Thursday marks the three-year anniversary of Congress’ passage of the health care reform law. And although Obamacare has had a high profile throughout the past several years of political fights over health reform, that hasn’t ensured that Americans understand what the law actually does. Even after three years, many Americans are still confused about Obamacare’s specific provisions, and can’t correctly identify what is and isn’t in the health law.

According to a new Kaiser Health tracking poll, a plurality of Americans incorrectly believe the health law cuts Medicare benefits, establishes “death panels,” gives health benefits to undocumented immigrants, and contains a public option. The idea that Obamacare includes a public option is the biggest misconception about it, as 57 percent of respondents asserted that they believed the law has a public health insurance option — compared with just 28 percent who know it doesn’t:

In general, Americans are less likely to be aware that widely popular policies are included in Obamacare, like the provisions that provide tax credits for small businesses and that help make prescription drugs more affordable for seniors. On the other hand, the public is much more likely to be able to attribute the less popular aspects of the law — like the individual mandate that compels every American to purchase insurance — to Obamacare:

The discrepancies are likely because of the ongoing, politicized misinformation campaign that’s been waged against Obamacare. Previous polling has shown that accurate knowledge about the health law tends to be divided along party lines: Democrats know more about what the law actually does than Independents do, and Independents know more than Republicans do. That’s been an issue for the health reform law since its inception. Before the Supreme Court handed down its decision to uphold the law, a slim majority of Americans said they opposed Obamacare as a whole — but when they were asked about its provisions separately, most of the law’s actual policies had broad support.

The tide is beginning to turn. Whereas Obamacare used to be solely associated with the negative fearmongering surrounding it, Democrats are now beginning to tout the health reform law’s accomplishments more confidently, hoping to raise awareness about its more popular provisions. Health care reform proponents are looking ahead to 2014 and beyond, when more Americans will start feeling the positive effects of Obamacare on their own lives. But there’s still a long way to go when it comes to educating the American people about the law.

Mike Ruffer, a Five Guys franchise owner who operates eight of the chain restaurants in the Durham, North Carolina area, has decided to join the restaurant industry’s war on health care reform, claiming that the additional costs of providing his workers with health care coverage will raise the prices of hot dogs and burgers for customers who patronize his establishments.

“Any added costs are going to have to be passed on,” Ruffer told the Examiner:

Ruffer was the star witness at a Monday Heritage Foundation seminar on the impact Obamacare will have on small businesses. He is typical of many: Because he has enough full time employees to activate the law, he faces either coughing up the money to provide health insurance or paying a fine of up to $3,000 per worker.

Ruffer initially thought he would escape the law because he created each restaurant as its own company. But the law doesn’t recognize that distinction, so now he’s trying to determine if he can fire enough workers, or cut enough hours, to slide out of the grasp of Obamacare.

As the Examiner explicitly states, Ruffer is actively trying to “escape” the health reform law, and has had his mind made up about it for a while. That’s become an increasingly common position among large employers — particularly in the service industry, where large restaurant chains have been threatening to cut workers’ benefits by shifting costs onto them, cut back on wages, cut back on hours, or raise their products’ prices. Ruffer has, by his own admission, considered every single one of those options. But that isn’t a reflection of the reform law itself — it’s a reflection of companies’ desire to protect their own bottom line by having their low-wage employees go uninsured or obtain coverage through Medicaid, rather than provide them with basic benefits.

To date, these employers’ efforts have not been met with much public enthusiasm, and have even resulted in massive PR backlashes. Employers who choose this route are also putting themselves at risk of driving away potential employees who would rather take jobs that offer more robust benefits, as the vast majority of employers plan to keep offering health coverage plans under Obamacare.

During an interview on conservative host Hugh Hewitt’s talk radio program Thursday night, Sen. Marco Rubio (R-FL) joined fellow Tea Party favorites Sens. Ted Cruz (R-TX) and Mike Lee (R-UT) in demanding that a continuing resolution to fund the government for the rest of the fiscal year include provisions to defund Obamacare in its entirety.

Over the course of the program, Rubio parroted the usual litany of wild — and widely debunked — conservative hysteria about the dire consequences that Obamcare will have on American businesses and the U.S. health care industry, asserting that he would only vote to avert a government shutdown if Obamcare implementation is halted completely:

HEWITT: Senator Rubio, the continuing resolution is headed your way. How is this stacking up as Act III of the spending drama?

RUBIO: Well first of all, I don’t think anyone is in favor of shutting down the government, but I think that’s where we’re headed ultimately here, unfortunately, if we don’t fix our debt problem… But here’s what I’ve said about this continuing resolution. Senator Cruz from Texas is offering this amendment to defund Obamacare. If that gets onto the bill, in essence, if they get a continuing resolution and we can get a vote on that and pass that onto the bill, I’ll vote for a continuing resolution, even if it’s temporary, because it does something permanent, and that’s defund this health care bill, this Obamacare bill, that is going to be an absolute disaster for the American economy. You’re already starting to feel the outer edges of that… I already am running into businesses that are planning next year on not hiring people or laying some people off so they don’t have to meet these mandates. Others are going to push their employees off of their private plans that they offer and onto these exchanges, driving up the cost for the public. So this is going to be an implementation disaster. It’s going to hurt our economy severely. And we’re not spending enough time talking about that.

Later on, Hewitt asked if Rubio would settle for partially defunding Obamacare — specifically, by repealing a provision levying a 2.3 percent tax on medical devices — in exchange for funding the government. Rubio replied, “I don’t know if that alone would be enough” to secure his vote for the continuing resolution, but that he “certainly would support that amendment.”

Defunding the health reform law would devastate tens of millions of Americans who would no longer receive federal subsidies for purchasing health insurance or have expanded access to public insurance programs such as Medicaid. It would also fly in the face of public opinion, since the majority of Americans believe that implementing Obamacare should be a “top priority” in their state. And contrary to some Republicans’ claims, a government shutdown would be a decidedly bad development for essential government services and the American economy at large.

Continuing the Republican propensity to use every single policy and political issue imaginable as an excuse to launch attacks against Obamacare, Rep. Charles Boustany (R-LA) — a member of the powerful House Ways and Means Committee — asserted on Tuesday that Congressional efforts to comprehensively overhaul America’s tax code would include measures to repeal several important Obamacare funding provisions.

Boustany explained that the Obamacare tax measures “will be considered, most likely, in the context of fundamental tax reform,” since wrapping them into a bipartisan tax reform bill makes them more difficult to vote against. Among the provisions on the chopping block would be Obamacare’s 2.3 percent tax on medical devices, as well as a tax on so-called “Cadillac” health plans that wealthier Americans may choose to purchase.

The GOP-led House already voted to repeal the medical device tax, and as many as 17 Democratic senators have voiced their support for getting rid of the tax. But revenue sources such as the medical device tax and the fee on high-end health plans are crucial to funding Obamacare’s subsidies for buying private insurance, its expansion of the public Medicaid program, and its consumer protections for Americans pursuing health coverage.

While there has been some debate over the wisdom of the medical device tax — particularly since some lawmakers worry it could place too much burden on hospitals and device manufacturers — it will help provide tens of billions of dollars in Obamacare funding, along with the law’s other tax measures. Replacing that funding won’t come out of thin air. The lawmakers pushing for repeal will need to make sure that alternative revenue is available to carry out important provisions of the health reform law that seek to extend coverage to millions of Americans.

Boustany’s comments make one thing crystal clear: Obamacare opponents will continue using every possible piece of legislation as a vehicle for obstructing health reform. And, given national lawmakers’ mercurial approach to budgeting, there’s always the distinct possibility that Congress will be tempted to take away more and more funding once they begin chipping away at some of Obamacare’s revenue sources.

From the minute that President Obama signed his landmark health reform bill into law, conservative critics have been issuing dire warnings about how expensive Obamacare will make employer-sponsored health coverage, asserting it would be cheaper for larger companies to drop coverage for their workers — and pay a fine if their employees obtain federally subsidized coverage through Obamacare’s insurance exchanges — rather than provide basic health benefits. As it turns out, those predictions aren’t actually becoming reality.

According to Modern Healthcare, a new “survey of nearly 800 large and midsize employers found that just 6 percent of respondents intend to completely exit the healthcare system over the next three to five years” over concerns about the penalty that Obamacare will level against large companies that don’t provide adequate benefits for their workers.

That assessment stands in stark contrast to some Obamacare opponents’ more outlandish claims. Major conservative institutions and healthy policy experts — including the Heritage Foundation and Douglas Holtz-Eakin, who is a former Congressional Budget Office (CBO) director — have predicted that anywhere between 20 million and 35 million Americans will lose employer-sponsored insurance because of Obamacare. Even respected consulting firm McKinsey and Co. predicted that “30 percent of employers will definitely or probably stop offering [employer-sponsored insurance] in the years after 2014,” the year that most Obamacare provisions — including the employer mandate — kick in.

In fact, that kind of mass exodus would be fraught with risks for companies, considering that approximately 70 percent of Americans receive health coverage through their employer. The prospect of losing workers over decreased benefits is a powerful disincentive for the companies that might have considered ditching health coverage to cut costs. As Jim Winkler of Aon Hewitt’s U.S. health and benefits department put it, employers’ incentive to stop sponsoring health insurance “is strong until you look at the numbers. Between the [Patient Protection and Affordable Care Act] penalties for failing to offer coverage and the ensuing talent flight risk, most employers believe they need to continue to play a role in employee health.”

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In a blow to Americans relying on Medicaid — the state-federal partnership public health insurance program that covers disabled and low-income Americans — the federal government on Tuesday reaffirmed to a California federal appellate court that, in the Obama Administration’s opinion, “states could cut Medicaid payments to many doctors and other health care providers to hold down costs in the program,” paving the way for massive state health care cuts that will further discourage doctors from treating low-income patients enrolled in the program.

Doctors, health care providers, and patient advocacy groups sued California in response to state health officials’ decision to cut already-low reimbursement rates for providers that treat patients on Medi-Cal — California’s Medicaid program — by an extra 10 percent. State leaders led by Gov. Jerry Brown (D) argue that the payment cuts are necessary for California’s fiscal security, especially as the state expands Medi-Cal to an addition 1.8 million Californians under Obamacare. But critics assert that the drastic payment cuts will make treating current and prospective Medi-Cal beneficiaries anathema to California care providers:

Medicaid is one of the fastest-growing items in state budgets. Cutting payment rates saves money for states and for the federal government, which will pay most of the costs for people who become eligible for Medicaid under the new law.

Health care providers said California’s payment rates were inadequate even before the cuts. They pointed to a federal study that said, “California stands out because of its very low Medicaid payment levels.”

In an interview, Dr. Paul R. Phinney, president of the California Medical Association, a plaintiff in one of the court cases, said: “Two-thirds of doctors in California cannot afford to participate in Medicaid because the rates are so low. The problem will only get worse if rates are cut as we move more and more people into Medicaid.”

The Administration’s endorsement of the Medicaid payment cuts underscores just how badly federal officials want states to take part in Obamacare’s Medicaid expansion. Formally blessing states’ abilities to “reasonably” lower their Medicaid physician payment rates is likely a concession aimed at luring reticent governors into accepting the expansion, since it will save both states and the federal government money. But while expanding Medicaid under Obamacare is crucial for the health and financial security for millions of low-income Americans, drastically lowering hospitals’ and physicians’ Medicaid reimbursements — which are already far less generous than Medicare reimbursements — is rife with risks.

Certainly, provider cuts are preferable to cutting special Medicaid benefits for the poor and disabled that are not available on lower-tier private insurance plans, especially in a state like California that has had its fair share of problems with providing adequate services to Medi-Cal beneficiaries. But California already has 6.8 million residents on Medi-Cal, including one in three Californian children and the majority of HIV-positive Californians. Payment cuts that discourage providers from treating these Medi-Cal beneficiaries will leave millions of Americans with few facilities to go to for their care, making them dependent on either free clinics, costly emergency room care, or forcing them to travel massive distances to find an accepting provider.

Reporting on a 2012 study finding that one in three American doctors won’t take new Medicaid patients, Wonkblog’s Sarah Kliff presciently wrote that that could spell trouble for states with historically low Medicaid reimbursement rates — such as California — that also wanted to expand Medicaid, since “fewer than 60 percent of providers accept new patients in the [Medi-Cal] program.” With Brown’s new Administration-endorsed payment cuts set to hit California’s safety net providers, that number has nowhere to go but down.

Universal Orlando, a theme park resort in Florida that generates more than $1 billion dollars in annual revenue, plans to drop insurance coverage for its part-time employees at the end of this year — a tactic to avoid providing its workers with adequate health benefits under Obamacare.

The health care reform law attempts to put an end to several predatory insurance practices, and requires employers to provide their workers with sufficient insurance plans that don’t put limits on essential benefits. Universal would be required to upgrade to a more comprehensive insurance plan under Obamacare. But instead of extending better benefits to its part-time employees, the company would rather drop those workers’ health care altogether:

Universal currently offers part-time workers a limited insurance plan that has low premiums but also caps the payout of benefits. For instance, Universal’s plan costs about $18 a week for employee-only coverage but covers only a maximum of $5,000 a year toward hospital stays. There are similar caps for other services.

Those types of insurance plans — sometimes referred to as “mini-med” plans — will no longer be permitted under the federal Affordable Care Act. Beginning in 2014, the law will prohibit insurance plans that impose annual monetary limits on essential medical care such, as hospitalization, or on overall spending. [...]

Critics of mini-med insurance plans say they ultimately provide little protection for workers, with meager payout limits that are nowhere near enough to cover medical emergencies. Supporters argue they are a realistic option for low-paid, limited-hour workers who can’t afford better plans. [...]

Universal’s announcement has angered some employees, who say the resort can afford to provide more-comprehensive health insurance for its part-time workers. Universal Orlando’s immediate parent company, Universal Parks & Resorts, generated approximately $950 million in operating cash flow last year, up 10 percent from a year ago.

Universal has about 17,000 workers, making it one of the largest employers in Central Florida. Company officials say that only a small percentage of its employees would be impacted by the move to drop part-time coverage, since most of Universal’s part-time workers are covered under a parent’s or spouses’s insurance plan. Still, about 500 people are enrolled in Universal’s “mini-med” plan and can expect to lose all of their current health benefits after December 31st.

The resort isn’t the only hugely successful company to balk at the prospect of providing basic health benefits for its low-wage employees — who typically don’t earn enough to be able to afford to purchase insurance on their own. Wal-Mart dropped health coverage for its part-time employees two years ago. And a wide range of businesses in the restaurant industry — including Applebee’s, Olive Garden, Denny’s, and Wendy’s — have also used Obamacare as an excuse to pass the cost of health care onto their low-wage workers.

This past Friday was the final deadline for governors to decide whether they will take some ownership over setting up a state-level health insurance exchange, as stipulated by the Affordable Care Act. But even though the Republican Party typically resists handing over any power to the federal government, the vast majority of GOP governors have decided to cede control over their own insurance marketplaces to federal officials — an uncharacteristic move that’s out of step with GOP ideals.

As stubborn Obamacare opponents continue to resist implementing the health care reform law, most governors have refused to do any work to set up an insurance marketplace. But those GOP-led states’ refusal won’t actually bring health reform to a grinding halt; instead, it has invited the federal government to step in and do the work for them. Altogether, the federal government will run health exchanges in 26 states, and partner with state officials in an additional seven states to help them set up their marketplaces:

Even though you wouldn’t know it from looking at the partisan breakdown in the chart above, state-run health exchanges are actually a conservative idea. Democratic proponents of reform initially advocated for a nationally-run insurance marketplace, but the final version of the health reform law gave more control to states in order to compromise with conservatives. Republican governors are now largely refusing to take advantage of the power that the law affords to them.

Ironically, as Wonkblog’s Sarah Kliff points out, GOP leaders’ refusal to set up their own exchanges means they’re defaulting to a more liberal version of health care reform. Some members of the Republican Party have already recognized this — but their attempts to convince their colleagues to implement Obamacare on a state level haven’t been met with much success, since the facts don’t matter to the partisan lawmakers who will stop at nothing to oppose the health reform law.

Gov. Scott Walker (R-WI) announced on Wednesday that he will turn down Obamacare’s optional expansion of the Medicaid program, which makes him the thirteenth Republican leader to refuse to extend public health insurance to additional low-income Americans. Six GOP governors — in Arizona, Michigan, New Mexico, North Dakota, Ohio and Nevada — have expressed support for expanding Medicaid, and the rest still need to decide what they want to do about that particular provision of the health reform law.

And even though most GOP leaders claim that expanding Medicaid would be too costly, they’re actually being lobbied by hospital companies, economists, and health care experts who all say the financial benefits — since the federal government will fully fund the first several years of expansion — are too good to turn down:

“It’s fascinating, because on the political level, it’s a classic clash between money and politics,” said Dan Mendelson, CEO of Avalere health advisory company. He said he and his 170 advisers working with the health care industry are hearing plenty about expansion.

“It sets up a really difficult tension between the Republican governors and the hospitals, but there’s an increasing level of political cover being given to the governors to expand their programs,” Mendelson said. [...]

In Florida, a recent poll found that 60% of residents would like to see Medicaid expanded, Mendelson said. Several economic studies have found the states may benefit both by federal funds going into local economies, as well as taxes from those sales going back into the coffers of local government.

The significant federal funds allocated to states that choose to expand Medicaid led the hospital industry to wonder if governors were bluffing about rejecting the expansion. That quickly proved not to be the case, as stubborn GOP politicians in some of the states with the highest rates of uninsurance in the nation still refused to cooperate with the health care reform law.

Diverse coalitions across the country have partnered to pressure resistant lawmakers to expand their Medicaid programs. The growing list of GOP governors who have accepted the optional expansion over the past few weeks seemed to signal that political deadlock may soon give way to reality, but the remaining Republican leaders may buck that trend when they eventually announce their own decisions.

After surviving a Supreme Court challenge, dozens of repeal attempts in Congress, and a presidential election, Obamacare is here to stay — and even some of the staunchest opponents of the health care reform law are finally starting to take steps to implement its provisions in their states. But that doesn’t mean anti-Obamacare Republicans aren’t still dreaming up new ways to create roadblocks to health care reform. In the battle to implement the health law on a state level, GOP officials have seized on an opportunity to hide behind Obamacare to limit women’s access to abortion services.

This week, Arkansas became the latest state to ban Obamacare’s state-level health insurance markets from offering any type of abortion coverage. Michigan and New Jersey are currently considering the same type of legislation. Eighteen other states already have similar bans in place, and two more — Kentucky and North Dakota — have laws on the books to mandate the exact same restriction on abortion coverage, even though they don’t mention the health reform law itself.

All told, the American Civil Liberties Union has mapped out 20 states where at least some women who are seeking to terminate a pregnancy can’t get insurance coverage for that legal medical procedure — including eight states where women can’t get any coverage whatsoever for abortion care:

Abortion services are simply another aspect of women’s reproductive health care — along with other potentially expensive services such as HPV vaccinations, regular gynecological exams, family planning services, and maternity care. Because of the range of gender-specific health services that women rely on, they already tend to pay significantly more for their basic health care than men do. Obamacare takes big steps to address the gender-based disparities in health insurance costs, partly by eliminating co-pays for many of women’s essential preventative services, like contraception.

But since the health reform law leaves abortion services up to each state to determine, anti-choice lawmakers are twisting Obamacare’s provisions to punish the women who seek abortions by forcing them to pay huge out-of-pocket costs in order to make their own medical decisions. “Abortion coverage restrictions were a nonissue for an incredibly long amount of time,” Elizabeth Nash of the Guttmacher Institute explained to Politico. “That law really encouraged states to go in and pass these abortion coverage restrictions in their own health exchanges.”

And now, women’s health advocates worry that — even though Obamacare itself doesn’t prohibit abortion coverage in its insurance marketplaces — anti-choice activists are successfully construing the health law so it appears to be a vehicle for restricting women’s reproductive rights. Fortunately, that’s not the case in every state. Connecticut lawmakers have taken the opposite approach to the issue and opted to classify elective abortion services as an “essential health benefit” under Obamacare, ensuring that insurers will have to cover the procedure.