Aaron Carroll: Hi, I'm Dr. Aaron Carroll, and on this new YouTube show, we're going to try to help you understand how medical research and health policy work, we're gonna make sense of a lot of the confusing information out in the world, and we're gonna have a lot of fun doing it.  We're officially launching in a few weeks, but today, we're gonna give you a little preview and talk to you about Obamacare.  

So I have this friend who's 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 Green: Wait, Aaron, I heard that the cost of my family's insurance is gonna triple in the next year.

Aaron: No.

John: Well, but my uncle told me his Medicare is being taken away, that's true, right?

Aaron: That's not gonna happen.

John: All right, Aaron, what about this?  I heard that, under Obamacare, medications are now going to have side effects.

Aaron: That was already the case.

John: Also, I just got this e-mail from a friend that 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 e-mail about someone whose lupus was cured by aliens. Why don't we just get our healthcare from aliens?

Aaron: Well, I suppose w--NO!  That's 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 for you.

(Healthcare Triage intro plays)

Although Obamacare was passed in 2010, the big pieces of the law are scheduled to go into effect on October 1st, just days from now.  But what does that mean to you?  Will your insurance change?  Will you still be able to get medical care?  If you don't have insurance right now, how will you get it?  No matter what you think of the law politically, it's in your best interest to get as much out of it as you can.  So today, we're going to explain how Obamacare works and how it will affect you.  

For decades, the most glaring problem in the United States healthcare system has been that millions of people are uninsured. We're one of the few industrialized countries in the world that doesn't provide universal coverage to its citizens. Here's a list of some of them that do.  For the past few years, the number of people who lack any coverage for a year in the United States has hovered at around 50 million people.  Is that list still scrolling? We'll wait.  By the way, all of those countries are democracies; they all voted to get that universal coverage.  

Lots of people don't have insurance because they have some form of chronic illness.  That's not a surprise, because I mean, come on! If you're already sick, what insurance company would want to cover you?  And if they do, the policy that they'll 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 health insurance policy cost almost $6,000 for an individual.  The average plan for a family cost more than $16,000.  The average two-bedroom apartment rents for about $12,500.  I'm just sayin', that's too much money for many Americans to afford.  

The architects of Obamacare had a number of very straightforward goals.  The first was to make sure that no one could be denied insurance if they wanted to buy it.  This idea is called guaranteed issue.  The second was that people should all be charged a similar amount, even if they have a chronic condition.  They shouldn't be punished for being sick.  This idea is called community 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's regulations.  

But there's a problem here.  If you make it so that no one can be denied a plan if they want it, and no one can be forced to pay more if they're sick, there's no reason for healthy people to buy insurance.  They can just wait until they get sick, and then they can go buy a plan for the same amount they could have before they got sick.  But if only sick people buy insurance, then the price of premiums goes way up.  This leads even more healthy people to skip buying a plan, only sick people are left, price goes up even more, more healthy people opt out, and we get what we call a death spiral for the private insurance industry, which, while it sounds really cool, we really don't want that to happen.

To avoid this, we need to come up with a way to convince healthy people to buy insurance.  One way is to charge people a penalty if they don't.  Obamacare handles this by charging people a fine of $95 or 1% of their income if they don't buy insurance.  That's the individual mandate, but that creates one more problem.  

How do you make people pay for something if they can't afford it? One way would be to subsidize it, and people who make less than 400% of the poverty line would get a tax credit from the federal government to help them pay for the insurance.  These are the subsidies of Obamacare.  These three factors: the regulations, the individual mandate, and the subsidies, form the three-legged stool of Obamacare.  The reason we call it that is because it only works if it's balanced.  Remove any one of the legs and the stool's gonna fall over.  Remove any one of these three things from Obamacare and the law would just fall apart.

So that's how Obamacare works. It also happens to be pretty 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 those Swiss people and Bostonians?  

But what will all of this mean to you?  You, like John, may have heard some pretty scary things about Obamacare.  But here are the facts: If you're 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 on October 1st. If you have insurance from your job, or from someone 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 continue to do so next year, too.  You also need to do nothing on October 1st.  If you get your insurance from Medicaid, or from the Veterans Administration, or from some other government source, then nothing will change for you either. You'll still get your insurance from the government and you, too, need to do nothing on October 1st.  

That leaves the group of people who really need to pay attention to what's coming up on October 1st, and those are legal citizens who are uninsured right now or think they might be uninsured next year.  That's who Obamacare is 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 the insurance that you're gonna be required to have in 2014. The site will ask you a few simple questions and use that information to make some recommendations for you for insurance.

If you make less than 133% of the poverty line, you'll qualify for Medicaid, which is free.  Some states, unfortunately, aren't participating in the Medicaid expansion, which'll be a problem for very poor people in those states, but that's still in flux.  Everyone else will go to the insurance exchanges, where companies will offer plans at bronze, silver, gold and platinum levels.  The more you're willing to pay, the more robust your coverage will be.  But it's your choice!

If you make less than 400% of the poverty line, you'll get a subsidy to help with the premiums, and the vast, vast majority of people who are uninsured in the United States right now are going to get those subsidies.  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 in future episodes, but this is what you need to know right now to get ready for 2014.  So whether 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.gov and see how much insurance is going to cost you.  It's not gonna be as scary as you've been told, even if it's not as awesome as getting healthcare from aliens.