Our guest bloggers are Emily Oshima, a Research Associate/Policy Analyst with the Health Policy team and Lindsay Rosenthal, a Special Assistant for Domestic Policy at the Center for American Progress.

While the ACA has helped millions of Americans since it President Obama signed it into law on March 23, 2010, a recent poll found that nearly half (47 percent) of uninsured Americans did not expect to be affected by the health reform law, either positively or negatively, and half (52 percent) were unaware of key provisions of the ACA that were designed to help them. 

Proponents of the ACA have produced a sea of fact sheets and issue briefs that try to make the law more approachable. At the same time, many have spread misinformation about the ACA, resulting in a great deal of confusion among the American people about what the law actually does and how it works.

So we at the Center for American Progress (CAP) teamed up with Jonathan Gruber, an economist at the Massachusetts Institute of Technology and former advisor to Governor Romney and President Obama on health care reform, and illustrator Nathan Schreiber, to explain the mechanics and importance of the ACA in a three minute easy-to-digest animated video. Illustrating the Success of Health Care Reform, based on Gruber’s new book, Health Care Reform: What It is, Why it’s necessary, and How it Works, tells the story of reform and explains why key components of the ACA, like the individual mandate, are necessary. We invite everyone to take a break from complex graphs and charts and meet the ACA-animated in this fun and informative cartoon. Watch it:

MIT’s Jonathan Gruber has published a new paper modeling the proposed alternatives to the individual health insurance mandate. While that provision will expand coverage to 32 million Americans, the two most talked about substitutes — auto enrollment and late enrollment penalty — offer less coverage at a higher cost to the newly insured:

- AUTO ENROLLMENT – 24 MILLION GAIN COVERAGE : Under this option, an individual is automatically enrolled in insurance unless she or he opts out. Gruber writes that employers could have an incentive to lower their health care spending by actively discouraging workers to opt of insurance and that younger employees — whose participation is so crucial to balance the health risk pool — would be more prone to going without coverage. That would increase premiums in the non-group market by 11 percent, he estimates. What’s more, auto enrollment would reach a small percentage of the uninsured, since “only about one-third of the uninsured are actually offered employer-sponsored insurance in which they can be auto-enrolled.”

- LATE ENROLLMENT PENALTY – 21 MILLION GAIN COVERAGE: With this alternative, an individual can opt-in to insurance under the Affordable Care Act, but then pay a penalty for enrolling at a later date. The effectiveness of this approach will depend on the size of the penalty, but that poses its own set of politically challenging decisions. As Gruber notes, “It seems highly unlikely that the federal government would be willing to tell a 30-year-old individual with cancer that they can’t get insurance coverage because they didn’t sign up when they were 27 years old — or that they have to pay some very large amount of money in the same situation.” Moreover, if younger people stay out of the risk pool, “they will raise prices for those left behind, causing even further exit — and potentially unraveling the entire market.” Gruber estimates premiums in the exchange “would rise about 20 percent relative to the mandate case as the healthy exit the exchanges.”

Politically vulnerable senators like Sens. Claire McCaskill (D-MO), Bill Nelson (D-FL) and Ben Nelson (D-NE) are publicly considering offering more popular alternatives to the mandate, but in doing so they should be mindful of the fact that any new solution should not go back on the progress made in current law. Democrats also shouldn’t be buying into the GOP’s premise that there is something inherently wrong or terribly coercive about asking able individuals to take personal responsibility for their health care expenses. Instead of playing defense, they should be reminding the public of the long history of Republican support for the idea.

The Democrats have responded to the success of the Missouri anti-health reform ballot initiative by arguing that the results were an anomaly. The heated Republican primary attracted a disproportionate number of conservative voters, most of whom don’t share the sentiment of the rest of the country, where support for reform is actually increasing. “It’s very obvious that people have a lack of understanding of our health care reform bill,” Senate Majority Leader Harry Reid (D-NV) said in response to the Missouri news. “The more people learn about this bill, the more they like it.”

Indeed, the opposite could be said for the GOP strategy of repealing the mandate requiring everyone to purchase health insurance — the more voters learn about that, the less they’ll like it. I’ve been arguing that eliminating the mandate would remove any incentive for younger and healthier Americans to purchase coverage and increase premiums for all American. Well today, MIT Professor Jonathan Gruber has released a report that estimates how much more we would all be paying for health coverage, should conservative efforts to repeal the mandate and other parts of the health care law succeed:

Consider this:

Gruber writes that health reform is like a three-legged stool with insurance regulations, the mandate, and subsidies representing the separate legs. Remove one of these components and the stool (reform) falls apart.

Without the mandate, younger, healthier individuals won’t buy into the pool and insurers won’t be able to offer coverage at community rates or cover pre-existing conditions. Healthier individuals can wait until they become sick to purchase coverage, causing premiums for older individuals to skyrocket and further discouraging healthier ‘don’t need insurance yet’ Americans from purchasing insurance. The result is a death spiral “that leads only the sick to purchase insurance at very high prices.” Finally, to ensure that everyone is part of the system and can afford the community rates charged by insurers, the third leg offers subsidies to individuals and families up to 400% above the poverty line.

As Gruber concludes, “Critics who propose to “repeal and replace” the Affordable Care Act don’t seem to understand that all three legs of the stool are critical for reform. Pulling out any of the legs while leaving one or two intact will critically undercut gains from reform.”