Subscribe to Here’s the Deal, our politics newsletter for analysis you won’t find anywhere else.
Thank you. Please check your inbox to confirm.
Leave your feedback
The season of open enrollment is upon us: On Sunday, Americans can shop for health care plans on the insurance marketplaces under the Affordable Care Act. Mary Agnes Carey of Kaiser Health News joins Judy Woodruff to answer real Americans’ questions and concerns about costs, coverage and penalties.
This Sunday marks the beginning of open enrollment in the health insurance marketplaces that were created as part of the Affordable Care Act. As of this summer, 9.9 million people had gotten coverage through the state and federal exchanges under Obamacare. Millions more were newly covered through Medicaid.
Heading into the new season, there are a number of questions and concerns people are asking about costs, coverage and penalties.
We're going to spend the next couple nights looking at those.
Mary Agnes Carey of Kaiser Health News is back with us again.
Mary Agnes, welcome again to the program.
MARY AGNES CAREY, Kaiser Health News:
So, let's start out by talking about what the administration's challenge is here. How many people out there are eligible, but have not yet signed up for Obamacare?
MARY AGNES CAREY:
The administration says there are about 10.5 million people that are eligible to enroll in the exchanges, and they're hoping to enroll about one in four of those.
This is going to be a tough group to go after. Maybe they're confused about the health care law. They may not understand how it works or that they need to have coverage, and so they need to have a very aggressive outreach for this enrollment period.
Well, let's look at one of those people who present, I guess you could say, a challenge. And that is, this is a woman — her name is Angela Denig. She lives near Miami in Margate, Florida. She decided not to sign up for coverage last year.
She said she was willing to pay the penalty. She'd rather do that. She ended up having a health scare, and she's trying to decide what to do now. Let's listen.
ANGELA DENIG, Florida Resident:
When the open enrollment was in 2013, I went online to explore my options, and when I plugged in my specific factors and my situation, I didn't qualify for the — for any subsidy.
So what it offered me was coverage through independent agencies, and the premiums were significantly expensive, something that wasn't in my budget. So, at that point, I had to decide that I couldn't afford medical insurance.
Full-time employment. I pay my taxes, I pay my bills. I live by the letter of the law. And the letter of the law said that year that, even though I couldn't afford medical coverage, I was required to pay this penalty. And I did. And it hurt.
So, Mary Agnes, what does the administration do to appeal, to win over people like this, who — it's not just a matter of persuading them. It sounds like she genuinely has an issue with the cost.
What they're asking people to do is to come back to the marketplace this year, to look again, to shop again. The hope is that, in some markets, perhaps in her market, that there are more choices that will be affordable to her. And they also are emphasizing the penalty. We have got to remember, for example, the first year, it was $95 or 1 percent of your income, whichever is greater.
That 'whichever is greater' part really surprised people. For 2016, that goes to $695 or 2.5 percent of income. So, while the administration is emphasizing they want people to shop on the exchange, they also want to make it clear that you must have coverage, unless you meet a hardship exemption or other exception. And there is a penalty if you don't sign up.
And people — and this — and people have to really focus on this. They have got to go online to get that information.
So, let's look at another situation. This is a man named Glenn Adler who lives in Redwood City, California. Now, he ended up buying private insurance. He decided for him that was the smarter thing to do, rather than the federal coverage. But he has found the cost of premiums, co-pays, deductibles are also rising.
Let's listen to him.
GLENN ADLER, California Resident:
Before Obamacare, my insurance had a fairly low deductible, had reasonable co-pay amounts, and the premiums were at about the same level that they are now. At that point in time, we had a family deductible of exactly $3,500. And once we fulfilled that deductible, there were no additional payments required from the policy.
Nowadays, the deductibles are in the order of $10,000 for a family. Every year, I see the rates increasing in terms of premiums, the deductibles going up, and the co-payments are going up. And out of pocket, it is costing more and more for a family, much, much — at a much more rapid rate than the rate of inflation.
So, Mary Agnes, what does the administration say to someone in his situation?
They understand the frustration about affordability. And they also are trying to make it clear, as he makes it so clear, that it's not just about your premium. It's your deductible, it's your co-payment, it's this combined package of expenses that everyone faces.
Chances are his health plan — he lives in California — they all had to sort of rise to the level of the plans that — the Affordable Care Act had certain coverages they wanted covered, so that's probably why his plan is more expensive. But consumers have to look at the total package.
And this is where the frustration comes in, because that out-of-pocket expense, your deductibles, your co-insurance, your co-pays, are all in addition to those premiums.
And this is, of course, the case with people who bought into Obamacare. People in the silver plan, for example. They're having to look at rising costs as well.
The silver plan is — the second lowest-cost silver plan is what they call the benchmark plan. That's what all the subsidies are tied to. You are seeing some increases. Oklahoma, for example, an average increase of 36 percent.
In Indiana, there is a decrease of 13 percent. But the thing that's important to understand is that, even within a state, even within a region, prices can vary. So, that's why it's important, even if you like your current plan, you should get on healthcare.gov or go to a local in-person assister or a broker, an insurance agent, and look at what your options are to see if you can make a change that's more affordable for you if you need to do that.
So how much tweaking is the administration able to do and stay within the law as it was passed?
In the sense of — what do you mean tweaking?
Tweaking in terms of making adjustments for people like this. As they go along, they're finding there are some challenges that they didn't recognize originally.
I mean, they can do a variety of things. They're trying to increase the number of competitors in the marketplace. That can certainly help with consumers. They're trying to make the Web site faster and easier, so when people go on the site, some of the frustrations, some of the screen crashes and so on, won't be there now.
They're trying to make it as clear as possible for people to type in their information and see their benefits and see their potential coverages right there. What does this premium cost? What's my out-of-pocket cost? What's the total package? You can rank them from cheapest to most expensive, to simply make it easier for you to find out what's out there.
How confident is the administration that they're going to be able to get many more people to sign up? When you talk to them, what is their expectation? What do they say?
They're expecting, of that 10.5 million, that they can get one in four. They know, for some people… simply may not be aware of it, they don't want to enroll in it, they won't do that. Some people may make the same calculation as Angela did, that it's too expensive for her.
But they're trying to go to those people, who so far have said no, they do an aggressive outreach to try to at least make them aware of what's out there and what their options are.
Alright, Mary Agnes Carey, we are going to continue this investigation tomorrow night with some more questions as we move into and approach the third enrollment period for Obamacare.
Watch the Full Episode
Broadcast journalist Judy Woodruff is the anchor and managing editor of the PBS NewsHour. She has covered politics and other news for five decades at NBC, CNN and PBS.
Jason Kane is a PBS NewsHour producer, focusing on health care and national affairs.
Support Provided By:
Additional Support Provided By: