A major part of the Affordable Care Act, passed in 2010, comes into effect October 1, giving Americans increased access to affordable health insurance plans.
Most Americans have private insurance to cover their medical care. That insurance is often partially subsidized by their employers. Elderly Americans receive health care largely paid for by a government trust fund. An estimated 40 to 50 million others — a majority of them considered the working poor — have no health insurance at all.
Many who are insured find rising health care costs a burden and coverage of medical conditions unpredictable. Many doctors say the reimbursements they receive from health insurance companies are not enough to keep them in practice.
Under the Affordable Care Act insurance companies will no longer be able to deny medical coverage to Americans due to pre-existing medical conditions.
According to Jonathan Weiner, professor of health policy at the Johns Hopkins School of Public Health in Baltimore, the biggest challenge is making sure no American is excluded because of a pre-existing condition or low income.
"That's the number one issue, getting them covered," he said. "Without a health insurance card — it's not as if we don't care for people without insurance cards — the care is sporadic and often incomplete."
Small business owners want to provide their employees with health insurance but say they cannot sustain the rising costs.
"We cannot afford a 44 percent increase in medical insurance, so that, in turn, makes us have to start looking elsewhere for different plans, and it makes us have to cut the plan back some," said Amy Millstead Ellzey, who manages an auto repair shop.
The new health care marketplaces opening on October 1 are intended to address these problems by providing access to private insurance with certain guarantees of coverage. Those who already have medical conditions cannot be turned away.