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From penalties to changing plans, get answers to your health care questions

Individuals can start to apply for health care coverage on state and federal exchanges starting Saturday. As a new open enrollment begins, many people have questions about signing up and the consequences of not signing up. Mary Agnes Carey of Kaiser Health News and health policy analyst Susan Dentzer join Judy Woodruff to answer questions from Americans around the nation.

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  • JUDY WOODRUFF:

    Now: what people need to know about the next round of enrolling for insurance later this week under the federal health care law.

    Individuals can begin applying on the state and federal exchanges starting this Saturday. The government estimates that roughly nine million will do so, but that's below earlier estimates.

    Last night, we started to answer some of the essential questions from the public, but there were a few more we wanted to tackle.

    I recorded this conversation with Mary Agnes Carey of Kaiser Health News and Susan Dentzer, a health analyst for the NewsHour.

    Susan and Mary Agnes, thank you for being with back with us again.

  • SUSAN DENTZER, Health Policy Analyst:

    Great to be with you, Judy.

  • MARY AGNES CAREY, Kaiser Health News:

    Great to be here.

  • JUDY WOODRUFF:

    So more questions from people across the country, a lot of questions about the health care law, as we are just days away from the start of the second enrollment period we said — as we said, starting on Saturday.

    So, here, we're going to hear now from a woman in Texas who is asking about the penalty this year.

  • JESSICA LANERIE, Texas:

    I'm Jessica Lanerie. And I'm from Houston, Texas.

    I have a brother who is currently uninsured. And so my question is, what is the penalty, the financial penalty going to be this year? And how is that going to be enforced?

  • JUDY WOODRUFF:

    Mary Agnes.

  • MARY AGNES CAREY:

    Unless you have an exemption — and there are several — for the penalty, if you didn't have health insurance in 2014, the penalty is $95, or 1 percent of income, whichever is greater for an individual.

    In 2015, that rises to $325, or 2 percent of income, whichever is greater. And they take it out of your income tax refund. So, if your income is too low to file taxes, you wouldn't get socked by the penal. In fact, you may be able to qualify for a subsidy, but that is the plan, to take it out of your income tax return.

  • JUDY WOODRUFF:

    All right, here is a woman. This is a — we spoke with a woman. Her name is Wynona Rowe. She's from Camarillo — I hope I pronounced that right — California. And her question is about dropped coverage.

  • WYNONA ROWE, California:

    I am concerned about my friends who I know have been dropped from their health care, and their doctors that they have been seeing for years and years don't accept the plan. And so now they're having to go to other doctors.

  • JUDY WOODRUFF:

    Susan?

  • SUSAN DENTZER:

    It's hard to know exactly what is going on there. It could be one of a couple of things.

    One is, a number of plans were extended last year. You may recall the president had said, if you like your plan, you can keep it. There was some back-and-forth over whether that was true. A number of states did decide to go ahead and extend plans. Others didn't. So, it could have been that that was the reason her friend was dropped.

    It is also possible that she is really talking about the network there. Plans, in order to be more affordable, have tended on the exchanges to restrict their network. So, not all physicians, not all hospitals are included in every network. So it could be that the coverage was intact. It is just that it wasn't being honored by a particular provider or hospital who is no longer in that plan.

  • JUDY WOODRUFF:

    Would you add anything to that about dropped coverage?

  • MARY AGNES CAREY:

    That is that some states have different powers to extend plans.

    For example, in their states, if an insurance commissioner wants to allow a plan that doesn't meet all the current requirements to be sold, they can. Some insurance commissioners have the power to say, if those plans don't meet the essential health benefits of the Affordable Care Act, they won't let them be offered.

    And, as Susan said, some insurers simply decide not to set the plan a second year. So, it could be a variety of circumstances that led to her friends' situation.

  • JUDY WOODRUFF:

    All right, we have one other question. And this one, we don't have a video, but what we can share with you is, we spoke with a small restaurant owner from Naples, Florida. Her name is Valerie Weinberg.

    She said that she was overwhelmed with the application process that small businesses needed to go through last year in order to insure their workers. Her question was, will anything be changing on that front this year?

    Susan?

  • SUSAN DENTZER:

    Well, last year, the enrollment through the so-called SHOP exchanges, to the degree it was available, was on paper. This year, it's online, both on healthcare.gov, or the federally facilitated marketplace, and, by and large, in all the state marketplaces that are offering the SHOP marketplaces as well.

  • JUDY WOODRUFF:

    So it will — there are more ways to sign up.

  • SUSAN DENTZER:

    And it won't be — it will be able to be done online, is the bottom line.

  • JUDY WOODRUFF:

    If you look at it overall, would both of you say there are more questions this year, fewer? Are you getting the sense that people feel a little more familiar with the process? Or is it just as confusing as it was before, Mary Agnes?

  • MARY AGNES CAREY:

    I think people know there is a federal health care law. They may know there is a Web site. They certainly heard about the debacle last year when healthcare.gov opened.

    But the question for me, will be what does the administration do to promote the plans this year, to promote healthcare.gov? Last year, about this time before enrollment, we saw tons and tons of advertising. Haven't seen as much this yet. So, how does that engage the public's attention? What do they do with that information? What are they looking for?

    And the key test is healthcare.gov. Does it work when you get on the site?

  • JUDY WOODRUFF:

    And how is the administration getting the word out, that — the second enrollment? Obviously, in the news media, we are talking about it this week. But if they are not doing a big campaign, Susan, how do people know?

  • SUSAN DENTZER:

    Well, it's also true that the people who didn't sign up last year are going to be the hardest-to-reach people. It's very clear that people who really wanted to get health insurance, many of them were able to get online and enroll last year.

    This year, there are going to be many more people who have language — face language barriers. One in five Americans who are uninsured say that they don't have health literacy, fundamental literacy or so-called numeracy. They really can't figure out premiums, co-pays and all of that.

    So a lot of this is going to be done through one-on-one assistance, at the state level in particular, through the use of navigators and other forms of consumer assistance, sitting down with consumers and working with them one-on-one to get them signed up.

  • JUDY WOODRUFF:

    So mass media announcements, running it on broadcast, on network television, on some popular…

  • SUSAN DENTZER:

    Churches.

  • JUDY WOODRUFF:

    These churches.

  • SUSAN DENTZER:

    Faith based organizations doing outreach, hospitals…

  • JUDY WOODRUFF:

    Yes.

  • SUSAN DENTZER:

    … et cetera.

  • JUDY WOODRUFF:

    OK.

    Well, we appreciate the two of you. As one of you said to us a few minutes ago — I think it was Mary Agnes — we will always keep on talking about the Affordable Care Act. There will always be questions.

    Mary Agnes Carey, Susan Dentzer, we thank you.

  • SUSAN DENTZER:

    Thank you, Judy.

  • MARY AGNES CAREY:

    Thank you.

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