Key elements of the Affordable Care Act have been delayed, most notably the mandate that employers with more than 50 employees must offer health insurance in 2014. In the case of the law's ill-formed, long-term care program, the provision wound up being abandoned. And when it comes to state decisions to expand Medicaid, the law's provisions have been denied in many states.
Opponents say these steps prove the entire law was misguided and should be tossed out. Supporters argue that such a sweeping set of changes is bound to encounter obstacles, and smart, well-intentioned people should adjust and put the beneficial provisions of the law into practice.
With Congress unlikely to agree on any meaningful changes to Obamacare, here is a look back at the many health care changes that have been triggered by the 2010 law. Here are 10 that Americans should be happy are in place:
1. Goodbye doughnut hole. Medicare drug plans (Part D of Medicare) stop providing insurance to people after their claims for covered drugs hit a certain level ($2,970 in 2013), and coverage doesn't resume until spending hits another level ($4,750 in 2013). Health care reform is closing this doughnut hole in annual stages, and it will be totally closed by 2020. Savings to Medicare beneficiaries will be in the tens of billions of dollars.
2. Free Medicare preventive services. Health care reform greatly expanded the menu of free preventive services to Medicare consumers.
3. Free preventive services to all women. Health insurance plans have added eight women's health benefits because of the law, in areas including breastfeeding, contraception, domestic violence, gestational diabetes, HIV screening and counseling, sexual diseases and wellness visits. These benefits are free, meaning they involve no co-payment or co-insurance, and women don't need to meet their plan deductibles to use these free services.
4. Pre-existing conditions. Beginning in 2014, no one can be denied health insurance because of a pre-existing medical condition.
5. Premium equity. Insurers can't gouge people with pre-existing conditions by forcing them to pay unreasonably high premiums. The law also limits insurers' ability to impose age-related premium increases for private coverage.
6. End of pre-existing restrictions on children's access to health insurance. The law has ended insurance denials based on pre-existing conditions for the roughly 20 million children under age 19.
7. Adult dependent insurance coverage. Adult children up to age 26 can now continue to get health insurance on their parent's policies.
8. Insurance payout limits. The law will end lifetime limits on insurance payouts. It also has been phasing out annual coverage limits, and these will be completely outlawed for insurance plans taking effect next year.
9. Minimum medical loss ratio for insurers. Health insurers must spend at least 85 percent of their premium dollars on health care (80 percent for smaller group plans) or rebate shortfalls to consumers.
10. New consumer health coverage reports. Consumers have begun receiving a standardized report explaining their health insurance. This seemingly modest accomplishment is actually a big deal. For the first time, different health insurance plans have to present their coverage details in the same format, using the same language. Consumers can now accurately compare different health insurance plans.