Updated June 13, 2014.

Healthcare reform by the Affordable Care Act has been extremely controversial. One side fears a government takeover of the healthcare system and a slippery slope toward socialism. The other side wants healthcare for everyone, regardless of their ability to pay. The combination of money, politics, and healthcare make the subject almost too hot to handle.

Let's put aside the name-calling and shed light on some of the more controversial aspects of the ACA with these frequently asked questions about healthcare reform.

 

Question: What's wrong with leaving things as they were?

Answer: Without reform, escalating healthcare costs would have become an unsustainably large burden on the country's economy.

In his March 1, 2010 CNBC interview, billionaire investor Warren Buffett compared that burden to a tapeworm, saying "everything we produce for export, everything we compete with . . . is bearing that cost, and it's a cost that the rest of the world isn't bearing."

The Institute of Medicine warned that both public coverage and employer-sponsored health insurance was being threatened by rising costs in its 2009 report, "America's Uninsured Crisis: Consequences for Health and Health Care."
 

Question: Will there be healthcare rationing?

Answer: We already have healthcare rationing to some extent. For example, insurers commonly require pre-authorization before procedures and hospitalizations. This won't change.

The ACA created an advisory panel, the Independent Payment Advisory Board, to propose ways to keep Medicare costs in check.

But, since the IPAB isn't allowed to propose changes that would ration care, raise premiums, or increase beneficiary cost sharing, it's hard to see this as a path to new rationing.

Source: The Affordable Care Act, section 3403
 

Question: Will there be death panels?

Answer: No, there are no death panels. There is nothing in the ACA that will force you into hospice care against your will, or mandate euthanasia.
 

Question: Is this socialized medicine?

Answer: The ACA doesn't create a system of socialized medicine. Actually, some parts of our healthcare system, like military medicine, have been socialized for years. Those aspects will remain socialized. But the ACA doesn't add to the existing socialized medicine systems. Under the ACA, most care is provided by private companies, just as it was before.
 

Question: Will there be long waits to see the doctor or for non-emergency surgeries like I've heard about in other countries?

Answer: Maybe. There is concern that the current number of physicians isn't sufficient to provide prompt care to the increased number of people who'll seek care once they're insured. In fact, the Association of American Medical Colleges predicts a national shortage of over 90,000 physicians by 2020. In some areas of the country, it's already hard to find a doctor who accepts Medicaid. This might worsen when the number of people eligible for Medicaid increases on January 1, 2014.
 

Question: Will the quality of my healthcare go down?

Answer: The ACA has multiple provisions to improve patient safety and increase the quality of healthcare. You'll find a summary of those provisions and a discussion of how some states are implementing them in this report by the National Academy for State Health Policy.

How you perceive the quality of your own healthcare may differ from how your doctor or the government does. The most important thing you can do to ensure you get the kind of quality healthcare you want is become an empowered patient.
 

Question: Will my taxes go up to pay for other people's health insurance?

Answer: There are several tax provisions in the ACA that might affect you. If you're single and earn over $200,000 or married, together earning over $250,000, your taxes will increase. Also, some tax deductions have decreased which might increase your overall tax burden.

You will pay a penalty, which the Supreme Court considers a tax, for going without health insurance after January 1, 2014. And, if you own a business with more than 50 full-time employees, you'll pay more taxes if you don't provide your employees with health insurance by January 1, 2014.

Sources: IRS Affordable Care Act Provisions, Supreme Court decision: National Federation of Independent Business et al. v. Sebelius
 

Question: Will I be forced to buy health insurance?

Answer: You won't technically be forced to buy health insurance, but you may be penalized if you don't. The Affordable Care Act's individual mandate imposes a financial penalty on most people who aren't insured by January 1, 2014. The penalty increases each year and varies by income level.

Read more about the penalty, called the shared responsibility payment, and find out if you might be exempt. If you're not exempt, learn how much your penalty will be.
 

Question: I run a business; will I be forced to buy health insurance for my employees?

Answer: A business with more than 50 full-time employees will face penalties if it doesn't provide affordable insurance for those employees. But, it may share the burden of the premium cost with the employee. Guidelines define how much the premium can cost the employee, and what type of coverage must be provided to avoid penalties.

Businesses with fewer than 50 full-time employees won't be penalized for not providing insurance. Some small businesses that want to provide health insurance to their employees may be eligible for tax credits.

Sources: Internal Revenue Code section 4908H, Internal Revenue Code section 5000A
 

Question: I like the health insurance I have now. Will healthcare reform force me to give up my current insurance?

Answer: Probably not. Most existing plans can be grandfathered, exempted from many of the provisions of the ACA, as long as they don't make significant changes to your coverage benefits, premiums, or out-of-pocket costs. If the plan does make significant changes, it will lose grandfathered status and become subject to all of the stipulations of the ACA. So, nothing in the ACA forces you to change your current health insurance. But, that doesn't guarantee that your insurance provider or employer won't make a change that would result in your plan losing its grandfathered status.

Source: the Whitehouse.Gov: "Putting American's in Control of Their Health Care."
 

Question: Why should I have to pay more so someone else can have health insurance?

Answer: Arguments against paying more so someone else can have health insurance differ, but many can be summed up by this quote from business philosopher Jim Rohn, "It can be dangerous to weaken the strong in our attempts to strengthen the weak."

While there are also many arguments for why you should pay for someone else's health insurance, it's not clear that you'll pay more in the long run under the ACA than you would have paid without healthcare reform.

What is clear is that the path we were on without reform was unsustainable. If the ACA can rein in healthcare inflation, then everyone's healthcare will eventually be more affordable. The Congressional Budget Office predicts the ACA will decrease the budget deficit over time. If that prediction comes true, things will be better for all concerned.