for the first time in 4 years. Being able to provide access to healthcare for my son.

for my 27-year-old, barely employed daughter. She is a part time waitress whose hours were recently cut down to two short shifts a week. She's got anxiety disorder that makes it very hard to work or attend classes. Thanks to the early part of the ACA, we kept her on my husband's insurance until she turned 26 a year ago. Since then we've been paying for her COBRA coverage because of her pre-existing anxiety problems, but it is expensive. I haven't looked into the Maryland exchanges yet, but hope to start looking soon to see if we can bring down the cost of coverage.

Maryland is doing the expansion, so your daughter will have good option -- either completely free or heavily subsidized.

I am not clear about what mental health services are mandated by ACA. This site talks only about mental health screening but not treatment. It doesn't make much sense to cover screening and then not actually treat the problems, so I hope there is more than that.

http://www.mentalhealthamerica.net/go/policy/aca101

Tell all of your friends to thank Governor O'Malley for doing the right thing for the citizens of Maryland.

Good luck with this.

is a different thing than what it is from a humanitarian standpoint. I think any decent human, even most Republicans, should appreciate the humanity issues such are described in the OP article. Anything that gets people any help for medical catastrophes is a good thing, even if it still leaves the USA solidly in last place among developed nations. I just mention that as a preamble because I don't want my following comments to be confused with the humanitarian things we all should agree on.

Structurally, things are becoming clear that probably were not clear to most of us throughout the whole political process that brought us to this point. We know the opposition has been nothing but lies. Unfortunately among the proponents, a lot of the hyperbole has been greatly exaggerated, and in some cases is just not truthful at all.

So here is what I believe is the really distilled, but truthful summary of what is happening.

We have Medicare for those of retirement age. That provides basic services for free and Seniors can purchase supplemental insurance which is almost a necessity for any kind of decent care in the older years. Medicare dictates the fees that providers will receive for services. That isn't changed with the ACA in any big way. Providers have to decide if they want to serve Medicare recipients. Most do. The fees aren't great, but seniors use a lot of services, so providers do get good volume.

We have most younger Americans receiving insurance from employer-based private group insurance. These are typically run by a few huge corporations (Anthem, Wellpoint, Kaiser, United Healthcare, etc.) The group plans dictate the fees they will pay the providers. Providers join the group plan networks in order to get the best terms. Many of these plans have large networks of providers who are more-or-less happy with that arrangement. There have been various attempts at restricted networks (aka HMOs, PPOs, etc.) but in most cases, people under employer-insurance have pretty good access to a large pool of providers. And if you really want to be seen by somebody out of network, you can do that, but you have to pay a higher share of the costs. None of that really changes with ACA.

We have Medicaid, which is a real hodge-podge state by state. it is supposed to cover the very lowest income. Some states do pretty well. others are extremely restrictive. The fees Medicaid pays are rock bottom and as a consequence, most providers do not accept Medicaid patients except on a pay-for-service basis. But there are enough providers to give some basic health care to the least among us.

And then there was the "everybody else" crowd, which was a combination of millions of people who purchase their own insurance, and about 45 million who had no insurance. The big goal of ACA was to get most of these uninsured into coverage. They law tried to do that by expanding Medicaid to cover everybody up to 133% of the poverty level income, regardless of assets or anything else, completely free of charge. And for those from 133-400% of poverty income, there would be a new "exchange" level that ends up being the medicaid-grade policies with the smallest supplier pool, but made affordable through generous government subsidies. It isn't great insurance, but it is vastly better than being uninsured.

That's the broad landscape. What most people (myself included) didn't really understand is that:

a) This new ACA-exchange is essentially "Paid Medicaid". The fees are dictated by the government and are rock bottom so very few suppliers are deciding to participate. It is certainly better than having no insurance, but it is nothing like the coverage that is provided in most employer plans. Not only do the ACA policies have tiny provider networks, they also eliminate any reimbursements whatsoever for out-of-network providers, except for emergencies.

b) At least in some markets and maybe on a widespread basis, the insurance companies are moving to ELIMINATE the individual policies that historically were comparable to employer plans. At least in my market, by the end of 2014, Anthem plans to force anybody buying insurance on their own into an ACA plan (i.e paid Medicaid). In other words, there may be no option whatsoever for an individual to even purchase a policy that gives them access to the best hospitals and specialists in their area.

Basically the people who had been purchasing their own insurance may be getting trounced in this change. We are a relatively small minority, so it seems that nobody even thought about how that was going to affect this group. ACA pushes us into what is essentially bare-bones Medicaid coverage. What we have to hope is that somebody will recognize this problem in 2014 and offer some better options by 2015.

Just to be clear, the people who get an even worse deal are all those in the red states who aren't covered by Medicaid expansion, but don't have enough income to get subsidies in the ACA exchanges. They get no insurance at all. We can thank the Supreme Court for that one.