How Does Health Care Reform Affect Health Insurance Companies? 
As Nancy Pelosi informed us , we wo n't exactly know until it all takes effect . The Affordable Care Act is still rolling out and the major changes start in January 2014 . Some things we do know , the insurance companies wo n't be able to decline or charge extra to people with poor health . That will definitely affect premiums for everyone . It will make premiums less affordable for people who were already paying for their own health insurance and DID health qualify . It will require a lot of people to buy health insurance that did n't buy it before . That part will be good for the insurance companies . It has required that they operate on a 20 % margin . This has caused them to tighten up and lay off thousands of salaried and hourly employees . Most likely in my opinion this is an experiment that is doomed to fail . Once it fails , the whole health insurance system will go to a single payer government run system exactly like Medicare . That will be an improvement over this . But it will be very , very expensive on our tax payers . 