how to obamacare

hi i'm dr aaron carroll. and in this new youtubeshow we are going to try and help you under stand how medical research and health policy work. we are goingto make sense of a lot of the confusing information in the world, and we are going to have a lotof fun doing it. we are officially launching in a few weeks,but today, we're going to give you a little preview., and talk to you about obamacare.so i have this friend that is a little bit of a hypochondriac, his name is john green.,and he's been asking me a lot of panicked questions about obamacare. john: wait aaron i heard the cost of my familiesinsurance is going to triple in the next year?. aaron: no

john: well my uncle told me his medicare isbeing taken away, thats true, right? aaron: that's not going to happen. john: alright aaron, what about this? i heardthat under obamacare medications are now going to have side effects. aaron: that was already the case. john: i just got this email from a friendwho said under obamacare anyone over the age of 45 will be euthanized. aaron: wow, absolutely not.john: also, that reminds me, i just got an email about someone whose lupus was curedby aliens. why don't we just get our healthcare

from aliens?aaron: well i suppose...wait no thats not how we get healthcare. okay, clearly we need to start with the basics.let's talk about what obamacare is, and what it isn't. and what changes are in store foryou. health care triagealthough obamacare was passed in 2010, the big pieces of the law are scheduled to gointo effect on october 1st, just days from now. but what does that mean to you? willyour insurance change? will you still be able to get medical care? if you don't have insuranceright now, how will you get it? no matter what you think of the law politically it inyour best interest to get as much out of it

as you can. so today we are going to explainhow obamacare works, and how it will affect you.(over 47,000,000 americans were uninsured in 2012)for decades the most glaring problem in the united states healthcare system has been thatmillions of people are uninsured. we are one of the few industrialized countries in theworld that doesn't provide universal coverage to its citizens. here is a list of some ofthem that do. for the past few years the number of people that lack any coverage for a yearhas hovered around 50 million people. is that list still scrolling? we'll wait. by the wayall of those countries are democracies, they all voted to get that universal coverage.

lots of people don't have insurance becausethey have some form of chronic illness. that's not a surprise, because i mean come on, ifyou're already sick, what insurance company would want to cover you? and if they do, thepolicy that they will give you will likely cost a fortune. and that's a whole other problem,health insurance is really really expensive. last year the average employer sponsored healthinsurance policy cost almost $6000 for an individual. the average plan for a family,cost more than $16,000. the average 2 bedroom apartment rents for about $12,500. i'm justsaying, thats too much money for many americans to afford.the architects of obamacare had a number of very straightforward goals. the first wasto make sure that no one could be denied insurance

if they wanted to buy it. this idea is calledguaranteed issue. the second is that people should all be charged a similar amount, evenif they have a chronic condition. they shouldn't be punished for being sick. this idea is calledcommunity ratings. that's not to be confused with the tv show community's low ratings,which are infuriating cause that show is awesome. these are the major thrusts of obamacare'sregulations, but there is a problem here. if you make it so noone can be denied a planif they want it, and no one can be forced to pay more if they're sick; there's no reasonfor health people to buy insurance. they can just wait until they get sick, and then theycan go buy a plan for the same amount that they could have before they got sick. butif only sick people buy insurance, then the

price of premiums go way up. this leads toeven more health people to skip buying a plan, only sick people are left, price goes up evenmore, more healthy people opt out, and we get what we call a death spiral for the privateinsurance industry. which while it sounds really cool, we really don't want that tohappen. to avoid this, we need to come up with a wayto convince healthy people to buy insurance. one way it to charge people a penalty if theydon't. obamacare handles this by charging people a fine of $95 or 1% of their incomeif they don't buy insurance. that's the individual mandate, but that creates one more problem.who do you make people pay for something if they can't afford it? one way would be tosubsidize it. and people who make less that

400% of the poverty line, will get a tax creditfrom federal government to help them pay for the insurance. these are the subsidies ofobamacare. these three factors , the regulations, theindividual mandate, and the subsidies from the three-legged stool of obamacare. the reasonwe call it that is because it only works if it is balanced. remove anyone of the legsand the stool is going to fall over. remove any one of these three things from obamacareand the law would just fall apart. so that's how obamacare works. it also happens to bepretty much how massachusetts's health care system works. and switzerland's for that matter.and those systems are working pretty well. i mean have you seen the healthy glow of thoseswiss people and bostonians?

but what will all of this mean to you? you,like john, may have heard some pretty nasty scary things about obamacare. but here arethe facts. if you are 65 or older and you have medicare, nothing will change for you.by which i mean you keep your medicare, nothing changes. you need to sign up for nothing onoctober 1st. if you have insurance from you job, or fromsomeone in your family, then it's very very likely that nothing will change for you either.most people in the united states get their insurance this way, and you will continueto do so next year too. you also need to do nothing, on october 1st. if you get your insurance from medicaid, orfrom the veterans administration, or from

some other government source. then nothingwill change for you either. you'll still get your insurance from the government and youtoo need to do nothing, on october 1st. that leaves the group of people who reallyneed to pay attention to what's coming up on october 1st. and those are legal citizenswho are uninsured right now, or thing they might be uninsured next year. that's who obamacareis really going to affect, and there are just over 30 million of you. you should go to www.healthcare.gov.that's been set up to help you get insurance that you are going to be required to havein 2014. the site will ask you a few simple questions, and use that information to makesome recommendations for you for insurance. if you make less than 133% of the povertyline, you'll qualify for medicaid., which

is free. some states unfortunately aren'tparticipation in the medicaid expansion which will be a problem for very poor people inthose states., but that's still in flux. everyone else will go to the insurance exchanges. wherecompanies will offer plans at bronze, silver, gold, and platinum levels. the more you'rewilling to pay, the more robust your coverage will be. but it's your choice. if you makeless that 400% of the poverty line, you'll get a subsidy to help with the premiums. andthe vast vast majority of people who are uninsured in the united states are going to get thosesubsidies. and for many of them the bronze level plans will be pretty affordable.and that's it! there are other bells and whistles to obamacare, and we'll be covering them infuture episodes., but this is what you need

to know right now to get ready for 2014. sowhether you like the idea of obamacare or you hate it., it's coming on october 1st.you owe it to yourself to at least take a look and consider your options . go to healthcare.govand see how much insurance is going to cost you. it's not going to be as scary as you'vebeen told. even if it's not as awesome as getting health care from aliens.