Opinion: The Civics Project explainer column: How does Obamacare work?

Q: What Is Obamacare and how does it work?

A: Obamacare is another name for the Affordable Care Act (ACA), a healthcare reform law enacted in 2010 under the Obama administration. Under the ACA, for most people, neither the government nor Barack Obama provide healthcare. Rather, the law attempts to make private insurance more accessible to more people. It is especially focused on helping those who were previously uninsured or underinsured.

While the ACA is certainly a significant reform, it did not change the underlying structure of our healthcare system, which still relies largely on private insurance provided as a benefit of employment. The law’s primary approach to expanding access to healthcare is in providing subsidies, in the form of tax credits, to people who purchase insurance through government-run marketplaces either on the federal website, healthcare.gov , or through state-run exchanges. These tax credits reduce monthly premium costs for individuals and families who earn between 100% and 400% of the Federal Poverty Level (FPL).

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In practical terms, this means that many families who are not getting employer-based healthcare qualify for assistance to lower their insurance costs. In some cases, people are also eligible for cost-sharing reductions, which further reduce out-of-pocket expenses like deductibles and copayments. Even for people who do not qualify for subsidies, the marketplace is intended to provide options that allow individuals and families to compare insurance plans from different providers and choose one that fits their needs and budget. It is also supposed to provide competition, though its effectiveness for either is mixed.

Additionally, the ACA also expanded Medicaid, the government-run health insurance program for low-income individuals. Essentially, the law provided money to states to expand the number of people eligible for free or low-cost healthcare, particularly those who earn less than 138% of the FPL. However, because Medicaid expansion is optional for states, some states, like Florida, have not adopted it, which means eligibility varies depending on where you live.

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For many people who receive insurance through their employer, the ACA matters less. However, there were some more universal changes. Before the ACA, insurance companies could deny coverage or charge higher premiums to people with preexisting medical conditions, such as diabetes or cancer. Under the ACA, that is no longer allowed. The ACA also requires that market-eligible insurance plans cover some essential health benefits, such as emergency care, maternity care and mental health treatment. While this provides more comprehensive coverage, it may increase costs and eliminate some more barebones plans.

You may have heard about penalties or mandates, though that’s overstated. Initially, the ACA included an individual mandate, which required everyone to have health insurance or pay a penalty. The idea behind the mandate was to encourage younger, healthier individuals to buy insurance, helping to balance out the cost of covering older or sicker people. However, in 2017, Congress effectively eliminated the penalty, making it no longer a requirement for people to have insurance.

In some ways, the ACA was a compromise between those seeking a government-run single payer system and those that wanted the status quo. It kept the structure of the old system but added subsidies and regulation. As with most compromises, many are unsatisfied. However, there seems to be little consensus about how to replace it. So, the ACA or Obamacare seems likely to be here for the long haul.

Kevin Wagner is a noted constitutional scholar, political science professor and Co-Director of the PolCom Lab at Florida Atlantic University. The answers provided do not necessarily represent the views of the university. If you have a question about how American government and politics work, email him at kwagne15@fau.edu .

This article originally appeared on Palm Beach Post: Opinion: The Civics Project explainer column: How does Obamacare work?