Affordable Care Act pointers for consumers

What do you need to know about the Affordable Care Act, aka Obamacare, the health-reform law?

The ACA aims to pull, push and persuade everyone to pile into the big “pool”—the insured. Some who study health care systems say it’s crazy to have health “insurance” that evaporates if you become too sick to work or can’t afford it in the first place. When the uninsured get sick, they seek care in emergency rooms or in “free” clinics, which depend on grants, taxes and donations.

This “cost-shifting”—getting someone else to pay the bills—has increased costs for people with insurance in many ways.

Proponents of the health care law say it’s fairer to spread the burden more widely. But many worry that bringing a lot of people into the system will create its own problems. Are there enough primary-care doctors? Or will health care systems adapt, perhaps relying more on other skilled workers such as nurse practitioners?

Cost remains a critical issue of the federal law. With pharmaceutical companies, doctors, hospitals, device manufacturers, insurers and others all jockeying to keep their income, will costs just keep rising?

Some experts say our current “system” of health care and insurance has kept costs down by keeping out sick people or limiting their access. But once most people are in the pool, expect some slow ratcheting down of costs as businesses, insurers and health systems find ways to reward care that works and discourage care that doesn’t. A recent Institute of Medicine analysis found that fully a third of the $2.6 trillion spent on U.S. health care in 2010 didn’t make patients healthier.

One of the biggest challenges, many ACA advocates say, is helping people understand the value of health care and having insurance. Here are some things to consider:

Your kids can be on your policy until they’re 26. That’s pretty much a blessing, because if they got hurt or seriously ill, you’d probably pay their health-care expenses anyway.

If you’re a parent, you’re the most-trusted adviser to over-26 kids. You’ll need to explain that, yes, they can skip insurance and pay the penalty. But if they break an arm, they could end up with a big hospital bill and a lousy credit rating for years.

The exchange isn’t the only way to get covered. You’ll still be able to buy individual insurance through a broker, or through the insurer the same way you signed up before. But there are no subsidies for purchases outside the exchange.