits to the uninsured.  The expansion of dependent coverage to age 26, even if they are married and employed elsewhere is also illogical.

Real reform would be to stop the immoral practice of allowing insurance companies to profit from the denial of benefits to people who need them.  Health care is a basic human right that a civilized society provides to all its citizens.

It's costing my company much more; thus costing me more.  Good intention, mostly bad execution.  I'm not seeing a lot about personal responsibility and ownership, which of course we can't regulate.  Thus I believe a small copay/coinsurance should apply to every service....not seeing we're going that direction in this 'you owe me/entitlement' country.

"If the US would just implement a single payer system, perhaps by opening up Medicare to everyone, that would be the most cost-effective and administratively efficient way of delivering health care.  As an added bonus, it should help to boost the economy as people who would love to start a business would be able to do so since they would not need to remain in a job solely for the health insurance benefits. 

No system is perfect, but relying on private insurers whose profits increase every time they deny a claim, is decidedly less perfect than a publicly funded, but privately delivered health care system."

Being from Massachusetts, where we're already further into this than the rest of the country, it doesn't feel all that alarming to me. Reporting will be a bear, I'm sure, and the whole thing feels like a drive toward mediocrity of health coverage which never makes me happy, but I do believe it is critical that more people have insurance coverage they can afford. In the long run, that goal is a good one and at least this legislation it trying to make that happen.


Coverage and service will be much worse at a higher cost and determined by ignoramuses that know nothing at all about health care and....don't care.  Governments may get away with levying taxes but there is no, and I mean NO, excuse for governments being able to force citizens to buy specific goods and services - not in a FREE COUNTRY.

It is absolutely necessary! I have never seen a piece of legislation that satisfied everyone, and this is no different. I don't believe that the true value will be realized until the plan has been fully implemented. Initially, I expect that costs will rise. Then as it becomes fully integrated costs will begin to decline. It is like an iceberg - you see the increased costs initially, but the savings are much bigger and not visible yet. They will come.

As a long time participant in the Federal employees health insurance through my husband's employment, I believe all the people who fear "government insurance" are simply uninformed. Never has a private employer offered me anything like the amount of choice that has been offered to government employees. Every year we can choose among multiple plans and providers according to our needs at the time -- and we can switch between plans without concern about pre-existing conditions.

Why are we even talking about this?  A judge ruled this law unconstitutional!  We should spread the word that we are under no obligation to implement this now.  And fight to make sure the judge's ruling is upheld...

Scrap it and start all over with more time spent on a good plan

If you take the time to understand what health reform really does, it's hard to see what the fuss has been about.  It plugs some holes that needed to be plugged, and adds some rationality on the cost side.

"The American Academy of Actuaries issued a number of position papers on components necessary for any health care reform.  It was all ignored.  The health insurance company vilification act is actuarially unsound, ignores basic concepts of what is insurance, and in fact was sold to the American public at least in part by misrepresenting that health care and health insurance are somehow synonymous.  Put another way, the Congress tried to fool all the people all of the time.  Even those members of Congress who should be sophisticated and know better toed the party line.  That means they deliberately lied to the public.  Shameful.  Then to top it off, in order to placate the insurance companies for creating mandates that are not actuarially sound, they were given the monopoly by created the individual mandate.  Clearly unconstitutional. 

If the objective was to ensure that all Americans could have reasonable access to heath CARE, then Congress could have easily passed a bill costing a third of what this costs, funding education for doctors, nurses, hospitals, PAs, etc in return for public service in low income and poor areas.  That wouldn't have been nearly as controversial, would have solved the real objective, and wouldn't have made the entire Democratic party look like liars, dribbling idiots, or both."

The devil is in the details and we don’t have all the details yet on the mandates of what must be covered. 

Reform- what a strange word for what is happening.

Repeal and replace with incremental changes upon which a consensus can be reached.

For me, my company will try to stay grandfathered for as long as possible, so my costs should stay the same for the foreseeable future.  Others aren't nearly as lucky.

Health care costs go in only one direction.

This may as well have been written by the insurance companies who got 30 million or so new customers who if they can't afford the premiums will have them paid by the taxpayers.

Encouraging competition would have been the single best thing that the government could have done.

I still feel that Obama's "health care reform" did nothing to control health care costs.  Call it what It is - insurance reform.  The picture is clearer to us on how this will affect our company's plan in years to come.  We are being forced to reduce our costs to avoid the "excise tax" by either passing on costs to our employees or reducing plan benefits.  Was the intention of "health care reform" to give everyone mediocre benefits?  Or is the real intention to incent employers to get out of providing health care benefits in order to socialize health care.  The deficit will never be reduced with provisions of this law in place.  Case in point - did you see the announcement from the IRS on how much this law will cost them?  We have some time before certain provisions take place so all I can do is wait to see what the future actually brings.

Some things needed to happen.  With PPACA they threw in everything but the kitchen sink.  Pieces and parts will be in the courts for years or re-visited in Congress for decades.  More deals were made than anyone knows about.   "The Book," when it is written should be interesting.

The PPACA has driven up costs for all.

Reform is greatly needed.  This is a start in the right direction in getting the majority of people insured with basic medical coverage without the fear of losing coverage when one needs it the most due to an illness or injury. 

The subsidies built into this bill will push us to  bankruptcy if the current debt issues don't, and if we have to deal with both issues...

Too much time is being spent on trying to repeal it instead of improve it.  We need to have the same kind of health care as other countries.  It's a shame that people in this country die because they don't have health insurance.  I don't understand why the Republican party doesn't see health care as a right rather than a privilege.  So if you're fortunate enough to have insurance through your workplace or if you are wealthy, then you deserve health care.  But if you work part-time jobs or for small companies that don't provide it, you are just out of luck.  You don't get annual check-ups and don't go to the doctor because you can't afford to so something that could have been prevented gets worse.  It is unconscionable to me that we lack some kind of universal healthcare for all Americans.

Health care reform was really health insurance reform. I would like to see reform aimed at astronomical malpractice costs and true medical practices.

The greatest concern for me is that our Congress passed the bill without having the opportunity to read, evaluate and address with its constituency.  This is not government by, for or of the people.

Like most landmark legislation - it is desperately needed, but so difficult to do . . . so many complexities and unfortunately, so politicized.  Would love to see our Congress actually work together for the good of the people -- there are so many out there that need these protections, and the way things are going the costs are unsustainable for companies and individuals.  Some people may not like it, but I don't see anything better out there.  Pretending the issues that it addresses aren't there won't make them go away.

But this week’s Editor’s Choice goes to the reader who noted, “I think more than anything PPACA is helping lawyers raise billable hours for compliance work.”

Thanks to everyone who participated in our survey!