Health care law turns 1: Who's up; who's down?
March 23rd, 2011
09:57 AM ET

Health care law turns 1: Who's up; who's down?

The White House is saying “Happy Birthday” to the Patient Protection and Affordable Care Act , signed into law by President Obama one year ago today. But you might not hear many celebrations.  Legal challenges were once considered a longshot, but more than two dozen states have signed on to lawsuits to try to overturn the PPACA, winning victories in Florida and Virginia. The Supreme Court seems likely to have the final word.

More subtly, some states – especially those led by Republicans – are simply refusing to implement parts of the law. In Georgia last month, Gov. Nathan Deal killed an effort to start developing a health insurance “exchange” – an organized marketplace to make comparison-shopping easy – even though the PPACA requires an exchange in every state by 2014.

Even among supporters, the birthday celebration is muted because it’s too soon to tell whether the law is a success.

There have been significant changes. Among them:

– 3.4 million people under age 26 became eligible to sign up on their parents’ insurance policies, according to the group Families USA, which supports the PPACA. President Obama called one of those young people this week, to mark the achievement.

– Many senior citizens will pay hundreds of dollars less for prescription drugs this year.

Other changes are a mixed bag:

– An interim plan to help people with chronic illnesses – so-called “pre-existing medical conditions” – has had a modest impact. The federal government is running plans in 23 states to help these people obtain coverage, while other states have their own plans. As of February 1, however, the Department of Health & Human Services says only 12,347 people have signed up nationwide. One reason: The coverage is very expensive.

–  Subsidies offered through the PPACA are helping many small businesses offer coverage for their workers, but a recent survey  by resources consulting firm Towers Watson found businesses planning to cut back coverage in 2012. One striking number in the Towers Watson survey: From 2007 to 2010, the number of employers who are confident they’ll be providing health coverage in a decade, fell from 73 percent to 38 percent.

– Figures for total health care spending in 2010 aren’t available yet, but critics say the law hasn’t done enough to rein in costs. “We have seen some niggling at the edges on the financial front, but nothing major. Insurance terms have gotten worse because health care costs continue to grow, the recession worsened risk pools, and the ACA mandates raised the costs for insurers,” says Douglas Holtz-Eakin, a health care analyst who was a top adviser to Sen. John McCain’s 2008 presidential campaign.

Any way you slice it, the one-year grade is incomplete. No surprise, when the non-partisan Kaiser Family Foundation can build a handy guide explaining 92 different provisions. For better or worse, the biggest ones – the requirement that private  insurers cover sick people, a requirement for individuals to carry coverage, subsidies to buy the coverage and then those exchanges – none of them kick in until 2014. At least, that’s when these provisions kick in if the courts don’t block the way.

That fourth birthday party could be a doozy.

CNN's Trisha Henry contributed to this report.

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.