Obamacare: 3 Challenges As Affordable Care Act Turns Age 3

This day in history: On March 23, 2010, President Obama signed the Affordable Care Act, better known as Obamacare, into law. The law works to increase access to care and curb rising health care spending in the country.

The past three years under Obamacare have not been easy for the Obama administration. Republicans have tried to repeal Obamacare over 30 times, despite the Supreme Court upholding the majority of the controversial bill. For some, Obama's re-election race was meant to serve as a referendum of sorts on Obamacare. If that was the case, Mitt Romney did flip-flop on health care reform and Obama pulled out a decisive victory.

As the Affordable Care Act enters its 4th year, the Obama administration has a lot of work ahead to determine its success and understanding among the American population.  All eyes are on the administration to carry out its promises expanding health care access and coverage for millions of Americans and curbing health care costs.

Here are three challenges that the Obama administration continues to face after three years of law:

1. Medicaid expansion:

Initially slated to expand coverage for 17 million Americans, the Supreme Court ruling left the decision to expand Medicaid to the governors.  Since that ruling, 14 states have announced plans not to expand coverage to 133% of the federal poverty level, with another 3 states leaning towards rejecting expansion.

However, there is still hope for widespread coverage expansion as some states have reconsidered initial decisions. Florida's Gov. Rick Scott recently reversed the decision and will expand Medicaid coverage to an additional 1.3 million people.

2. Health insurance exchanges:

The online marketplaces serve as a way for Americans to purchase private health insurance or enroll in the Medicaid program. While the exchanges need to be tailored to the states to a certain extent, the states have been given several options for developing these exchanges. Although encouraged to develop their own state exchanges, only 17 states and D.C. opted for this option. Seven states have created a state-federal hybrid exchange, while 26 states are leaving it to the federal government to create and run their state's health insurance exchanges.

3. Public understanding & tax increases:

A recent poll by Kaiser Family Foundation found that two-thirds of uninsured American adults and 57% of the American population still do not properly understand the impacts of Obamacare. There is also a health insurance tax that will be tacked on to every insurance premium, projected to bring in an additional $101.7B in tax revenue over the next 10 years.

People need to know the specifics of the Affordable Care Act, policy decisions at the state level, and general implementation strategies. It would be unfortunate to see public misinformation and general lack of knowledge about Obamacare overshadow all the potential benefits of the law  expanding access to health care coverage and working to curb health care expenditures. The administration has a lot of work to do to change public perceptions as January 1, 2014 is less than a year away.