US & Canada

Why is Obamacare so controversial?

Media captionWhat do Americans think of Obamacare today?

After a troubled rollout and despite widespread unpopularity, President Barack Obama's 2010 healthcare law is forging full-steam ahead.

The Patient Protection and Affordable Care Act, known as Obamacare, is the largest overhaul of the US healthcare system since the 1960s.

What does the law do?

Its aim is simple: to extend health insurance coverage to some of the estimated 15% of the US population who lack it. Those people receive no coverage from their employers and are not covered by US health programmes for the poor and the elderly.

To achieve this, the law requires all Americans to have health insurance, but offers subsidies to make coverage more affordable and aims to reduce the cost of insurance by bringing younger, healthier people into the health insurance system.

It also requires businesses with more than 50 full-time employees to offer health coverage, although this provision was delayed until 2015 to allow more time for compliance.

The law creates marketplaces - with websites akin to online travel and shopping sites - where individuals can compare prices as they shop for coverage.

In addition, the law bans insurance companies from denying health coverage to people with pre-existing health conditions, allows young people to remain on their parents' plans until age 26, and expands eligibility for the government-run Medicaid health programme for the poor.

The law aims eventually to slow the growth of US healthcare spending, which is the highest in the world.

Media captionWhat is "Obamacare", and why are Republicans against it?

What went wrong?

The phased rollout of the law has been bedeviled by setbacks, including:

July 2013: The mandate that businesses with over 50 workers must provide insurance is delayed a year until 2015

Oct 23: The deadline for individuals to avoid penalties is pushed back six weeks to March 2014

Oct 30: Mr Obama acknowledges "no excuse" for website meltdown, which his health secretary concedes is a "debacle"

Nov 14: Mr Obama announces insurers can keep customers on existing plans for another year, amid fury at his broken promise

Nov 22: Enrolment deadline for individuals is pushed back a week in December

Nov 26: Spanish-language sign-up tool is postponed until December

Nov 27: Online insurance enrolment for small businesses is delayed for a year

Feb 4 2014: Congressional budget analysts predict the health law will cut the US workforce by equivalent of 2.3 million workers by 2021

Feb 10: The mandate that businesses with over 50 workers must provide insurance is delayed for another year, until 2016

Media captionObamacare explained in 75 seconds

What happened to the website? is a federal website that serves as a marketplace where individuals in 36 states can compare private insurance plans, learn about available public subsidies, and sign up for a coverage. The remaining 14 states and Washington DC have set up their own websites.

The federal portal was plagued with technical glitches from its rollout on 1 October, though exchanges run by individual states did not appear to have the same problems.

Despite initially sluggish enrolment figures, the Obama administration succeeded in surpassing its revised sign-up figure of six million by the 31 March deadline.

Media captionResidents of Kentucky, one of the unhealthiest states in America, talk to the BBC of their hopes and concerns about Obamacare

Why do conservatives oppose the law?

Republicans say the law imposes too many costs on business, with many describing it as a "job killer". They have also decried it as an unwarranted intrusion into the affairs of private businesses and individuals.

The party and a veritable industry of conservative think tanks and advocacy groups have fought the law since Mr Obama first proposed it in 2009 at the start of his first term in office.

After the law was passed in 2010, Republicans launched a legal challenge, which ended in June 2012 when the US Supreme Court declared it constitutional. It was also a central issue in the 2012 presidential election, when Mr Obama won a second term in office.

Meanwhile, the House of Representatives, controlled by the Republicans, has taken dozens of symbolic votes to repeal the law and forced a partial government shutdown over the issue. Republicans in state capitals have also sought to undermine it in various ways.

Democrats say Republicans are politically motivated to attack Mr Obama's flagship domestic achievement in order to weaken him.

Media captionThe BBC's Mark Mardell assesses the potential legacy of Obamacare

When do its elements take effect?

The law has been phased in:

2010: Insurers were banned from denying coverage to children with pre-existing conditions, adults under 26 years of age were allowed to remain on their parents' plans, and insurers were barred from cancelling coverage in some circumstances. Insurers were forbidden from imposing lifetime limits on health coverage.

2011: The law expanded access to preventative health services, and offered drug discounts for people in the Medicare programme for pensioners.

2012: Provisions to encourage healthcare providers to lower costs took effect.

October 2013: Consumer health insurance marketplaces went online, and were initially plagued by glitches.

2014: People without health coverage from the government or their employers are required to purchase it. The government Medicaid health programme for the poor is expanded to cover more people, tax credits to subsidise individual and family purchases of health policies, and insurers are barred from denying coverage to those with pre-existing health conditions.

Image caption The success of the law will depend on how many younger people sign up