“Is there anything else I can help you with today Ma’am?” It’s not the polite customer service agent’s fault, but no, after a second 45-minute phone call, and the magic words “you are now enrolled”, there’s nothing else you can do for me.

After four phone calls, and several hours spent online, I’d finally been cleared to buy a health care insurance policy…not a free one, or a subsidised one, but one I would pay for myself.  The bureaucracy involved to willingly part with your own money – for something you hope never to have to use – was mind-boggling.

Admittedly, because I am a newly-arrived “alien” here, perhaps things took longer than normal, but nevertheless, the process was long and slow and frustrating. And asking around anecdotally it seems my experience was pretty standard.  The DC Health Link website crashed on me, and then proceeded to register my household twice…resulting in a lot of fodder for my recycling bin as all notifications arrived in duplicate.

But one day last week, I became one of the six million people who now have ‘Obamacare’.  So I can stop worrying about getting sick for financial reasons.

To put it mildly, President Barack Obama has received a lot of flak for the Affordable Healthcare Act – Obamacare’s official name – with Republicans continuing to object to it, and planning to row back what they can if they end up with control of both Houses of Congress after the Mid-Term elections this November and then the White House in 2016.  Even many Democrats running for election and re-election this autumn are focusing their campaigns on the economy rather than have to debate healthcare on the doorsteps.

For such a wealthy country, it is difficult to fathom how – before now – its citizens did not have access to a basic level of healthcare; here in this country that considers itself exceptional and a world leader on so many fronts.

The Affordable Care Act, introduced almost exactly four years ago, made a few main changes to that.

It banned insurers from charging sick people higher rates than the healthy. In order to make this worthwhile for the insurance companies, the act also requires all citizens to have health insurance.  The deadline for enrolling in a programme is today (31 March), but as of last week this has been extended for those who’ve begun the process, due to the ongoing difficulties in signing up.

If you’re not enrolled in an insurance programme you will be fined, in the form of a tax penalty, levied at the end of the year for each month that you had no insurance.  The penalty amounts to $95 per adult and $47.50 per child (up to $285 for a family) or 1% of taxable income, whichever is greater.  But this rises to $325 per adult, $162.50 per child next year (or 2% of taxable income), and $695 per adult, $347.50 per child (or 2.5% of taxable income) by 2016.

But with 15% of the population (almost 47 million people) officially living below the poverty line in the US, compulsory paid health insurance is not a realistic expectation, unless there are provisions to make it affordable.  So two points of the act do this, the Medicaid (free health care through a public system for those less well-off) was extended to anyone whose income is $16,000 or less; and subsidies to help offset the cost of insurance premia were introduced for those earning above that but below $46,700.

But a significant number of states have availed of a Supreme Court ruling and have refused to expand Medicaid, leaving millions of people without affordable cover.

In addition, to make things more transparent, health insurance policies are now offered for sale through central websites.  These group policies together in terms of benefits and minimum payments, making it easier to compare what the different providers offer.

About two thirds of the states use the national healthcare.gov site, while others use their own. My experience of the DC HealthLink in that regard was positive. It makes life a lot easier to find everything you need in one spot, without having to trawl lots of websites or spend afternoons on the phone to different call centres repeating your personal circumstances and writing down quotes on scraps of paper.

The problems and frustrations I encountered though, were nothing compared to those who signed up in the first few weeks, those who managed to do so between website crashes.  Despite ironing out those quirks on healthcare.gov, still only 26% of people say the launch of the marketplaces has gone well, according to an Associated Press/gfk poll.  (But this is an improvement on the mere 12% who thought so in December).

Problems are still rife though, prompting President Obama to extend the sign-up deadline last week, past 31 March for those who’ve registered before then, but haven’t managed to complete their enrolment.  He also made a personal video plea for people to sign up. (http://www.whitehouse.gov/blog/2014/03/26/president-wants-you-get-covered-today-don-t-just-think-about-it-just-do-it).  Also another change; permitting those with existing policies to keep them with the same terms and conditions for two years to allow for a smoother transition.

The exact extension deadline hasn’t been decided yet, but it is assumed it will be 14 April so people can use tax refunds to pay for policies.

Although many in Ireland complain about the two-tier healthcare system, and the price of private health insurance, it’s highly unlikely you’ll get turned away from the door of a doctor’s surgery or hospital because you don’t have insurance, or because you don’t have the right type of plan.

Even with platinum, the highest level of insurance here (there are four plans; bronze, silver, gold and platinum), you still get a list of doctors and other healthcare facilities that you are only covered to attend. Go somewhere else and your insurer won’t stump up for the bill, even if you are paying them several thousand dollars a year. If you change provider, your list of doctors and health centres inevitably changes, so it is hard to see how you could cultivate a ‘family doctor’ like so many in Ireland do.

The primary goal of Obama’s ‘Obamacare’ was to reduce the number of people in America without health insurance, which last year stood at around 48 million.  A recent McKinsey poll showed that of the six million who’ve signed up (as of last Thursday), only 27% were previously uninsured.  So, in reality, only the tiniest dent has been made in that trench of people without cover.

In general there seems to be an understanding in the US that the provision of accessible healthcare is a work in progress.  Even if the Republican Party gains full legislative control, it will be difficult to completely reverse the Affordable Care Act as doing so, would mean taking back healthcare from that 27% who can now afford it for the first time.

However there can be no denying that Barack Obama’s pet project is not as successful as he would like it to be.  Furthermore, as medical bills are the number one cause of bankruptcy in America, some further measures, or at least tweaks, will be needed if that situation is to be improved.