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A look at the challenges threatening the health of Obamacare

More than 11 million people have enrolled for health insurance in the second year of the new marketplaces, and more than 80 percent of enrollees have been eligible for subsidies. The Supreme Court will soon decide whether states can provide those subsidies sold through the federal exchange. Gwen Ifill speaks with Health and Human Services Secretary Sylvia Mathews Burwell.

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  • GWEN IFILL:

    It's been an important week for the health care law that may provide the cornerstone for President Obama's legacy. More than 11 million people have signed up for insurance coverage in the second year of the new marketplaces. That's higher than year one, when 6.7 million people ultimately enrolled through federal or state exchanges.

    But there are big questions ahead. In just two weeks, the Supreme Court will hear its second challenge to the law, this one about whether states can provide subsidies to buy insurance sold through the federal exchange. More than 80 percent of enrollees have been eligible for the subsidies, and 8.6 million of those who signed up this year enrolled through the federal exchanges.

    Sylvia Mathews Burwell is the secretary of health and human services. I sat down with her earlier today at the agency's headquarters.

    Secretary Burwell, thank you for joining us.

    You announced this week that 11 million people have now signed up for the Affordable Care Act, but that the numbers could change?

    SYLVIA MATHEWS BURWELL, Secretary of Health and Human Services: The 11.4 million people have signed up, and what we know is, as we go through the process, the number of people that pay may be lower than that number.

    And there will be puts and takes. You probably also saw we have a special enrollment period for those who were still in line at the time that open enrollment closed. There will be some additions and probably be some subtractions from those numbers over time.

  • GWEN IFILL:

    You mentioned a special enrollment period. Is there some discussion under way about also extending this in April for people who don't realize they're about to get socked with some pretty tough tax penalties if they don't enroll?

  • SYLVIA MATHEWS BURWELL:

    So, that is an issue that has been raised.

  • GWEN IFILL:

    Yes.

  • SYLVIA MATHEWS BURWELL:

    And we are considering and will come out very soon with a decision one way or another on whether or not we will extend the period for those individuals.

  • GWEN IFILL:

    So, last week, we saw the president make a big pitch for young enrollees with his YouTube/BuzzFeed video. How did that work out? Did that effort to try to reach young people who are the young invincibles who are necessarily signing up for insurance, is there any way to measure whether that worked?

  • SYLVIA MATHEWS BURWELL:

    What we do know is, we know the access in terms of the numbers of people that viewed the video. And certainly, in the first less than 24 hours, it was 22 million views.

  • GWEN IFILL:

    Well, I viewed the video, but I'm not the — who you're going for.

  • SYLVIA MATHEWS BURWELL:

    You're not the — so this is why — we know the number of views, so we know that people accessed the information.

    What's important to know over time is whether people acted on that information and that, we will have to wait and see until we can break down the demographics.

  • GWEN IFILL:

    If you had to measure from the beginning of the enactment of the Affordable Care Act to now, how would you measure the trajectory toward your goal of getting uninsured people enrolled? Is it steep? Where are we?

  • SYLVIA MATHEWS BURWELL:

    So, I would actually think about from the passage of the act the question of the three things that the act was about, quality, affordability and access, about all three of those things and how we're making progress against all three of those things.

    With regard to the issue of quality, in terms of what has happened to people who are in the employer-based market, their quality improved. Preexisting conditions, something you don't have to worry about. If you're a woman, you don't have to worry about being discriminated against in terms of pricing, things like you can have your 25 — up to 25-year-olds on your plan.

    And so that's improvements in quality that are happening and happening to millions. And so that's been a steady pace at the point at which those things kicked in. With regard to the number of uninsured, we know that last year, from 2013 to 2014, we saw about a 10-million person drop in the number of adults uninsured. And that was a jump that we hadn't seen since the 1970s.

    It was basically historic in its level. And this year, we're building on that. So, that is how I would describe that part.

  • GWEN IFILL:

    One big cloud looming on the horizon is the Supreme Court. March 4, they are going to hear challenges to the law. What is the best possible outcome and the worst possible outcome from that Supreme Court case?

  • SYLVIA MATHEWS BURWELL:

    We believe the best possible — and confident about in terms of our position going into this case — is the fact these subsidies were meant for everyone in the United States.

    I have traveled all over the country to a number of places. And the idea that the United States Congress would pass legislation that would give a federal tax benefit to people in New York, but not Texas, is just something that doesn't make a lot of sense. And when you meet the people that are benefiting from this across the country, you know, the individuals — and whether it was a woman who had M.S. and had not treated her M.S., except through the emergency room, that she wasn't supposed to get a tax subsidy, and someone in New York was, the idea of that, I think we believe we're in the right position.

    With regard to what the ramifications are, it's been articulated I think by many folks, and that is we know that 87 percent of the people who have come through the federal marketplace are eligible for subsidies and, on average, they qualify for $268 per month per individual.

    When that goes away, you lose affordability. And when you lose affordability, we increase the number of uninsured. In addition, when that happens, what we see is, we see a path that people that will be insured in the individual market will be sicker, most likely. Less healthy people will go in. And that drives premiums up as well.

  • GWEN IFILL:

    And so the plan B is what if that were to happen, for states to step in? Several of them have said they won't.

  • SYLVIA MATHEWS BURWELL:

    As I have said before, we're focused on where we believe we are in the right place right now.

  • GWEN IFILL:

    Have you been speaking to governors or to state legislators about what they do, giving them advice on what their reactions should be and what kinds of things they should do to protect their citizens should this be overturned?

  • SYLVIA MATHEWS BURWELL:

    So, my focus has been on implementation of the law. And whether that's in open enrollment or with governors, my conversations have focused on Medicaid and those issues of expansion.

    You probably know that, in Indiana recently, we have seen that expansion. We're continuing those conversations. In Arkansas, we saw a new governor move through his legislature pretty quickly that he would continue on this path.

  • GWEN IFILL:

    But a lot of states are resisting expansion.

  • SYLVIA MATHEWS BURWELL:

    Absolutely. And we want to continue to work with them.

  • GWEN IFILL:

    If this doesn't happen, if Medicaid expansion doesn't expand, if the Supreme Court were to step back, how severely damaged would be the ultimate goal of this administration, of expanding health care coverage to all?

  • SYLVIA MATHEWS BURWELL:

    So we have made so much progress. As we just mentioned earlier, the idea that we have had that 10 million drop, that there are millions of people, the 11.4 million that we're talking about, this is and baked into how they lead their lives, their financial security, their health security.

    The people I have met, the women I have met who have gone for their wellness exams, one woman, her mother and her grandmother had the BRCA gene. She has gone, she's found out she didn't have it. And just seeing what this means and how this is built in — or the woman who said — who is in her '50s who said, you know, I used to walk down the street and be afraid I would fall, because it would bankrupt me.

    And so this is built into the system now for so many people.

  • GWEN IFILL:

    Sylvia Mathews Burwell, secretary of the Department of Health and Human Services, thank you very much.

  • SYLVIA MATHEWS BURWELL:

    Thank you, Gwen.

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