Politico recently summed up the president’s recent sales pitch for Obamacare this way: “Make the big sell by talking small.” And indeed, in a mid-July address, the president tried to assure Americans that all was going according plan, Politico reported, by painting “an optimistic picture of how Obamacare is putting money back into the pockets of consumers who will soon see new competition drive down insurance rates.” While the president has been focusing on some early small victories—like the rebates some people are getting due to a provision in the law—at its core the Affordable Care Act is about insurance.

When it passed, it was about giving some 30 million of the 50 million people uninsured at the time, in 2010, a chance to get insurance—for some, to buy it with help from subsidies from the federal government, and for some others, getting it through Medicaid, via an extension of the existing federal/state program for the poor. A secondary goal was to get rid of some of the worst practices in the so-called individual market, which prevented sick people from obtaining coverage and well people from affording it. There was also talk that the law would slow down the rise in the cost of US medical care, though it arguably did not contain teeth strong enough to make that happen. Forces that could actually raise healthcare costs—like consolidation in the insurance and hospital markets—would have continued with or without Obamacare. It is within this context that the Affordable Care Act to date must be scored. In Part 1 we examined what parts of the original law have been implemented, what parts are on hold, and what parts are gone. In this, Part 2, we assess the law as it stands so far—its hits and its misses, as well as the parts that get mixed reviews.


Coverage for young adults.
According to the 2012 Biennial Health Insurance Survey, from 2010 to 2012 about 3.4 million young adults up to age 26 gained coverage under their parents’ insurance policies, thanks to Obamacare. While some states and some employers already permitted young adult coverage, this popular provision has helped many young people who are starting their working lives.

No lifetime limits on insurance coverage.
Anyone who has experienced a catastrophic illness or accident and found that their insurance stopped paying the bills because the costs exceeded the policy limits knows how important this provision can be. While most people never reach those limits, they could mean financial ruin to those who did. Now, insurance companies can no longer impose lifetime dollar limits on coverage, a provision the White House says http://www.whitehouse.gov/healthreform/myths-and-facts has already affected 105 million Americans with individual or group coverage. Annual limits, too, will be entirely phased out by 2014. Insurers, however, are still allowed to limit the number of physician visits or treatments. Whether a policy comes with such limits will be a factor of the premium and the cost sharing a policyholder will pay. But the overall dollar limits for healthcare benefits—a factor when serious illness or accidents occur—will be a thing of the past.

Prescription drug savings for seniors.
Early on, the government sent a $250 rebate check to Medicare beneficiaries who had high drug expenses—those who in 2010 had reached the so-called “donut hole,” where the Medicare prescription drug law, passed in 2003, provides no benefits. The Affordable Care Act closed the donut hole gap, thanks to a deal the administration made with the drug companies. The companies helped fund some coverage for brand name drugs needed by consumers whose expenses were high enough to reach the coverage gap. That, of course, gave them entrée to new customers for those drugs. In 2011, the White House says, seniors saved, on average, $604 per person.

Preventive care benefits.
The law requires most health plans to cover core preventive services recommended by the US Preventive Services Task Force—with no cost sharing on the part of the patient. These include such services as immunizations and blood pressure screenings. Other services are aimed at women, such as well-woman visits and gestational diabetes screening, are also covered without cost sharing.

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.