ABILENE, Texas - When President Barack Obama signed the Patient Protection and Affordable Care Act into law in 2010, it once again changed the way the healthcare industry operates in America.
In Part 1 of our series "The Facts: Health Care in America," we cut through the clutter, the partisan bickering and the spin to bring you the facts on this landmark legislation.
(For the complete Health Care in America series, CLICK HERE.)
Good or bad, right or wrong, the Affordable Care Act was designed to help reign in medical costs.
The law is basically this: Almost everyone has to have health insurance. If you don't have it, you'll have to pay a penalty, starting at about $100 a year. Remember people getting turned down for having a pre-existing condition? Insurance companies can't do that anymore. If a patient is part of the lower-middle class or poor, a tax credit may be available to help pay for insurance.
They are all big changes, but change isn't new. Creating a system for universal healthcare has been a goal for many presidents over the past century.
In 1965, the federal government introduced a program that would truly change that system. On July 30 of that year, President Lyndon Johnson signed Medicare into law, providing medical insurance for Americans 65 and older.
The federal government was in the healthcare business.
Medicaid was signed the same year, but it's not insurance. Medicaid is government-provided healthcare for those who can't afford it. Another piece of legislation, the Emergency Medical Treatment and Labor Act or EMTALA, signed by President Reagan in 1986, forced hospitals to provide emergency room care for everyone.
Then, in 1993, after campaigning heavily on creating universal health care, President Bill Clinton tried to pass the Health Security Act. The centerpiece of that plan was to mandate that employers provide insurance for their employees.
"For every American, for a lifetime, healthcare that is comprehensive, that is always there and cannot be taken away," President Bill Clinton said of his plan.
His attempt failed.
Another dramatic change to health came a decade ago, when President George W. Bush signed the $1.2 trillion Medicare Modernization Act, making prescription drugs more affordable for seniors.
"The stories about people saving money and getting better healthcare have warmed my heart," President Bush said.
So how did we get to the Affordable Care Act?
In the year before the ACA was passed, 50 million Americans lacked health insurance. Out of pocket expenses had risen 150 percent in 10 years. The idea was this: If more people have insurance, and they're footing their own bills, costs can be kept under control for everyone else.
With the help of a Democratic House and Senate, President Obama was able to sign what some call "Obamacare" into law.
"Today, after almost a century of trying, today after over a year of debate, today, after all the votes have been tallied, health insurance reform becomes law in the United States of America," President Obama said.
Opponents of the law said that Congress didn't have the power to require people to buy a product, but that withstood a Supreme Court challenge in 2012. In a 5 to 4 decision, the court decided that it was constitutional. Chief Justice John Roberts, writing for the majority, ruled it to be legal under the Constitutional power given to Congress to levy a tax.
That hasn't stopped the opposition, however. If anything, tension between the parties has only escalated, as witnessed by a government shutdown just a month ago.
Dr. Austin King, president-elect of the second largest medical association in the United States, the Texas Medical Association, speaking on behalf of the physicians he represents, said the law is just too burdensome.
"There is so much red tape and things you have to do," Dr. King said.
Requirements for physicians are difficult. They are forced to move records from paper to electronic. In addition, new coding and requirements for Medicare and Medicaid will force doctors to pay higher penalties if they don't comply with increasingly difficult requirements.
Another challenge: Doctors are the first line of communication with patients.
"There's so much confusion from the patient's standpoint," Dr. King said. "They come into physician's offices all the time asking ‘Can you possibly help us understand?'"
Longtime family physician Dr. Alan Shultz said he sees the issue two ways: It's difficult for doctors, but it will help keep rising health care costs in check. It will regulate how much hospitals can charge by enforcing an 80 percent rule, meaning 80 percent of the cost has to be in "direct" healthcare to the patient.
"When we get hospital bills you never know what the true cost of the service you received is, and my feeling is we're moving more in the direction of prices making sense," Dr. Shultz said. "When the consumer has more choice, they will choose the care which is most appropriate for them, the best value for their dollar."
We also spoke to Dr. Kim Peck, associate dean of Admissions and Diversity for the Texas Tech University Health Sciences Center School of Medicine.
"We were concerned that we might see a decrease in the number of applications to medical school," Peck said. "Anytime there is going to be a big impact affecting the positions and opportunities that physicians have, there's concern that students might elect to pursue other professions."
Instead, that school and others across the country are seeing more applicants. Texas Tech has even increased its class size by 30 students a year to help put more doctors in practice.
There was one thing that stood out as we worked to get the facts behind this large, controversial and at times confusing bill. Everyone said the law is well-intentioned, but flawed. Yet, there is still hope that both sides can come together to fix what needs to be fixed.
"It has potential," Dr. Peck said. "I feel like most people in medicine feel like there is something broken and we need to work on that."
"It either will or it will go to the brink of disaster like we did in the most recent financial crisis," Dr. Shultz said. "And things will begin to fall apart and then we'll act out of crisis rather than act in a much more adult and responsible way."
"The two parties at some point have to come together to make this a better bill for all of us," Dr. King said.
Open enrollment for the marketplace ends March 31, with coverage beginning as early as Jan. 1. The state of Texas has opted out of the Medicaid expansion and has left the marketplace in the hands of the federal government.
KTXS News will feature Part 2 of our special report series, Healthcare in America, Tuesday when we take a closer look at what is inside the Affordable Care Act.
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