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We answer your health care questions as open enrollment nears

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    This is a big week for the nation's health care law, also known as the Affordable Care Act or Obamacare. People who want coverage will soon have another opportunity to enroll to purchase health insurance policies through federal and state marketplaces.

    In the first year of the new exchanges, the government reported more than seven million people bought private plans. Just yesterday, the Obama administration lowered its estimate of how many would sign up in the second round of enrollment, from 13 million down to nine million. That comes just days after the U.S. Supreme Court said that it would hear a crucial challenge on whether some federal subsidies for coverage are legal.

    We know there are lots of questions people have. So we turn right now to two who know all this very well.

    They're Mary Agnes Carey of Kaiser Health News and Susan Dentzer, a health analyst for the "NewsHour."

    Great to have you back on the program, both of you.

    So let's start first, Mary Agnes, from this word yesterday from the Obama administration. They had said — projected 13 million would be signed up by the end of next year. Now they're saying nine or a little more than that, nine million or so. Why the change?

  • MARY AGNES CAREY, Kaiser Health News:

    This is the difference between estimates of different agencies. The Congressional Budget Office, which is sort of the unofficial scorekeeper for Congress, had estimated 13 million would be in the exchanges.

    The administration is now saying, from their estimates, as you say, are down to about 9.9 million. They think that people will enroll on a more slower basis than the Congressional Budget Office estimated. And also you have to remember that there is a variance in income. Sometimes, people qualify for the exchanges vs. the Medicaid expansion if their states expanded Medicaid.

    Sometimes, people don't pay their health insurance premiums. Sometimes they have citizenship or immigration issues that play with that number, but basically they think it will be a slower rollout of people enrolling.


    And, Susan Dentzer, what about this other development, the Supreme Court saying that they are going to look out whether these subsidies on the federal exchanges involving, what, 36 states, could be invalidated? How much worry, how much concern is there about what that could do to health care, the health care law?

  • SUSAN DENTZER, Health Policy Analyst:

    Well, there's concern.

    The law — the language of the law does tie the subsidies to exchanges — quote, unquote — "established by the state." And now the question is, does that language literally just mean state-based exchanges, or does it pertain much more broadly to the overall notion that federal — the federal exchange could step in, as it has done, and back up the states that didn't set up their own exchanges?

    We will have to see how the court rules. It's important to say though that there are probably some work-arounds. Even if the Supreme Court were ultimately to rule — and, by the way, this won't happen until next year — were to rule that for some reason the language applies only to state-based exchanges, there's really nothing in the law that would prevent a state from in effect kind of outsourcing it — that back to the federal marketplace.

    So we will have to see what the court's decision actually is, but it really is this question of, does this language — is it literal language about state-based exchanges or is it really more the broader intent of the law to cover all — have subsidies apply to purchases across the exchanges?



    So with this second round of enrollment coming, we asked people around the country to submit some questions they have about the process. We have — and we some of them on video. We talked to a woman from Washington, D.C., about enrollment. Here's what she asked.


    I'm Christina Sturdivant. I'm from Washington, D.C.

    For the last enrollment period, I waited too long to get insurance. So, I wanted to make sure I was on top of hit the time. So, I wanted to know, when does it open and how will I have to sign up?


    Mary Agnes, what would you say?


    Enrollment opens on November the 15th. But you only have three months this year, until February 15, to enroll. That's three months shorter than the six-month period they had last year.


    And so it's half the time, but it starts this weekend.


    Right. You can get online. You can even shop right now. We did that when we were preparing for this segment. We got on the Web site. You can look at plans, look at prices, but enrollment does begin this Saturday.


    All right. We have another question now. This is a man from California who asked about the status of the Web site.


    My name is Nicholas Zambrano from Hemet, California. And I'm just curious to know if the Web site is going to crash like last year. Everybody tried to sign up and nobody has access.


    Susan, that has to be the question on the minds of a lot of people.



    Well, the government says it's cautiously optimistic that things will go much better. And, in fact, it has said that the capacity on the first day will be able to handle as many as twice as many simultaneous users as tried to sign up on the first day a year ago. So the capacity should ensure that the Web site doesn't crash with regularity.


    Is that your sense as well, Mary Agnes?


    That's certainly been the case. The officials are saying that.

    But one thing to keep in mind is, they talk about improvement, but not perfection It's almost giving themselves a little bit of wiggle room, but certainly you can't have a repeat of what happened a year ago.


    All right, now, this is another question. This is from an uninsured man from Colorado who is asking about affordability.


    My name's Ron Zito. I'm from Denver.

    I'm self-employed. And for many years, I was able to afford my own insurance. It wasn't exactly cheap, but I was able to afford it. And last year, what happened was, it doubled, and I just couldn't afford it anymore. So I now am actually going without insurance.


    So I guess the question here is, Mary Agnes, are those people looking for insurance likely to keep seeing these rising costs? And why are the prices so much more after the ACA than before?


    Well, a lot of what — what you pay will depend on where you live.

    And one thing I'm thinking, if I listen to this gentleman, is maybe go back to the Web site. Federal officials have been talking about things may be different this year. Perhaps there are more plan options that were available for him than there were last year. It's unclear whether or not he went through the process. Could he have qualified for a subsidy to get some assistance?

    Could he go for a plan perhaps that has a higher deductible and a lower premium? So, it's — I think it's something that maybe he should check out again and see if it works for him.


    Susan, what else?


    Well, in quite a number of states, actually, the premiums for even the silver plan, which is the second lowest-cost type of plan, are actually lower than they were last year.

    Some states, they are a little bit higher, 5 percent, in some states even more. I think, more broadly, people should keep in mind, especially if they're thinking not just comparing this year the last year, but this year to what they had before the Affordable Care Act went into effect, the coverage by and large is broader. The annual limits have been done away with of payout. The lifetime limits have been done away with. The essential benefits are now in place.

    So people have to think about the whole breadth of their coverage, not just the premium.


    All right. Final question for today — and, by the, we're going to continue this segment tomorrow — but we talked to a woman from Delaware and it was — and her question was about employer-based coverage.


    My name is Carolyn Manuel. And I'm from Delaware.

    My question is — I have employer-based insurance, but why are many co-pays going up if this is the Affordable Care Act?


    Mary Agnes?


    The trend in the employer market has been to shift more of the cost to workers, to increase their share of the premium, their co-pays and deductibles. This was happening separately from the Affordable Care Act.

    And I think a lot people that see a price — help with the price of health insurance, for example, are those on the individual market, people who are purchasing their own health insurance. So people in the employer market may not see the same sort of effect on their health insurance as you might as if you bought your own health insurance and maybe couldn't afford it before and can get it now.


    Susan, what would you add?


    It's a big law, but, as Mary Agnes says, it doesn't pertain to every aspect of health insurance.

    And to the degree that employers can decide their level of coverage, they have a lot of latitude still to decide what it is they want in their health insurance plans, and specifically what share of that they want employees to pick up.


    All right, a lot of questions. And we are going to continue this conversation tomorrow as we count down the days to the actual beginning of the second enrollment period.

    Susan Dentzer, Mary Agnes Carey, thank you.


    Thank you.


    Great to be with you, Judy.

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