The PPACA is 2,309 pages long, and full of technicalities and complexities. A shorthand outline of what the law provides and prohibits:

Provisions going into effect this year

allow uninsured adults younger than 26 to be added to their parents' health plans

require new private health insurance plans to cover the full cost of preventive care, including annual physicals and children's immunizations

ban insurance companies from excluding children under 19 from their parents' health insurance plan because of preexisting health conditions

allow people who are considered "uninsurable" (they've been turned down by private insurers because of their health status) to qualify for insurance through a new federal program

prohibit private health insurers from imposing lifetime limits on coverage

offer tax incentives to small businesses if they pay at least half of employees' premiums

phase out a gap, or "doughnut hole," in the Medicare prescription drug program

increase funding for community health centers

prohibit the government from providing or subsidizing insurance plans that cover abortion

prohibit the government from providing insurance for illegal immigrants

Provisions to be phased in over several years

require most Americans without insurance to buy it, or else pay a fine

provide subsidies for those who can't afford the full cost of insurance

through these and other other provisions, see that about 32 million Americans currently without health insurance become insured

require insurers to accept all applicants regardless of "preexisting conditions"

allow an individual not covered by an employer and earning too much to qualify for Medicaid (a state-administered program for low-income people) to buy insurance through a state insurance exchange and, depending upon their income, be eligible for a subsidy

forbid insurers to discriminate on the basis of sex or to cancel a policy once a person becomes sick

expand Medicaid to cover 10-12 million new people

tax health benefits on the most expensive insurance plans

cut sharply government subsidies for Medicare Advantage, a private plan option, to make it similar to Medicare

The first two items on this list are especially controversial. Those opposed to the new law argue that the government has no business forcing people to buy something they don't want, requiring private insurance companies to accept applicants they don't want, or supporting those with low incomes.

Those supporting these provisions argue that the mandate to buy insurance will bring health insurance costs down by giving insurance companies a larger risk pool. Spreading out risk is a key idea behind insurance. Because of the mandate, insurers will get millions of new customers--including both healthy, young people who will cost them little and subsidized lower-income people and those in poor health, who will cost them more. (Most of the sickest Americans, however, will continue to be covered by government programs, especially Medicare, the federal program for seniors and the disabled.)

For discussion 1. What is the answer to arguments that the government should not require people to buy insurance if they don't want it? Does it make sense to you? Why or why not? 2. What do you think are other objections to PPACA and why? What answers might there be to such objections? 3. What do you think are the most valuable elements in the PPACA and why? 4. Should the program have included government spending on abortion, a legal medical procedures? Why or why not? 5. Should it have included insurance for illegal immigrants? Why or why not?

6. Why would a large risk pool bring down the cost of insurance?