30 million Americans are expected to gain health coverage

The 2010 health care law expands the role of the federal government, but also builds on the foundation of private health insurance, providing subsidies for millions of low and moderate income people to buy private insurance. With that law, close to 30 million Americans are expected to gain health coverage, according to the Congressional Budget Office.

Many of them would receive insurance through the expansion of Medicaid. The federal government will initially pay the entire cost of Medicaid coverage for newly eligible beneficiaries and would never pay less than 90 percent.

In addition, the federal government would subsidize the purchase of private insurance for millions of people with incomes up to four times the poverty level (up to $92,200 for a family of four). Private insurers would thus have many new customers.

 

Projections by the nonpartisan office of the actuary at the Department of Health and Human Services show that federal, state and local government health spending will account for nearly 50 percent of all health spending in the United States by 2021, up from 46 percent in 2011. The federal share of all health spending is expected to rise to more than 31 percent, from slightly less than 29 percent.

The changes reflect the expansion of Medicaid eligibility and the new subsidies for private insurance, as well as the increase in Medicare enrollment as baby boomers join the program.

When Mr. Romney and other Republicans complain of a federal takeover, they are referring to more than spending and enrollment in government health programs. They say the new health care law will require most Americans to purchase “government-approved insurance” or pay a new tax. The tax issue was at the heart of the Supreme Court’s much-debated 5-4 decision in June to uphold the president’s health care overhaul law, the Affordable Care Act.

Republicans also say that health insurance will be subject to much more federal regulation, specifying the types of benefits that must be offered; the value, or generosity, of the benefit package; and many other details.

Mr. Obama and other Democrats say these standards are needed to make sure consumers get real protection, not just “bare bones” coverage.