I'm a member of the second most put-upon group when it comes to health care: individuals who do not receive their health care through the government or an employer, and who must purchase it themselves from a private carrier. The only group in worse shape than mine is people who don't have health insurance at all. But, while it's clear how reform will help those people--they'll have coverage they didn't have before--it's not clear how reform will help people like me.
There are three arguments on that score.
First, there's the argument that insurers will no longer be able to deny coverage based on pre-existing medical conditions, nor will they be able to rescind policies based on technicalities.
This is definitely good stuff (other things being equal, an assumption I will address in a moment). I've had my insurance for almost 10 years, and I developed some serious health issues a couple of years into my policy term. I can tell you from experience that because of those health issues, I can't get coverage from a new insurer (or even change policies with my existing insurer). I'm a bad risk; one that insurance companies don't want to take. And who can blame them? They're in business to make money.
The consequence for me, though, is that I'm stuck with the policy I've got, like it or not. If the government changes the rules, I'll be able to switch policies, even switch companies, if I think that would work better for me.
HOWEVER, I'd expect the new policy to cost me much more. It's simple business; if insurers are required to take everyone who comes in the door, sick or healthy or somewhere in between, then they are going to be paying out more to health care providers; if insurers are paying more to health care providers, they're going to have to charge more in premiums, co-pays, and deductibles to cover those new costs.
So, for people like me, there's an upside and a downside. The upside is that I can change policies and companies whenever I want. The downside is that I'll be paying an as-yet-undetermined premium for that privilege. Would I be willing to pay $75 more per month for the privilege? Probably. How about $250? No. So, whether or not reform turns out to be a good deal for me depends on how much my costs go up.
As far as costs go, keep in mind that the requirement that insurers take all comers isn't going to be the only thing creating upward pressure. Insurance companies will have to stop selling policies that don't meet the new federal standards for coverage, and will have to upgrade the list of covered services. That will add to insurer costs, which means it will probably add to my costs. Bringing tens of millions of new consumers into the system will shift the demand curve to the right, while the supply curve remains stable--at least in the short run. That will probably add to medical provider fees, which in turn will add to insurer costs, which means it will probably add to my costs. Finally, if the government does succeed in carving some savings out of Medicare reimbursements, medical providers may seek to make up those losses by charging private insurance patients more. Again, that looks like it will make my wallet skinnier, not fatter.
The second argument has to do with subsidies: "Well, your costs may go up, but the government will be subsidizing those costs under the reform law, so your net costs--including the subsidy--might actually go down."
Subsidies, however, only apply to people whose income is up to 300% of the poverty line. And even for that group, no one is sure whether the amount of the subsidy will be large enough to offset any increase in the cost of insurance. For me, though, that's a moot point. I don't qualify for a subsidy.
The third argument is that state insurance exchanges will foster competition in the market, which will bring down prices.
That might be true in some places, but I live in Texas. I just did a quick request for health insurance quotes for someone in my demographic (43 years old, non-smoker, 78741 zip code, movie star looks, etc.), and I got back estimates from nine companies offering a total of 134 plans. Do I need any more competition than this?
I don't know how typical my case is, and I'm certainly not basing my appraisal of health care reform solely on whether or not it's good for me. But if I had to guess about the consequences of reform, my guess would be that: (a) it would bring a lot more people into the system, which is good; but (b) it will accelerate health care cost increases for both government and the private sector (especially people like me, who don't have any leverage because we're not part of a group); and so (c) we'll have to reform health care all over again within about five years, once it's clear that the costs are going to bankrupt us much more quickly than we thought.