The federal Affordable Care Act will impact different people in different ways.

Some stand to benefit from the law. For others, very little may change.

Here’s a short list of the winner and losers of federal health care reform.


President Barack Obama campaigned on a platform of health care reform, and the Affordable Care Act represents the most sweeping example of reform since the Social Security Amendments of 1965, which established Medicare and Medicaid.

The uninsured who currently earn between 100 percent and 400 percent of the federal poverty level will qualify for government subsidies to help pay for health insurance, making the price more affordable for many people than ever before.


Residents who make below 100 percent of the federal poverty level, but are currently ineligible for Medicaid in South Carolina, will not qualify for Medicaid next year because the state has rejected federal money to expand the program. As the law is written, they won’t qualify for a subsidy to help lower the cost of private insurance either, because the law assumed all states would expand their Medicaid programs to these residents.

Gov. Nikki Haley, a vocal critic of the health care law, was one of several conservative leaders who wanted to challenge its constitutionality in court. The U.S. Supreme Court ultimately upheld the Affordable Care Act with a major caveat: States aren’t obligated to expand Medicaid, one of the law’s major building blocks. In a sense, Haley won that battle. She has convinced the S.C. Legislature, at least for now, that South Carolina doesn’t need to expand Medicaid.

Hospitals in the state could lose millions because the federal government intends to cut back payments historically made to help cover the cost of delivering free charity care. Expanding Medicaid was intended to offset these cuts, but South Carolina leaders have decided to opt out of the expansion.

U.S. House of Representative Republicans, many of whom ran for office as tea party conservatives, have voted more than 40 times to overturn the health care law without success.

Reach Lauren Sausser at 937-5598.