Health care law: What's going on?

In light of President Obama's announcement on Thursday, what's afoot and who's affected:

Q: What's the nub of the change, and why is Obama changing course at this late date?

A: The president is letting insurance companies offer people another year of coverage under their existing plans even if those plans don't meet the requirements set out in his health care overhaul law. He's doing so because of mounting frustration — even anger — over the millions of cancellation notices that have been going out to Americans whose plans don't measure up to the law's coverage standards.

Q: Problem solved?

A: Perhaps not. Obama's decision doesn't force insurance companies to do anything. It just gives them the option of extending old plans for existing customers in the individual market, and only if state insurance commissioners also give their OK.

Q: Why wouldn't insurance companies let people re-up?

A: The companies aren't happy about being thrown a curve ball after they've already firmed up 2014 rates and plans. It will take a while to see how many agree to reinstate old plans for another year — and at what price.

A: Most companies and state insurance commissioners say they need time to study the changes before making a commitment. Aetna Inc., the nation's third-largest health insurer, said it plans to extend some of its canceled policies. Washington state's insurance commissioner said he won't allow insurance companies there to extend the old policies. He said people can get better coverage on the new health care exchange.

Q: Why not make the extensions mandatory, and not just optional?

A: Some Democrats want that to happen, but it almost certainly would require legislation from Congress, and Republicans would object to such a stiff new requirement on the insurance industry. More steps may be required, nevertheless, to restore coverage for people losing it.

Q: The changes mainly affect the 5 percent of people who get their insurance through the individual market. What's the big deal?

A: In a country of more than 300 million people, 5 percent is a lot. Roughly 14 million people buy their own policies, and many of those plans are not just junk insurance, contrary to what the White House suggests. Already, more than 4 million people have gotten cancellation notices. And some small businesses are losing coverage for their workers, too. Plus, if the government can't get its healthcare.gov website running better by Dec. 15, some people who got cancellations run the risk of having a break in coverage. The health care law was supposed to reduce the number of uninsured people, not increase it.