Healthcare Reform

1. POWER: It is about limiting the power and control of the government over the people. Republicans fear that control over healthcare choices is just the beginning to control ove citizens' lives.

2. IDEOLOGY: Republicans are center/conservative and Democrats are center/liberals. They disagree with each other. The conservatives ideology is the government should have less control over citizens' lives. They also strongly believe a person's success and advancement is attributed solely to dedication and hard work. In other words, if you don't work, you shouldn't eat. That is why it is very difficult for a republican to feel obligated to pay more taxes for health insurance for someone who they feel has a bad work ethic or who wants to over eat, smoke and chose not to be healthy.

3. TAXATION FOR WEALTHY: Most Republicans do not want higher taxes for the wealthy; those making more than $250,000 per year, as they will be the ones paying for most government spending...e.g the heathcare bill.

Republicans also state that it is the wealthy that create jobs by investing and that if their taxes are raised, there will be less investing and job creation. While this thinking is not incorrect in of itself, 60% - 80% of job creation comes from small businesses, not large corporations. If the government wanted to give tax breaks to stimulate job creation, the breaks should go to small businesses and startups.

Also, the upper class spends 75 cents for every dollar they earn (and save 25 cents), while the lower class spends 95 cents for every dollar they earn (and save 5 cents). So if tax breaks are giving to stimulate the economy, the theory is that it should go to the poor, since they are more likely to spend it. The reason being is that they need to for necessities.

4. FEAR OF SOCIALIZED MEDICINE: Republicans believe the healthcare system in America needs reform, but feel the best solution is not to hand it over to the government. Although the Obama plan is not socialized medicine, it appears in time employers will dump their employees into an "exchange/public option" and most people will eventually be enrolled in the one payer system. Long Lines, Death panels, deciding what medicine you should get etc...

5. BUDGET DEFICIT: Republicans believe the American government is nearly bankrupt. Although Obama and the CBO has stated the health care bill will reduce government expenses. There may be a moderate risk it does not and the government may have to take on more debt. The deficit is already high. As our government has had to borrow money from other countries such as China, which must be paid back with added interest.

6. FOUNDING PRINCIPLES: America, was founded on the principles of absolute minimalist government, both economically and socially, and was intended to be run as capitalistically as possible. Republicans believe our Constitution strictly forbids the federal government's interference into our personal and economic decisions, including healthcare.

Excellent answers above, but also consider:

Re: 1 ~ Yes. The needs of sick and dying Americans are being ignored and the US people are being politically manipulated to foster a small number of politicians' job security and bank accounts and Big Insurance.

2. Most people who are under-insured or uninsured today in the US are hard working, tax paying, currently employed people. Some have lost coverage due to the loss of a job during the economic crisis, but they are actively seeking employment, they aren't just lazy and wanting a free ride. The indigent (and those who may choose to be lazy and not work) are covered already by Medicaid, a form of nationalized healthcare similar to Medicare (insurance for the elderly and disabled). They are self-employed, work for a company that doesn't offer health benefits, or live pay check to pay check and simply can not afford the rapidly rising cost of insurance or healthcare in the US.

3. Clearly, the "Trickle Down" economic theory has been proven to be wrong. While the wealthy were given tax breaks during the Bush administration's time in office, the economy was in the absolute worst crisis with job loss, loss of healthcare coverage, and the theory that giving tax breaks to the wealthy will increase the number of jobs and improve the economy has clearly been shown to be incorrect.

4. "Death Panels" are a figment of someone's imagination. They were dreamed up by someone who clearly did not read the proposed plans and who did not understand healthcare. I know as a nurse that they don't exist, they have never been proposed as part of any reform package, and the lies spread about them have done a huge disservice to the American people. They were lies used as part of a tactic to promote fear and to distort the truth. A public option is not socialized medicine.

5. The government budget office has agreed that the original Obama proposal would not increase the deficit. To say that we won't cover health care for dying Americans because there is a "risk" that it will cost too much and add to the huge deficit left from the Bush administration (who had a surplus when they took office) even though studies do not support that risk, seems like cutting off your nose to spite your face. On the one hand we spend gazillions on war to supposedly prevent the threat that another American may die at the hand of terrorists, while at the same time we refuse to fund health care for thousands of Americans who are literally dying daily because they have no way to pay for the high costs of health care (through no fault of their own).

6. I believe that most Americans believe that our government was founded on principles that also promote life, liberty, and the pursuit of happiness. The first of that being LIFE, we watch as fellow Americans die due to lack of necessary care because they can not afford it regardless of how hard they work. No other civilized country puts such a low priority on their people's healthcare needs. The fact is that currently, 45,000 people die each year in the US due to a lack of health care insurance. (See link below to Reuters article).

Fear of Socialized Medicine: The healthcare system in America clearly needs reform, but quite possibly the worst possible choice of solutions to this problem is to hand it over to our government, which has earned an almost impeccable record for failure and tendency towards corruption. A few countries that have socialized medicine run their programs quite well. Without exception though, none of those few countries have debts anywhere even close to the size of America's, and several of them have no debt. By and large though, the countries which have nationalized health care have seen a marked decline in quality and availability of healthcare. In short, socialized medicine has proven to be an unsuccessful venture in countries throughout the world.

The heath care reform that President Obama is proposing is in no way a government takeover. That is simply a scare tactic the Republicans are using to essentially scare the people out of agreeing with the reform. And when people say that the government has "an almost impeccable record for failure and tendency towards corruption" that again is an opinion with very little fact behind it. There are very corrupt corporations, some of which control health insurance. They right now deny to insure patients with pre-existing conditions so they can make more money, one of the very reasons Obama is calling for this reform.

Government run programs, such as Medicare and Medicaid and the Veterans Administration, are actually considered by many to be very well run and organized. We use that system for our senior citizens, the financially indigent, and our veterans. And lets not forget that corrupt elected officials are indeed elected by the public and can be impeached. Corrupt CEOs of corporations cannot be either of those things.

The countries that have socialized medicine can afford to have healthcare for all of their citizens, rich or poor. The USA as of now has a healthcare system that denies its middle to lower class citizens healthcare depending on how much they can afford. We have welfare, public schools, and other publicly funded programs to help people live with basic necessities they can't afford on their own. Why should healthcare be any different?

That is why we have a government that takes care of programs that the people need or that capitalism should have no part in. The government-controlled healthcare Public OPTION that is being proposed may have a slight decrease in quality but that is why it is an option. Others can choose to stay with their existing healthcare plans, and those who can't afford that can choose the government option.

I would also add that many congressmen and congresswomen get significant donations from the Health Care Insurance companies, mainly conservative Democrats and moderate Republicans who end up being the swing votes for reform.

Although I do believe that Obama is making the right decisions in this reform, I do believe that he is having some issues. Basically, Obama needs a little more George W. Bush in him. He has an idea but doesn't know how to put it into action, he is being too much of a wimp about it. He needs to give the republicans a little more input about the situation. He needs to explain that public OPTION means, OPTION! you do not have use this free health care system you will still be able to get service by Red Cross and etc.

The State of the Union speech was at the capitol building in Washington DC. I think that the republicans disagree with president Obama because the republicans have different beliefs about healthcare system, war in Iraq and the economy. The democrats are for Obama. Also I think most ideas might be for the democrats so that is bad for the republicans.

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I live in Massachusetts, the only state in the Union that currently has a public option. I am self-employed, and before Mass. undertook health-care reform I was paying $450 for private Blue Cross/Blue Shield health insurance. When I went to sign up with the state, I learned I could get THE EXACT SAME INSURANCE FOR $100 less! I ended up not taking it, though, because there was an even cheaper option, for $250 a month.

I have had the $250 coverage for at least a year now, and am very happy with it. It does have a sort of high deductible - $2,000 - but even if I paid out the whole deductible, my total annual cost would only be $5,000; whereas with BCBS, my monthly premiums alone would have been $5,400. So at a minimum I'm saving $400 a year. Co-pays are the same as I was paying before. I don't take any medications regularly, but the few times I've gotten prescriptions they cost about the same as on my old plan. And all the doctors and nurses have been very good so far; I don't have a single complaint about this plan.

The lead story in yesterday's Boston Globe said that according to the Boston Foundation, one of the oldest and largest community foundations in the country and publisher of independentresearch, cities and towns in Massachusetts would save "tens of millions of dollars in health care costs for employees, retirees, and elected officials by joining the state's much larger, more flexible health care system." (ref 1)

I can understand why elected Republicans don't want health care reform - for the reasons listed above - but what I can't understand is why people in this country continually vote against their own economic interests by electing people who are pushing big businesses that let the already obscenely rich get richer on the backs of working Americans. Health insurance companies are FOR-PROFIT entities; don't blame them when they hike your rates by 30 to 39 percent, as happened recently to some customers in California (ref 2). Don't blame them when you can't get insurance because you're diabetic, or had your gall bladder out three years ago, or have breast cancer. They're just trying to make sure they make the most money they can for their shareholders; that's why they're in business. It's just like with any other kind of insurance: They'll find any reason they can to get out of paying. You keep paying them every month; but when you need them, they won't be there. Their allegiance is to the bottom line, not to you. Government (or, in Republican-speak, "BIG government" - sounds scarier that way) is the only thing that can keep companies like this in check, by REGULATING their practices. Without regulations, credit card companies, banks, and, yes, insurers, have no watchdog. The media can report all they want about the abuses of such companies, but it won't make a dent as long as there are no consequences for their steal-from-the-little-guy practices. There needs to be someone keeping them from the worst abuses - and it's called government. Because you better believe if you ever have an argument over payment with an insurer, you are the one who's going to lose.

P.S. Check out the American Journal of Medicine's report on how 62.1 percent of all bankruptcies are caused by medical problems - up from 46.2 percent in 2001. "Most medical debtors were well-educated, owned homes, and had middle-class occupations," it says. "Three-quarters had health insurance." (ref 3) There's something very wrong with this picture.

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"our government, which has earned an almost impeccable record for failure and tendency towards corruption..."

That's because it was allowed, especially under Bush, but also really started in the days of Nixon, grew in the Reagan Era, and cemented itself in the "W" years.

Failure has to do with the people appointed by the President. Inevitable, if the President is conservative, he hates government and will put the most incompetent people in positions of power, and point to their failures as part of the "government sucks" plan. If the President is liberal, he will try to put people in power who can do the most good, but again is sabotaged by the lobbyists and former CEOs of big corporations who have already made a name for themselves there.

Basically, what needs to happen, is that many of those people need to be fired and jailed, and the people who love this country (i.e., want to get back to what Ben Franklin and Thomas Jefferson helped create) need to step up and take it back. Since Ben Franklin and Thomas Jefferson and all them weren't the wealthiest men in the colonies, we don't need govt by the rich. Since our founding fathers were not religious, we don't need that kind of govt either. Anyone who wants to know...their writings can be found online. Study them, don't just take someone's word for it.

We need a public option, a Medicare-like system that helps everyone, and cuts the insurance companies out of the deal. One that doesn't criminalize those who don't have insurance. That is funded by whatever props up Britain and Denmark and Sweden and all those other countries that offer their people free healthcare.

More Republican Views & Opinion

Deficit: The American government is bankrupt. We simply cannot afford to take on these enormous debts of public welfare. It is irresponsible for our government to borrow even more money from China, which must be paid back with added interest.

Constitution: America, unarguably, was founded on the principles of absolute minimalist government, both economically and socially, and was intended to be run as capitalistically as possible. Our Constitution strictly forbids the federal government's interference into our personal and economic decisions, and our government's recent shift to Socialism.

Fear of Socialized Medicine: The healthcare system in America clearly needs reform, but quite possibly the worst possible choice of solutions to this problem is to hand it over to our government, which has earned an almost impeccable record for failure and tendency towards corruption. A few countries that have socialized medicine run their programs quite well. Without exception though, none of those few countries have debts anywhere even close to the size of America's, and several of them have no debt. By and large though, the countries which have nationalized health care have seen a marked decline in quality and availability of healthcare. In short, socialized medicine has proven to be an unsuccessful venture in countries throughout the world.

The heath care reform that President Obama is proposing is in no way a government takeover. That is simply a scare tactic the Republicans are using to essentially scare the people out of agreeing with the reform. And when people say that the government has "an almost impeccable record for failure and tendency towards corruption" that again is an opinion with very little fact behind it. There are very corrupt corporations, some of which control health insurance. They right now deny to insure patients with pre-existing conditions so they can make more money, one of the very reasons Obama is calling for this reform. Government run programs such as Medicare and Medicaid are actually considered by many to be very well run and organized. We use that system for our senior citizens and our veterans. And lets not forget that corrupt elected officials are indeed elected by the public and can be impeached. Corrupt CEOs of corporations cannot be either of those things.

The countries that have socialized medicine can afford to have healthcare for all of their citizens, rich or poor. The USA as of now has a healthcare system that denies its middle to lower class citizens healthcare depending on how much they can afford. We have welfare, public schools, and other publicly funded programs to help people live with basic necessities they can't afford on their own. Why should healthcare be any different? That is why we have a government that takes care of programs that the people need or that capitalism should have no part in. The government controlled healthcare OPTION that is being proposed may have a slight decrease in quality but that is why it is an option. Other can choose to stay with their existing healthcare plans, and those who can't afford that can choose the government option.

I would also add that many congressmen and congresswomen get significant donations from the Health Care Insurance companies, mainly conservative Democrats and moderate Republicans who end up being the swing votes for reform.

Although I do believe that Obama is making the right decisions in this reform, i do believe that he is having some issues. Basically, Obama needs a little more George W. Bush in him. He has an idea but doesn't know how to put it into action, he is being too much of a wimp about it. He needs to give the republicans a little more input about the situation. He needs to explain that public OPTION means, OPTION! you do not have use this free health care system you will still be able to get service by Red Cross and etc.

Even if you want universal health care, this bill is not the anwer. It is poorly written, , muchly incomprehensible, hundreds of pages long, contains "pork" not related to health care and passed the Senate only because of a political manouver and passed the House by about 5 votes with many Democrats against it. I doubt that anyone actually read it all the way through.

Many Republicans stand behind the same concepts that President Obama is making at the moment. The massive cost, limited benefit and the crippling of the U.S. economy all are so apparent that even President Obama himself has delayed implementing many portions of this bill.

The reality is that the only reason Republicans oppose the Affordable Care Act, aka "Obamacare", is that Obama proposed it. Everything else they present as reasons are a smokescreen at best. Prior to Obama taking office, many Republicans were proposing near-identical reforms.

BTW, this nation absolutely was not "founded on the principles of absolute minimalist government" and capitalism is nowhere to be found in the nation's founding principles. Historical revisionism is not a valid argument.

Please see related link below: http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200

This was obtained by going to senate.gov => active legistlation on the right hand side => health care reform under "H" => text of bill

Healthcare is a right in most civilized countries.

Answer

Maybe in some countries, but not the US. We have enough entitlements already, and this new bill will bankrupt the economy.

Answer

Health Care is not a "right". A "right" is something that everyone is born with, or as some would say "endowed by their creator with". A "right", by definition, does not impose any burden on another individual, except that of non-interference. Any right that takes away rights from others cannot be a right. Furthermore, a "right" is both free and unlimited. You don't have to pay anything to exercise it, and you can have as much of it as you want.

It is tempting to think of health care as a right. The problem with that, however, is that, in order for you to receive health care, someone ELSE has to PROVIDE health care. Maybe it's the doctor that treats you in the emergency room. The doctor who treats you, the nurse who assists, the receptionist, the pharmacist that fills your prescription, the drug company that made the drug. All of those people are providing your health care. They don't HAVE to provide your health care. There's no law that says they MUST work in the medical profession. They do so because they CHOOSE to do so. If health care is a RIGHT, then they have no choice. They MUST provide your health care.

Health care is not free. All of those people involved in providing your health care have to be paid. Someone has to give them money for providing health care. The payer might be you, or it might be your insurance company, or it might be the government, but SOMEBODY is going to pay for health care. If health care was a RIGHT, then no one would have to pay for it. And the poor doctors, nurses, pharmacists, and drug companies would not only be forced to be involved in a profession they might not want to be in, they would have to do so WITHOUT COMPENSATION. That is the very definition of slavery. How can you possibly define health care as a "right", when exercising that "right", by necessity, denies the most important right - freedom - from others?

Okay, so maybe you don't want the health care providers to be slaves. Well, who's going to pay them? The insurance companies? If health care is a right, then it's free, and the insurance companies cannot charge premiums, and therefore cannot stay in business. So (and this is what "health care" as a "right" inevitably comes down to), the GOVERNMENT has to pay for everyone's health care. But where are they going to get the money to do so? Taxes. That means that the government is forcibly taking the hard-earned fruits of one person's labor, against his will, and using it to pay for a service to another person. So, exercising your "right" to health care, does in fact put a BURDEN on another person. So it cannot be a right.

Health care is not unlimited. There are only so many doctors, nurses, pharmacists, and drug companies in existence. If everyone in the country wanted to go to the emergency room every day, for every little minor ailment from a hangnail to a headache, the emergency rooms could not possibly handle that much traffic. That, of course, is an extreme example, but let me be clear. IF health care is a right, then if everyone in the country went to the emergency room every day, they would ALL receive health care. That won't happen, so health care is NOT a right.

But, putting aside my extreme example, there is no doubt that, if health care were free and unlimited (as any "right", by definition, is), then there would be huge increase in people seeking health care. Meanwhile, the numbers of doctors, nurses, pharmacists, and drug companies will not increase (in fact, it is likely that those numbers will DECREASE, as evidenced by polls that say over one-third of doctors will consider retiring from medicine if the health care reform bill passes). There is no way that the larger number of patients can be accommodated by the current number of health care providers, let alone by the drastically reduced number of health care providers we are likely to see in the not-too-distant-future, as young people starting college now will be less likely go into medicine. Health care will have to RATIONED. Rights cannot be rationed.

(This is not directly related to the question, but I'd like to make another point here. When working men and women get sick, they have to take time off from work. As the number of people seeking health care - for minor problems that don't really require missing any work - increases, it will take longer for working men and women with more serious problems to be seen by a doctor, and therefore it will take longer for them to get well, and they will miss more work. So, even if they don't have to pay actual cash dollars out of their pockets to be seen by a doctor or get a prescription, there is still a COST, namely lost wages, that they will have to pay, and this cost will, without a doubt, INCREASE if health care becomes "free". Moreover, the economy will suffer a huge loss in overall productivity because of the increased amount of time workers have to take off to receive health care.)

Viewing health care as a "right" might win an election, but it is not a tenable policy. Health care is not free. It cannot be exercised without limit. It cannot be exercised without imposing a burden on others. It simply is NOT a right. The notion of health care as a "right" must be immediately discarded, along with such things as a "right to food", or a "right to housing", or a "right to a job". None of these things can be viewed as a "right" because they are not free, they are not unlimited, and they impose burdens on others. Now, I'm not saying that we shouldn't do something to provide health care, food, a home, or a job to those who are in need of them. But we simply cannot allow politicians to portray these things as "rights".

Answer

The concepts of "right" and "personal responsibility" are not necessarily mutually exclusive.

We have a moral and ethical imperative to ensure everyone has access to resources governing basic survival, such as health care.

Moral and Ethical Imperative?

Just because you SAY that I have a moral and ethical imperative does not make it so. I do not recognize any such imperative. The only moral and ethical imperative I recognize is to ensure freedom. And no one has a "right" to my hard-earned money. Health care is a service, provided for a fee. Just like a haircut. Sure, health care is more important. But that has nothing to do with it. In fact, if anything, the importance of health care is a very good reason why it should NOT be viewed as a right.

You talk about "resources governing basic survival". But what are these resources? The skills and knowledge of doctors, for one. Who OWNS those resources? The doctors themselves, for now. But if everyone has access to those resources, then the doctors don't own their skills and knowledge anymore, and cannot be paid for them. They spent tens of thousands of dollars in tuition to obtain those skills and knowledge, but they don't own them. Instead, these skills and knowledge are now at the beck and call of every Tom, Dick, and Harry whose life is in danger. Similar arguments can be made for all of the resources that go into providing health care: the skills and knowledge of nurses; the expensive equipment used to diagnose patients; the bandages, syringes, and other supplies; the equipment and raw materials that go into making and testing drugs; the skills and knowledge of the scientists and lab technicians that make and test the drugs; even the skills of the receptionists at the doctor's office - if health care is a "right", then all of these resources, BY DEFINITION, are PUBLIC GOODS, and no one owns them. Aside from the obvious violation of private property rights, intellectual property rights, and the prohibition of slavery, this creates another huge problem. Namely, the complete lack of profit incentive. The entire health care industry will fall apart if we ever start seriously treating health care as a "right".

You can talk all day long about whether it is a good thing to provide health care for those who cannot afford it. And I will be glad to debate you on that. But you cannot call health care a "right". Because health care is not free. Health care is not unlimited. Health care imposes a burden on others. Health care completely fails every criteria of a "right". Health care is N0T a right.

Another County heard from:

It's encouraging to have debate on important issues, but discouraging to see the same tired old arguments that have been rejected time and again as if those arguments are something new. We need better.

The argument that no one can be forced to pay for health care because others have no right to one's hard earned money has been argued and dismissed already. Medicare provides health care to persons over a certain age and everyone who works pays into the system even though not at that time even entitled to the health care being paid for. The same goes for the Social Security System. Try refusing to pay those payroll taxes and see what happens. So that argument is out.

The argument that a person cannot be forced to buy insurance is decent but deceased as well. Mandatory automobile insurance laws in various states have been held to be constitutional. So that argument is out.

The argument that somehow doctors' services and medical equipment will be at everyone's beck and call is frivolous, since health care will come at a price just like Medicare does. Medicare payroll taxes are used to pay doctors and buy medical equipment. No one is forced to provide such services or goods for free. So that argument is out.

A criminal defendant has a constitutional right to counsel under the Sixth Amendment even if they cannot pay for one. No one has conscripted all the lawyers or their legal pads in order to provided legal services even that type of service is a right. So that argument is out.

The argument that if somethings are deemed rights they become PUBLIC GOODS by definition is simply false. If something is a "right", it must be provided by the government not the providers. The Due Process clause forbids a taking without just compensation. That means the government cannot just take a doctor's services or a drug company's medications without first paying just compensation for them. Legal services to indigent defendants are not public goods available for the taking by the government.

It's time to stop using all these worn out cliches. Sure an argument can be made that health care will be a burden on some, but those arguments have already been made and overruled. Nothing in the Constitution prohibits government from placing burdens on people.

Answer

Just because one side happens to have temporarily won a legislative or legal battle does not mean that the other side's arguments are "wrong". Slavery won many legislative and legal battles for nearly a hundred years. Did that make slavery right? Were the abolitionists dismissed?

Social Security and Medicare are just as bad (though not to the same extent as the current health care bill). They take money from one person and give it to another. There's nothing in the Constitution to support that, regardless of what any politician or judge says.

Automobile insurance is NOT mandatory. I have every right to not purchase automobile insurance. I just have to give up the privilege of operating a motor vehicle on state-owned roads. Therefore, so-called "mandatory" automobile insurance is not a violation of my rights. Mandatory health insurance, however, most certainly IS a violation of my rights, because I have to purchase it, whether I want to or not, whether I want medical care or not.

Of course doctors will continue to be paid. That's why, by definition, health care is not a "right", which is what this question is all about. You can argue all day about whether it's a good thing to do, but you can't call it a "right".

The sixth amendment does not guarantee a court-appointed attorney when a defendant can't afford one. Read it.

"Rights" are not provided by governments. They exist, IN SPITE of governments. If the government (or anyone for that matter) has to provide something, by definition, it is not a "right".

If by "worn-out cliches", you mean the generally accepted definition of the word "right", then I'll stop using that worn-out cliche when hell freezes over, and not a day sooner.

Answer

A key principle of why a National Health care service is bad is because it takes away from actual rights. If the government is your health care provider they have access to your files, that they normally would need a warrant to. This means if you was to have a DNA test for medical reasons, that DNA that normally would require a warrant to be on government file, is now on a government database as soon as it was taken.

If health care eliminates other rights, such as needing a warrant for DNA, than how can it with in it's self be a right.

The Patient Protection and Affordable Care Act (known as "ObamaCare")

extremely complex and controversial topic; please use the discussion area for all theories of how future costs may be impacted (as well and theories around changes in coverage or other impacts on the medical system). This main page should be used only for verified factual statements about what the PPACA actually does.

The bottom line answer is yes. No health care is free and it can not be free. Someone somewhere has to pay for it. Obamacare makes some changes about who will be covered by government programs, and also makes substantial changes about how individuals buy or obtain private healthcare insurance. Obviously, government programs will be paid for out of taxes, while private insurance will be paid for directly by individuals and/or businesses, though in certain cases subsides for the purchase of private insurance can be obtained from the government (which, once again, are paid for out of taxes).

In terms of healthcare coverage, here's what is required. All individuals are required to obtain healthcare insurance, though one of the following means:

1. Be covered by a government-sponsored plan, such as Medicare, Medicaid, or equivalent state-run programs
2. Obtain health insurance though an employer-sponsored plan (which may or may not require the employee to pay a portion of the plan's expense)
3. Purchase coverage though state-run exchange
4. Purchase insurance directly from a provider

All coverage must meet certain minimum requirements; in particular, many high-deductible Health Savings Account setups will NOT meet the requirements, and thus not be allowed anymore.

Persons NOT obtaining proper insurance will be hit with an increasing penalty each year they are not covered, up to $700 each/$2100 per family, OR up to 2.5% of taxable income (whichever is greater).

People up to 133% of the income level for the Federal Poverty Line will receive free coverage under an expanded Medicare. Those making between 133% and 400% of the poverty level are eligible for a sliding scale (based on income) of subsidies when purchasing insurance through the state-run exchanges.

Companies are NOT required to offer health insurance, and if they do, they are NOT required to subsidize it. However, for companies of 50 employees or more, they will pay a fine of between $2000 (if the person receives subsidies from the government when buying insurance on the exchange) and $3000 (if the person is covered by Medicare) for each employee which has to obtain coverage that way (option #1 or #3 above).

As far as costs go, here's where there will be actual specified costs:

1. Individuals will have to pay for their own insurance plan, if they use options #3 or #4
2. Individuals and employers will share costs (though, not necessarily equally) when the individual obtains insurance though an employer-sponsored plan (option #2)
3. Medicare will incur costs for all people under 133% of the federal poverty line
4. The federal government will incur costs for providing subsidies to people between 133-400% of the poverty level, when those persons buy insurance on a state-run exchange. The amount of subsidy will depend entirely on the cost of the plan chosen, and the exact income level of the purchaser.
5. States will incur some regulatory and administrative costs when setting up and monitoring the state-run insurance Exchanges, and will incur some additional regulatory costs to monitor all insurance plans being offered in that state, to insure compliance with various PPACA-required benefit levels.
6. States will share with the Federal government the costs associated with the expansion of Medicare to under-65 individuals who are not currently covered by Medicaid and other state programs. That is, people who are NOT currently eligible for government-provided programs, but DO become eligible for such programs under the PPACA's expansion of coverage of Medicare, will be a new cost. Initially, the Federal government will cover 100% of this cost, shrinking to covering 90% of the costs by 2020, with the state being required to pick up the difference.

Due to the Supreme Court ruling on the Medicare expansion part of the PPACA, states can OPT OUT of expanding coverage of Medicare for those exceeding 100% of the federal poverty line. Those states which opt-out of the expanded coverage DO NOT get a waiver of requirement for their residents. In those states, this means that the PPACA will require any person making more than the Federal Poverty level of income to obtain their insurance via options #2, #3, or #4, without any additional government subsidy. It is anticipated that large percentages of those who would be eligible for subsidy under expanded Medicare (in particular, those between 100-133% of the Poverty Level who would otherwise be given free Medicare coverage) will NOT be able to obtain health insurance, and thus, be required to pay the penalty for non-coverage.

The PPACA includes a number of taxes, almost all of them on companies in the healthcare industry (insurance, providers, manufacturers, etc.). These funds will go back to the states for coverage of the administrative costs of PPACA, with the extras being taken by the federal government.

So, the costs of the PPACA will generally be borne by three different organizations:

1. Individuals and companies paying for plans to cover those individuals
2. State governments will be hit with a small percentage of the costs to cover under the expanded Medicare program those people which the existing Medicare/Medicaid programs didn't cover, plus regulatory and administrative costs to enforce the PPACA.
3. The Federal Government will pick up the lion's share of the costs for those covered by the expanded Medicare program, plus the subsidies given to certain eligible people when purchasing insurance on an Exchange.

The actual answer to the question asked is of course, YES, you do pay for the PPACA. Certain individuals will pay more (either directly or indirectly) than others, for varying levels of coverage. Of course, this is no different than any other healthcare scheme, were you end up paying for it one way or the other. The real question here is whether the PPACA is more cost-effective than the existing system - this is, does the PPACA save society money as a whole.

The total costs of the PPACA are completely unknown right now. There are a huge number of variables which are too complex to model, and while there are certain hoped-for-benefits that the changes may provide, it is far too early to tell what the actual financial benefits or costs will be. Certain states have already chosen to opt-out of the expanded Medicare, while certain others have indicated they will expand their coverage.

It will be at least 2015 until we have an approximate estimate of the cost/benefits of the PPACA, and probably not until somewhere about 2020 will a full actuarial analysis be possible.