IT WAS about 3 1/2 years ago that then-House Speaker Nancy Pelosi said famously that "we have to pass the [health-care bill] so that you can find out what's in it."
The remark was ridiculed at the time, but Pelosi appears to have been on to something.
In 2013, the core provisions of the Affordable Care Act - a/k/a "Obamacare" - are finally taking effect, and it appears as if Americans are just now learning what's in the bill. Some like what they're finding, while many particularly vocal folks do not.
What's really going on with Obamacare? Let's break it down.
Q: I know I've asked this before, but I already have health insurance . . . don't most people?
A: Yes - most Americans have insurance, either through their employers (nearly 50 percent), a private plan they pay for (5 percent), or, if they're poor or elderly, through Medicaid or Medicare (nearly 30 percent with military insurance added in). But - unique among industrialized nations - the U.S. has an estimated 47 million people, or 16 percent, uninsured (1.3 million of those in Pennsylvania). Many of these are the low-wage "working poor."
The law requires everyone to sign up for insurance by the end of the year, with the carrot of expanded Medicaid for those near the bottom of the income ladder and federal subsidies for millions more. But there's also the stick of financial penalties for those who don't act on the so-called individual mandate to purchase insurance.
Q. With all the hype, how many people have enrolled for health insurance under the law?
A. Not many, although the first official numbers aren't due until this week. With the widely publicized problems with HealthCare.gov, the federal website, an estimated 90 percent of the sign-ups so far have been through the Medicaid expansion - including nearly 300,000 in just five states. But many states - including Pennsylvania - have not yet joined the Medicaid part of the program.
The number of citizens who signed up for insurance through exchanges created by some states or directly through HealthCare.gov has been abysmally low. Last week, Delaware acknowledged that its exchange - created with the help of a $4 million federal grant - had signed up just four people.
Q: Will the Obamacare website ever work?
A: Federal officials say they're frantically working through "a couple of hundred functional fixes" that will be needed to get HealthCare.gov fully functional by their self-imposed deadline of Nov. 30, which would still give the uninsured time to sign up for a plan. They maintain that much of the problem is that they had expected more states to set up their own insurance exchanges, which would have reduced pressure on the federal website.
Q: But now I keep hearing horror stories about people whose insurance is being canceled because of Obamacare - what's that all about?
A: OK, here's where it gets even more complicated. Remember the folks who aren't insured through their job and are too well-off for Medicaid but not old enough for Medicare? It's estimated that 14 million Americans purchase private individual insurance. Some of these plans work well but others are what experts call "junk insurance" - policies that might cost as little as $50 a month but cover few costs of a major illness.
Many of these plans run year to year, and they are often radically changed or even canceled by insurers - especially since some large companies don't find this market very profitable. Now, "junk insurance" won't even meet the mandates for comprehensive coverage under the law. (The measure allowed for "grandfathering" of some insurance plans, but ultimately very few qualified.)
Officials say as many as 7 million or more of those with private insurance are learning their policies have been canceled. And at least a few million are expected to pay more next year - although often for better coverage; many are expected to qualify for affordable policies, often subsidized, but it's hard for them to know how that will work out with all the startup glitches.
So you can understand why some folks are furious. "The transition to a much better health-insurance system is going to have a disconcerting effect on some people in the beginning," acknowledged Sara Rosenbaum, professor of health law and policy at George Washington University.
Also, experts say many of the same issues are going to affect small-group policies used by small businesses, although that impact won't largely be felt until next fall at the earliest. Rosenbaum also noted that a lot health insurance at small businesses disappeared in the Great Recession.
Q: One of the goals of Obamacare was to lower costs for consumers - is this actually happening?
A: Some of the news on costs is good; one early study found that premiums in the insurance exchanges were coming in 16 percent lower than expected, which would have a positive effect on the federal deficit. But again, for that small sliver in the individual market, it's hard to make easy comparisons because of the turmoil.
Q: But I heard President Obama say that if I liked my current insurance plan, I could keep it. Was that a lie?
A: Yes - and there are reports that the White House foresaw a few years ago that millions would be dumped by their current plan. It's hard not to believe that Obama wasn't eager to prevent this complicated information from becoming widely known before he was re-elected in 2012.
"I personally believe he oversimplified a very technical, complex law that led to a distorted understanding of the ACA by many individuals," said Bridget Kevin-Myers, senior legal analyst in the Institute of Public Policy at the University of Missouri.
Last week, the president said he was sorry for those who received cancellation notices and that he didn't intend to mislead anyone. Will he be forgiven? History will be the judge, and history is often not kind.