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Obamacare Is Doing At Least One Big Thing Right

Jeffrey Young   |   September 16, 2014   10:06 AM ET

Another day, another survey showing that Obamacare is beginning to cure America's uninsured problem.

The latest numbers come from the federal Centers for Disease Control and Prevention, which polled more than 27,000 people during the first three months of the year. Forty-one million U.S. residents, or 13.1 percent, were uninsured during the quarter when benefits started to kick in for people who signed up for coverage into private insurance or Medicaid via the Obamacare exchanges or elsewhere.

That's the lowest number and percentage of uninsured people since the CDC started using this version of its survey in 1997. It's also down 3.8 million people and 1.3 percentage points from the end of 2013.

The Affordable Care Act's impact on the uninsured actually is understated by the CDC survey. More than 30 percent of Obamacare's 8 million private health insurance enrollees signed up in March or later. That means their benefits wouldn't have kicked in by the end of the third quarter, so a portion of them wouldn't have had coverage by the time of the CDC poll.

Polling and research by other organizations indicates a greater reduction of the uninsured after March. By the end of June, the uninsured rate fell to 13.3 percent, the lowest since 2008, according to Gallup survey findings released last month. Gallup's number for the second quarter was down down from 17.1% at the end of 2013. In an article published in the New England Journal of Medicine, the Department of Health and Human Services and the Harvard School of Public Health pegged the number of people who gained coverage since last year at 10 million. The Congressional Budget Office projects 12 million people will gain health insurance by year's end.

While the CDC survey shows the uninsured rate for children and adults over 65 years old didn't change much, the share of working-age adults who had no health coverage fell from 20.4 percent at the end of the last year to 18.4 percent during the first three months of 2014. The biggest drop was among adults 19-25 years old; the uninsured rate for this group fell more than 5 points to 20.9 percent.

As other studies have shown, states that adopted Obamacare's expansion of Medicaid benefits to more poor residents covered a lot more uninsured than those that didn't. During the first quarter of this year, the uninsured rates in Medicaid-expansion states fell from 18.4 percent to 15.7. In states that refused to accept the Medicaid expansion, the uninsured rate was virtually unchanged, the CDC found. Twenty-three states, mostly in the South, have not opened up Medicaid to more people.

The CDC report also makes plain the connection between income and health insurance. The uninsured rate for poor U.S. residents was 24.1 percent, compared to 26.2 percent for "near-poor" people and 9 percent for everyone else. Obamacare provides financial assistance to people who earn up to four times the federal poverty level, which is about $94,000 for a family of four.

The ethnic group with the highest uninsured rate was Hispanics, at 27.2 percent in the first three months of this year, a decline of more than three points since 2013. The uninsured rate also fell for African-Americans, from 18.9 percent to 15.1 percent. Asians had the third-highest rate at 13.3 percent, followed by whites at 11.5 percent; the share of uninsured Asians and whites didn't significantly change.

The Census Bureau also released survey findings about health insurance in the United States Tuesday, but its figures are from 2013, before benefits from Obamacare enrollment began to take effect. The Census also changed the way it conducts this survey, making comparisons to previous years impractical.

In 2013, 13.4 percent of the population, or 42 million people, lacked health insurance for the entire year, the bureau found. By contrast, the CDC survey asks respondents whether they have coverage at the time of the interview, meaning they may have had coverage at another point during the same year.

The next phase of sign-ups on the health insurance exchanges begins Nov. 15 and will run through Feb. 15. According to the Congressional Budget Office, 7 million additional people who currently lack coverage will gain it during the open enrollment period, and more are expected to sign up in the coming years.

But neither the Congressional Budget Office nor anyone else believes Obamacare will ever bring the number of uninsured Americans down to zero. A decade from now, CBO projects 31 million people will not have health insurance, 25 million fewer than if the Affordable Care Act hadn't been enacted, but still 11 percent of the population.

This story has been updated with figures from the Census Bureau survey.

360,000 Obamacare Enrollees At Risk Of Losing Subsidies

Jeffrey Young   |   September 15, 2014    4:45 PM ET

More than 360,000 individuals enrolled in health insurance via the Obamacare exchanges must provide federal authorities with updated information about their incomes by Sept. 30, or risk losing the subsidies that cut the cost of their coverage, the Centers for Medicare and Medicaid Services announced Monday.

Federal authorities will begin contacting 279,000 households, representing 363,000 individuals, on Monday to urge them to provide additional information about how much money they make because the figures submitted in their Obamacare subsidies applications don't match federal tax records, said Andy Slavitt, the principal deputy administrator of the Medicare and Medicaid agency, which also oversees the health insurance exchanges. More than 8 million people enrolled into private health insurance plans via the Obamacare exchanges during the six-month sign-up period that began last October, and 85 percent received subsidies.

Consumers who do not contact health insurance exchange authorities to verify the accuracy of their income or to offer up-to-date information risk seeing their tax credits reduced beginning next month, Slavitt said. These people may also have to repay the government if they received more subsidies than their income should have allowed.

Discrepancies between Obamacare applications and other federal records don't necessarily indicate consumers attempted to defraud the government, and enrollees may have submitted more accurate information than found in previous tax records, the agency emphasized in a press release.

The Centers for Medicare and Medicaid Services already has worked through the majority of the cases where records didn't match. As of May 30, income information about 1.2 million households, and more than 1.6 million people, wasn't consistent with other federal records. Since then, issues for 467,000 households have been resolved, and another 430,000 cases are in progress, according to the agency.

In addition, the agency disclosed that 115,000 enrollees haven't verified their citizenship or their immigration status, and will lose their health insurance coverage if they do not. Federal authorities set a Sept. 5 deadline for these individuals to provide accurate information about their legal status when they contacted 310,000 people last month. Advocates for immigrants have complained that some enrollees who attempted to comply encountered bureaucratic obstacles.

The Centers for Medicare and Medicaid Services will begin notifying those 115,000 enrollees that their coverage will be cut off at the end of the month. Those who wish to re-enroll with updated citizenship or immigration status documentation will be allowed to do so, Slavitt said.

The next Obamacare enrollment period begins Nov. 15 and runs through Feb. 15.

Employee Health Insurance Costs Barely Increased This Year

Jeffrey Young   |   September 10, 2014   10:01 AM ET

For a change, the cost of the health insurance you get at work didn't go up much this year.

The cost of job-based health benefits stayed nearly flat in 2014, according to survey results released Wednesday. This year's figures continue a trend of slow growth in premiums for health insurance provided by employers.

The average annual premium for a family plan rose 3 percent to $16,834, and the average price for a single worker increased 2 percent to $6,025, the Henry J. Kaiser Family Foundation and the American Hospital Association's Health Research and Educational Trust found. Workers on family plans are paying an average 29 percent of that cost, while single employees are paying 18 percent of it. The groups polled more than 2,000 small and large employers for their report.

Workers aren't reaping much of a tangible benefit because the cost of job-based health insurance is still increasing faster than wages and overall inflation. But the growth over the last five-year period is much lower than during the two five-year periods preceding it, the survey findings show. From 1999 to 2004, family health plan premiums exploded by a total of 72 percent, followed by a cumulative 34 percent from 2004 to to 2009. Since 2009, these costs have risen 26 percent.

employee health benefits
Source: Henry J. Kaiser Family Foundation

Despite the recent trend of smaller increases, the cost of employer-sponsored insurance has ballooned over the past 15 years, eating up a larger share of workers' total compensation. Since 1999, the average annual cost of health benefits has nearly tripled.

employee health benefits
Source: Henry J. Kaiser Family Foundation

The historically slow increases in national health spending during recent years contributed to lower premium hikes for employer-sponsored health insurance. But companies also are limiting their health benefit expenses by making workers pick up a bigger share of the monthly premiums and of their medical bills, the survey found.

High-deductible health plans with lower premiums but greater out-of-pocket costs have become increasingly common. In 2006, just 6 percent of workers were enrolled in these plans, compared to 26 percent in 2011 and 32 percent this year. And the average size of the deductible for a single employee has risen from $584 in 2006 to $1,217 in 2014. Under plans with deductibles, policyholders must spend the full amount of the deductible out of pocket before the insurance coverage kicks in.

employee health benefits
Source: Henry J. Kaiser Family Foundation

"The relatively low growth in premiums this year is good news for employers and workers, though many workers now pay more when they get sick as deductibles continue to rise and skin-in-the-game insurance gradually becomes the norm," Kaiser Family Foundation President Drew Altman said in a written statement.

Eighty percent of workers covered with company health benefits have plans with deductibles this year, the survey found. More than 40 percent of covered employees have plans with deductibles of $1,000 or more, and 18 percent of the plans carry deductibles of at least $2,000. Workers at firms with fewer than 100 employees are more likely to face high deductibles than those at larger employers.

The survey also found that the share of employers that offer health benefits to workers, 55 percent, was about the same this year as last year. Small companies are less likely to provide health insurance, but 90 percent of workers are employed by a company that offers benefits to at least some of its workforce. Eighty percent of employees who have access to job-based health insurance accept it, according to the poll.

Looking ahead to next year, the Kaiser Family Foundation and the Health Research and Educational Trust expect the Affordable Care Act, or ACA, to exert greater influence on job-based health insurance. Beginning in 2015, the law requires companies with at least 100 employees to offer health benefits to full-time workers, or pay penalties when employees obtain subsidized coverage via the Obamacare health insurance exchanges. In 2016, that employer mandate will extend to companies with 50 or more workers.

"The relatively quiet period in 2014 may give way to bigger changes in 2015 as the employer shared-responsibility provision in the ACA takes effect for large employers," the report says.

According to survey findings released last month by the National Business Group on Health, premiums for job-based coverage at large companies will rise 5 percent next year, and more employers will offer only plans with high deductibles. These companies expect the ACA to have only a modest effect on 2015 health benefit costs, the poll found.

Why Is CVS Walking Away From $2 BILLION A Year?

Jeffrey Young   |   September 3, 2014    9:04 PM ET

The company formerly known as CVS Caremark made a big splash Wednesday by yanking whatever tobacco products it had left on the shelves a month earlier than planned, becoming the first big pharmacy chain to do so. The company, now known as CVS Health, has estimated it will lose $2 billion a year in revenue as a result of the move.

That sounds like a lot of of money, until you consider two things. First, CVS recorded $126.7 billion in sales during the last fiscal year. In other words, it took the company less than six days to generate $2 billion in revenue. Second, the United States will spend more than $3 trillion on health care this year and more than $5 trillion by 2023, according to projections released by federal auditors Wednesday.

CVS dumping tobacco sales and rebranding itself says more about the future of the American health care system and emerging areas of competition for shares of those trillions than it does about smoking cessation. (One smoking-related fact that CVS' actions do point toward is that way fewer people use tobacco now than did decades ago, making it easier for a chain store to ditch cigarettes -- although CVS's competitors like Walgreens and Rite Aid aren't doing so, despite urging by state officials.)

By ending sales of cigarettes and other tobacco products and changing its corporate name, CVS is signaling that it wishes to be known as a health care provider, not merely a convenience store with a pharmacy in the back and wide array of smokes up front. After all, you can't buy cigarettes at the doctor's office. In numerous interviews with news outlets tipped off to the company's announcement, CVS CEO Larry Merlo has made a similar point, though often worded a bit differently.

That messaging is consistent with Merlo's statement in the company's annual report issued in February, just after CVS first said it planned to end tobacco sales.

As the delivery of health care evolves with an emphasis on better health outcomes, reducing chronic disease, and controlling costs, we’re playing an expanded role in providing care through our pharmacists, nurse practitioners, and physician assistants. This significant action further distinguishes us in how we are serving our patients, clients, and health care providers, and better positions us for continued growth in the evolving health care marketplace. Although this decision will have some impact on revenues and profits, we believe that it is the right thing to do given our expanding role as a health care company.

One area in which companies like CVS, Walgreens and Walmart are making bets is so-called retail clinics, where customers can get basic medical care like flu shots and treatments for minor injuries and ailments at low cost during hours more like those of a hospital than a doctor's office, and without the long waits and indignity of visiting an emergency room.

CVS already has more than 900 "MinuteClinic" locations, and it plans to expand over the next few years. Walgreens has close to 400 "Healthcare Clinics" in its stores. And Walmart, which dipped its toes in the water several years ago by partnering with independent clinic operators, is in the process of opening more than a dozen company-owned primary care clinics this year.

It's a growing market: In 2009, retail clinics at CVS, Walgreens and the grocery chain Kroger recorded nearly 6 million patient visits, which was almost exactly four times the amount in 2007, according to a study published in the journal Health Affairs this month. That's still a tiny number compared to the hundreds of millions of doctor and emergency department visits annually, but the growth trend is clear -- and demand for health care services is only becoming greater.

These companies are responding to other trends in the health care system, starting with the expansion of health coverage brought about by Affordable Care Act. There are as many as 10 million more people with health insurance or Medicaid benefits now than before Obamacare enrollment began.

These patients need someone to treat them, and retailers figure it might as well be them, not least because those patients are probably already customers. CVS has been transforming from a retailer into a big health care company for years already, notably since the company merged with Caremark, a provider of prescription-drug benefits for employer-provided health insurance plans.

The movement toward health insurance plans with deductibles in the thousands of dollars -- meaning policyholders have to spend that much out of pocket before their insurance kicks in -- could also drive people to clinics that will charge them an affordable fee for minor care, rather than the costlier bill associated with a doctor's office or emergency department visit.

What's more, there's a well-known national shortage of primary-care doctors -- although supply varies a lot by geography -- and retail clinics, along with urgent care facilities and other sites of care, could be key to ensuring access to timely, cost-effective treatment in some areas.

What changed Wednesday is this: Those patients will have to stop somewhere other than CVS if they want a pack of smokes for the drive home. Maybe there will be a Walmart, Walgreens or Rite Aid nearby.

Health Care Spending To Tick Up In 2014, But Just A Little

Jeffrey Young   |   September 3, 2014    4:02 PM ET

After five years of historically low inflation, national health care spending will grow a bit faster this year, according to a federal audit released Wednesday. The expected increase is due to the economy's continued recovery, millions gaining health benefits from Obamacare and more baby boomers signing up for Medicare.

Households, businesses and the government will spend $3.06 trillion on health care in 2014, a 5.6 percent increase from projected expenditures during the previous year, according to a report by the Office of the Actuary at the Centers for Medicare and Medicaid Services published in the journal Health Affairs. From 2009 through 2013, growth came in below 4 percent, the actuaries estimate. In the two decades before that, there were much higher increases; health care spending has nearly quadrupled since 1990.

Despite the uptick in spending on health care services and products like hospital procedures and prescription drugs, these expenditures are still expected to rise more slowly than they did from 1990 to 2008. Even though the economy will grow faster, more Americans will have health coverage and more will age into Medicare, other factors will keep spending increases below those historical highs, the audit concludes.

"The growth rate that we're projecting would be higher than the recent past, but much lower than the previous two decades," Sean Keehan, an economist in the Medicare actuary's office, said at a press conference Wednesday. "We're not projecting that growth will get back to its rapid pace of the '90s and early 2000s."

Health care spending will rise 5.7 percent during the 10-year period that began in 2013, which is lower than the 7.2 percent increase from 1990 to 2008 and higher than the 3.7 percent increase from 2009 to 2012, when the Great Recession drove down demand, the report says. Data from 2013 to 2023 represent the auditors' projections. A separate report next year will detail actual spending in 2013, and the tally for this year won't be available until 2016.

health care spending 2013

Source: Centers for Medicare and Medicaid Services

The last year for which actual spending information, not projections, is available from the Medicare actuaries is 2012. That year, health care expenditures rose 3.7 percent, which was lower than the rise in gross domestic product for the first time since 1997. The actuaries expect the increase in spending in 2013 to be lower than economic growth as well, but they say it will outpace GDP starting this year.

By 2023, health care will make up 19.3 percent of the U.S. economy, as spending will rise 1.1 percentage points faster than gross domestic product. From 1990 to 2008, health care spending grew 2 percentage points faster than the economy.

health care spending 2013

Source: Centers for Medicare and Medicaid Services

The reasons health care spending inflation has slowed down are disputed. The White House and some analysts partially credit the Affordable Care Act with constraining health care spending directly via lower payments to medical providers and to health insurance companies serving Medicare beneficiaries. They say it has had an indirect effect as well, spurring private health care entities to become more efficient.

The actuaries at the Medicare agency mainly attribute the very low growth in recent years to a poor economy, which caused workers to lose jobs and health benefits and gave individuals less income to spend on medical care, and to strained state and local government budgets for health care programs. Other factors include the proliferation of health insurance plans with high deductibles and other requirements that patients pay a larger share of their medical bills, and Medicare spending cuts from Obamacare and a federal budget law enacted last year, the report says.

The Office of the Actuary estimated last year that Obamacare would account for less than 2 percentage points in the increase in health care spending during 2014, despite millions gaining coverage, and just one-tenth of a percentage point in the growth through 2022, compared to expenses if the law hadn't been enacted.

But the auditors are no longer breaking out Obamacare's effects on health care spending and drawing comparisons to a hypothetical world in which the law doesn't exist. "Now that the Affordable Care Act has been in place for well over four years, it is becoming increasingly difficult to accurately estimate a counterfactual -- meaning, what the world would look like in the absence of the Affordable Care Act," Andrea Sisko, an economist in the actuary's office, said at the press conference.

Here's Where Obamacare Has Made The Most Progress

Jeffrey Young   |   September 2, 2014   10:10 AM ET

More than 8 million people enrolled in private health insurance under Obamacare for 2014, topping expectations despite a rocky start. But that's less than one-third of the number of people who could have signed up -- a sign of the huge untapped market for Obamacare coverage and the challenges still facing the program.

In their first year, the Affordable Care Act's insurance exchanges signed up 28 percent of the people eligible to use them -- mainly people who don't get health benefits from their jobs or from a government program like Medicare or Medicaid -- according to an analysis by the Henry J. Kaiser Family Foundation.

And there was a lot of variation among the states: Some captured a big share of the market for these customers and others barely made a dent, as this map illustrates:


Infographic by Jan Diehm for The Huffington Post.

Using data from the Census Bureau and the Department of Health and Human Services, the Kaiser Family Foundation estimates 28.6 million U.S. residents are eligible to buy health insurance via an exchange, compared to the 8 million who did.

Growing the insurance exchanges created by President Barack Obama's health-care reform law is key to continuing to shrink the ranks of the uninsured and to enrolling a broad and diverse population of customers that can spread the cost of the sickest patients across a large number of people.

The foundation's analysis includes people who remain uninsured and people who buy their insurance directly from an insurance company without accessing the exchange or applying for financial aid. The estimate excludes people who qualify for Medicaid, and those who aren't allowed to use an exchange, such as undocumented immigrants and workers who turn down their employers' health plans. It also excludes people who live in states that didn't expand Medicaid and who earn too little to qualify for subsidized private insurance.

The early enrollees also are seen as those in greatest need: They had pre-existing conditions that shut them out of the pre-Obamacare market, qualified for subsidies available to people who earn up to four times the federal poverty level -- about $94,000 for a family of four -- or both. Eight-five percent of the 8 million people who enrolled received tax credits that reduced their monthly premiums, and millions more who didn't sign up for the financial assistance are eligible.

People who earn too much to get financial help or are eligible for only small subsidies may have preferred to avoid the exchanges, especially given their glitches. And insurers in some states offered products outside the exchanges with more choices of providers and other features.

The technical failings of the federal HealthCare.gov website and several state-run exchanges hampered exchange enrollment, driving some consumers to buy directly from an insurance company, even if they might have gotten subsidies on an exchange. Poor public understanding of how the exchanges worked, and especially about the availability of financial assistance, also depressed enrollment.

The share of the potential market that signs up through an exchange is expected to grow. Enrollment on the exchanges for next year begins again Nov. 15 and runs until Feb. 15, and millions more people are expected to use these marketplaces to shop for coverage. By 2017, the Congressional Budget Office projects, 25 million people will get their health insurance this way, including those who get subsidies and those who don't.

Websites that actually work would boost enrollment. More choices of insurance companies in most states, modest premium increases for a significant number of plans and the ability to comparison-shop should lure more consumers to explore the exchanges. And people who were allowed to keep their pre-Obamacare insurance this year after having it canceled will have to transition eventually to plans that meet the law's benefit standards.

What's more, the minimum penalty for not complying with Obamacare's individual mandate that nearly everyone be covered jumps from $95 this year to $325 in 2015.

Policy decisions made by state leaders partly account for the wide variation among states.

"States that wanted to make the law work clearly did better than states that didn't. It's not a one-to-one correspondence, but it's a strong effect," said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.

Seven of the top 10 states had exchanges that were either state-operated or jointly run by the state and the federal government. That includes California, which signed up 1.4 million people, or almost 43 percent of the potential market.

But a large share of eligible Floridians signed up via the federal exchange, owing to concentrated efforts by the Obama administration and enrollment organizations, Levitt said. The troubles with the state-run exchanges in Minnesota, Maryland and Hawaii put them in the bottom 10, along with the federal-state partnership exchange in Iowa.

The ranking also reveals some peculiarities among the states. Vermont consolidated more than 85 percent of its individual health-insurance market into its exchange, largely because that state and the District of Columbia are the only jurisdictions that don't let consumers buy insurance another way.

In Iowa and South Dakota, the company that had the most customers before Obamacare, Wellmark Blue Cross Blue Shield, didn't participate in the exchanges. The federal marketplace in those states was denied the biggest player's marketing muscle, and Wellmark customers inclined to stay with the company didn't use the exchanges, Levitt said. Wellmark also will not join the Iowa or South Dakota exchanges for 2015, the company announced in June, reversing the decisions made public about the Iowa and South Dakota markets in July 2013.

Massachusetts has had an insurance exchange since 2006 and near-universal coverage before Obamacare, leaving a small pool of people not already participating. And the state's exchange website performed poorly.

Although the exchanges will attract more customers next year and in the future, there are obstacles, Levitt said.

The 2015 enrollment period is just three months, half the duration of the 2014 sign-up window, and there will be fewer resources available to help people with the application process. Federal and state authorities also will have to devote efforts to retaining current customers. And there will be less publicity about the exchanges the second time around because it's no longer novel. Plus, the people who didn't sign up already may be the most challenging to enroll, Levitt said.

"It's going to be a lot harder for the program to exceed expectations in the second year than in the first year -- and the first year was plenty hard," Levitt said.

CORRECTION: An earlier version of this article incorrectly stated Wellmark Blue Cross Blue Shield would sell health insurance on the exchanges in Iowa and South Dakota for 2015.

Here's What's Going On With Obamacare Premium Increases

Jeffrey Young   |   August 21, 2014   10:59 AM ET

Health insurance premiums are going to skyrocket under Obamacare next year, maybe even double! No, wait -- they're only increasing a little, and less than before Obamacare! No, wait -- they're … decreasing in some places?

The crucial question about the second year of enrollment on the Affordable Care Act's health insurance exchanges is: How much will coverage cost? Actual prices won't be available in most states until the exchanges open Nov. 15, or shortly before that, so consumers are left to sort through political spin and preliminary reports that don't make things any clearer.

So what's going on? First, most people will pay more for health insurance next year. That's true whether you get coverage from a job, on your own through an exchange or directly from an insurer, or from Medicare. Health insurance prices tend to go up. It's their nature, and it's closely tied to how much the cost of medical care rises.

The good news is that available information indicates the doomsayers were wrong, and premiums under President Barack Obama's health care law aren't going through the roof.

The average increase for Obamacare plans will be 8.2 percent next year in 29 states and the District of Columbia where data about health insurance premiums for 2015 are available, according to PricewaterhouseCoopers, which has conducted the most thorough review to date. That's significant, but it's a little lower than the 10 percent annual rate hikes typical before the Affordable Care Act, according to a recent analysis published by the Commonwealth Fund.

The map below shows average premium increases in the states PricewaterhouseCoopers reviewed, with darker shades indicating higher rate hikes. States with limited information are shown in gray and states where no data were available are shown in white.

obamacare premiums 2015
See an interactive version of this map from PricewaterhouseCoopers.

But none of that is worth much to an individual consumer worried about her pocketbook, and it's no consolation to the family seeing rates for their coverage increase by 10 percent or more, even if that happens only to a fraction of the more than 15 million people the Henry J. Kaiser Family Foundation estimates are in this market.

Averages mask a lot of variation between the states, and even within them, because rates typically are set on a local level. Also, these big-picture numbers don't account for individual variables that affect prices, like age, family size and tobacco use. There are multiple health insurance companies operating in nearly all states, and each sells numerous products to individual households, both on and off the exchanges. The plan one consumer has this year could cost 15 percent more, while her next-door neighbor may see his price go down.

What's more, the numbers used by PricewaterhouseCoopers and others are preliminary in most states, meaning they could change after insurance regulators review them. Plus, states report the prices differently, making comparisons difficult.

Take Florida, where the anti-Obamacare administration of Gov. Rick Scott (R) says health insurance premiums will go up 13.2 percent on average next year. The U.S. Department of Health and Human Services responded to Florida's announcement by arguing that rates for the most popular type of insurance are actually going down in the areas where three-quarters of Sunshine State Obamacare enrollees live.

Similarly, in California, the health insurance exchange touted a 4.2 percent "weighted average" statewide increase, a calculation that considers the number of people on each health insurance plan, rather than a simple average of the price hikes. The state didn't release a plain average.

Comparing states, there's a wide gulf between a place like Oregon, where the average rate will be 2.5 percent lower, and Indiana, where the average price is set to increase 15.4 percent, the PricewaterhouseCoopers report shows. Even within those two states, the change in premiums varies a lot -- from 20.6 percent lower to 10.6 percent higher in Oregon, and from no increase to 35 percent higher in Indiana. Rates vary this year, too, as they have in the past.

The problem is, all of these numbers can be correct, but are are being placed into context by people who have an agenda. And they don't factor in the tax credits that subsidized premiums for 85 percent of the 8 million people who signed up on an exchange this year. While subsidies could shield those enrollees from higher premiums, these consumers still may have to shop around for a new, cheaper plan to keep their costs down next year.

Why will health insurance premiums rise, and why does it vary so much from location to location? There are a host of reasons. Some reflect the nature of the U.S. health care system, and some are Obamacare-related.

Mostly, insurance rates climb because health care costs climb, even though the growth in national health care spending has been historically slow for several years. Factors like prices for medical services and drugs and how much health care people use, vary by state and local area, for reasons that aren't always clear. Generally, premiums are lower in states where multiple insurers compete. All of this was true for 2014, and for every previous year.

What about the Obamacare effect? The most important change this year is that the law required insurance companies to cover people with pre-existing conditions, which led to the expectation that they would need more health care and drive up costs. The share of young adults who enrolled is below what the Obama administration hoped, and there's evidence that previously uninsured people are getting medical care, but that doesn't seem to be leading to widespread, massive price hikes.

The initial enrollment period didn't end until spring, so insurers still don't have a great idea of how much their new customers will cost them, As a result, they're making educated guesses about next year's premiums. This is one reason some companies are cutting rates or seeking big increases -- they guessed wrong last year and set prices too high or too low and want to boost enrollment next year. Increased competition in states where more insurers are joining exchanges also could keep premium increases down.

Why Obamacare May Have Trouble Signing Up As Many Uninsured Next Year

Jeffrey Young   |   August 14, 2014   12:46 PM ET

Obamacare made huge strides in extending health coverage to millions of uninsured people in its first year. Keeping up that momentum could be challenging.

An estimated 54 million Americans are still uninsured. But many of those who haven't yet been helped by the Affordable Care Act might be some of the hardest people to get signed up, according to the people trying to reach them.

"The people the second year are going to be a little bit harder. We got the low-hanging fruit," said Richard Onizuka, the CEO of the Washington Health Benefit Exchange, the insurance marketplace for consumers in Washington state.

More than 10 million previously uninsured people signed up after Obamacare enrollment began last October. That group is considered the most eager for coverage. People with pre-existing conditions, who had been shut out of the market under pre-Obamacare rules and needed health care the most, were now able to get covered. Lower-income families were offered expanded Medicaid and subsidized private insurance.

One big hurdle to future sign-ups is the public's chronically poor understanding of how key parts of Obamacare can help low- and middle-income people afford coverage. These include the availability of Medicaid or subsidies for people who earn up to four times the federal poverty level -- or $46,680 for a single person this year. And public opinion about the law itself is negative.

Certain segments of the population also proved more difficult to reach during the initial sign-up period. Sign-ups of Hispanics lagged behind those of other groups, even though the uninsured rate is higher among Hispanics. People who have less education, live in remote rural areas, are disconnected from community or religious groups, are homeless, don't have Internet access or don't consume news often may not always know that new programs are in place. And smaller numbers of people will find they can't afford even subsidized insurance, or will simply opt to remain uncovered.

And as evidence from California suggests, those who have been without health insurance the longest may turn out to be the most difficult to get signed up. Eighty-two percent of those still uninsured in the Golden State have lacked coverage for at least two years or have never had it, according to a survey by the Henry J. Kaiser Family Foundation in Menlo Park, California.

"There's an expectation that the farther along we go, that it will be the kind of chronically uninsured who end up being the hardest to reach," said Karen Pollitz, a senior fellow at the foundation.

No one expected Obamacare to give everyone health insurance in a single year -- or ever.

The Congressional Budget Office projects the law will reduce the uninsured by 12 million through the end of this year, but that just 7 million will gain coverage in 2015.

And the CBO also expects there still will be 57 million U.S. residents without health insurance a decade from now. That equals 11 percent of the population, including undocumented immigrants who are ineligible for government-supported health benefits. Though it's 26 million fewer uncovered people than there would be absent the ACA, the gap suggests the law can never achieve universal coverage.

Besides undocumented immigrants, there's another category of people left out of the coverage expansion: residents of the 24 states that took advantage of a Supreme Court ruling allowing them to refuse expanding Medicaid eligibility up to 133 percent of poverty, or $15,521 for a single person. The uninsured rate fell in states that expanded Medicaid, but barely moved in those that didn't, a July Gallup poll found. According to the Urban Institute, more than 60 percent of the remaining uninsured live in states that opted against expanding Medicaid.

The results of the first year of the coverage expansion, however, can't be denied. The most official national count of the uninsured, from the census, won't be available until more than a year from now. But numerous polls and analyses make plain that the ACA has made rapid progress in reducing their ranks despite the law's rocky rollout last year.

Obamacare reduced the number of people without health insurance by 10.3 million people in 2014, researchers from the Department of Health and Human Services and the Harvard School of Public Health reported in the New England Journal of Medicine in July. The uninsured rate fell 3.7 percentage points to 13.4 percent between last fall and this March, the lowest rate since 2008, according to Gallup.

Kentucky, which expanded Medicaid and operated a state-run exchange, achieved a big reduction in its uninsured rate, largely through Medicaid. With more than one-quarter of the state's residents now enrolled in that program, finding and signing up more eligible people may not be easy, said Lisa Lee, deputy commissioner of the state's Department for Medicaid Services. "It's almost like looking for a needle in a haystack at this point, but we will continue our aggressive outreach," she said.

In states that resisted Obamacare and didn't expand Medicaid, the path to making major progress on the uninsured is steeper, said Jodi Ray, program director of Florida Covering Kids & Families at the University of South Florida in Tampa.

"There's a huge number of folks," Ray said. "To assume we've captured all the low-hanging fruit would be a gross misstatement in a state like Florida."

An Enroll America survey conducted in April provides some insights into why uninsured people didn't get covered, and what might work to get them enrolled. One key finding is that 61 percent of them want health coverage, compared to 15 percent who don't.

Improving public understanding of the subsidies appears to be crucial to boosting enrollment. More than half of the people who signed up were aware there was financial assistance available, compared to just over one-quarter of those who didn't enroll, the survey shows. Likewise, nearly half of people who didn't try to enroll believed they couldn't afford it, according to the survey.

"There was sometimes a mismatch between perception and reality," said Jenny Sullivan, director of Enroll America's Best Practices Institute. "They didn't necessarily have the knowledge that financial help was available."

Advocates believe they can build on their success with methods that have already proven effective, such as in-person help with applications and spreading the word about financial assistance. Groups plan to expand such efforts to more communities and more people.

"We're going to see continued progress there," Sullivan said of the strategies. "It's really leaning into some of those very same messages that worked well during the first open enrollment period and making sure that we get those to an even broader swath of folks."

Companies Predict Small 2015 Health Cost Rise -- With A Catch

Jeffrey Young   |   August 13, 2014   10:06 AM ET

Large employers expect their health care expenses to rise a modest amount next year, but they plan to continue requiring workers to pay a growing share of the cost of medical care, according to survey findings released Wednesday.

The cost of job-based health insurance at big companies will go up 5 percent in 2015, approximately the same as it did the year before, the National Business Group on Health found in a June survey of 136 companies that employ about 7.5 million people.

Companies will constrain their health spending by shifting costs onto employees. Employer health care costs would be increasing 6.5 percent absent mechanisms like higher deductibles and other tools that make patients responsible for more of the bills they receive for doctor visits, prescription drugs and the like. Company health plans also more commonly require workers to get prior approval for the most expensive drugs or to try cheaper therapies before costlier ones are allowed, the survey shows.

While the most common type of job-based health plan remains a PPO, or preferred provider organization, that carries a deductible that's usually below $1,000, higher-deductible plans are becoming more popular among large companies as a way of limiting their own health care expenses.

Forty-four percent of employers said that so-called consumer-directed health plans, or CDHPs -- mostly high-deductible insurance paired with tax-free health savings accounts -- are the most common chosen by workers. These plans have lower monthly premiums, but expose workers to higher upfront costs before insurance starts paying a share of their bills.

Next year, fewer workers will have a choice between low- and high-deductible plans. Under a strategy known as "full replacement," 32 percent of companies will offer only high-deductible options next year, compared with 22 percent this year, the highest share this decade, according to the National Business Group on Health.

Consumer-directed health plans, higher employee cost-sharing, programs to manage workers' chronic diseases and employee wellness programs are the most effective ways to control health care costs, companies reported.

How Are Companies Trying To Save On Health Care?

employer health insurance

Source: National Business Group on Health

The rise in national health care spending has slowed to historic lows in recent years, but employers face other cost pressures, according to the survey. Workers with especially high medical expenses and particularly expensive ailments, such as joint and back problems, were most commonly identified by employers as causes of increasing medical costs.

The Affordable Care Act, also known as Obamacare, is a small factor by comparison, the survey reveals.

Why Are Company Health Care Costs Rising?

employer health insurance

Source: National Business Group on Health

Starting next year, employers with at least 100 full-time workers will have to offer health benefits to at least 70 percent of them or face financial penalties under Obamcare's employer mandate, the full effects of which have been delayed until 2016. But nearly all large employers already provided health insurance to full-time workers before the ACA and will continue to do so next year, the survey shows. Just 2 percent of companies reported they wouldn't offer health insurance that fully complies with Obamacare, compared with 81 percent that said they would.

Employers also are looking ahead to 2018, when another Obamacare policy is due to take effect, and which will require them to make changes to their health benefits. Under the law's "Cadillac tax," expensive health benefit plans will face a 40 percent tax on their value above $10,200 for an individual plan and $27,500 for family coverage. As with their overall cost-cutting strategies, companies are taking steps to reduce the cost of these plans to avoid or minimize the tax by using mechanisms like higher cost-sharing and expanded wellness programs, the survey shows.

Obamacare At Risk For 310,000 Who Must Provide Proof Of Legal Status

Jeffrey Young   |   August 12, 2014    2:41 PM ET

President Barack Obama's administration is contacting 310,000 Obamacare enrollees starting Tuesday to warn them that they must verify they are U.S. citizens or legal residents -- or their benefits will be cut off.

In letters being delivered in English and Spanish, the Centers for Medicare and Medicaid Services instructs the enrollees to provide additional documentation regarding their citizenship or immigration status by Sept. 5. Without that documentation, their health insurance plans will be rescinded Sept. 30. The recipients of these letters are people who have not responded to five to seven previous attempts to obtain their documents, according to a press release from the agency.

"We want as many consumers as possible to remain enrolled in marketplace coverage, so we are giving these individuals a last chance to submit their documents before their coverage through the marketplace will end," Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, said in the press release. Discrepancies in an individual's application does not necessarily mean that person is ineligible for coverage, the press release notes.

The 310,000 people being contacted represent only a small fraction of the more than 8 million individuals who have enrolled in private coverage via the Affordable Care Act's health insurance exchanges. Nonetheless, this effort by the administration underscores the challenges left from Obamacare's troubled first open enrollment period, which began last October for benefits that took effect this year.

Since the sign-ups in that six-month period ended, the Department of Health and Human Services has been working to reconcile problems with more than 2 million enrollees, including questions about the income they reported to qualify for subsidies and about their immigration status or citizenship.

Undocumented immigrants are barred from receiving subsidies under the Affordable Care Act or even using their own money to purchase health insurance on the exchanges. Immigrants who are legal residents or have become naturalized citizens can do both.

Initially, there were questions related to the citizenship or legal residency of some 970,000 individuals who applied for Obamacare subsidies, according to the Centers for Medicare and Medicaid Services. To date, the issues with 450,000 applicants have been resolved and another 210,000 are in process, the agency reported. These issues are specific to applications made through the federally run exchanges in 36 states, not the exchanges operated by the states themselves.

The largest number of letters are going to Florida, where 93,800 people haven't replied to prior requests by mail, phone or email, according to the agency. The next two states on the list are Texas, with 52,700 people affected, and Georgia, with 20,900.

Even after the letters are sent, federal authorities will try to make contact with these enrollees three more times before their benefits are canceled, an HHS official said on condition of anonymity. To help people document their eligibility for benefits, the federal government also is enlisting the aid of community-based organizations that provided application assistance during the enrollment period, Tavenner said in the press release.

Where Are The Obamacare Warning Letters Going?
obamacare enrollment immigration
Source: Centers for Medicare and Medicaid Services

Read the letter sent to Obamacare enrollees who have not adequately documented their citizenship or immigration status.

Act by September 5, 2014 or Your Marketplace Health Insurance May End

In States Where It's Wanted, Obamacare Is Working Well

Jeffrey Young   |   August 5, 2014    1:01 PM ET

Obamacare is already making a big difference in the states that actually embraced it.

States that expanded Medicaid and created their own health insurance exchanges, or worked closely with the federal government to cover more people, have shown the largest drops in their uninsured rates this year, according to a new poll released by Gallup and Healthways on Tuesday.

Leading the pack was Arkansas, where the uninsured rate has fallen by 10.1 percentage points so far this year, and Kentucky, where it has fallen 8.5 percentage points.

Multiple surveys and studies conducted since the first Affordable Care Act sign-up period officially ended on March 31 suggest President Barack Obama's signature health care reform law is succeeding in one of its chief aims: extending coverage to Americans who lacked health insurance.

The Gallup poll underscores the crucial role played by states, which varied in their approach to Obamacare from fully cooperating with its implementation to actively obstructing it. States have the option of establishing their own insurance exchanges, partnering with the federal government or deferring entirely to the Department of Health and Human Services. States also have a choice between accepting federal dollars to make Medicaid available to more of their poorest residents or rejecting the funding.

The results of those decisions are clear. States that welcomed the law saw significant drops in their uninsured rate, according to Gallup. The findings are consistent with other recent research showing the uninsured rate barely moved in states that didn't expand Medicaid.

The uninsured rate fell 10.1 percentage points to 12.4 percent as of June 30 in Arkansas, which broadened Medicaid eligibility through its "private option" plan using private insurance companies and teamed up with the federal government on an insurance exchange. Kentucky, which has its own exchange and expanded Medicaid, saw its uninsured rate drop 8.5 percentage points, to 11.9 percent. And in Delaware, which also expanded Medicaid and has a partnership exchange, the uninsured rate fell from 10.5 percent to 3.3 percent, Gallup found.

Washington state, Colorado, West Virginia, Oregon, California and New Mexico each cut their uninsured rates by at least 5 percentage points, and Connecticut's fell 4.9 percentage points.

Overall, the uninsured rate fell 4 percent in states that expanded Medicaid and either set up an exchange or partnered with the federal government, compared with 2.2 percent in states that did neither, Gallup found.

The nationwide uninsured rate is 13.4 percent, the lowest since 2008, Gallup reported in a separate survey last month. HHS estimates that thanks to Obamacare, more than 10 million more people are now covered by private health insurance, Medicaid or the Children's Health Insurance Program than before.

Even without expanding Medicaid, the uninsured rate still fell at least slightly in most states that didn't help with Obamacare, according to the Gallup poll. This likely is due in large part to the availability of subsidized private health insurance via the exchanges for people earning more than the federal poverty level, which was $11,490 for a single person during the enrollment period for this year.

For instance, several states that had higher-than-average uninsured rates saw declines. In Florida, the share of residents without health coverage declined 3.2 percentage points to 18.9 percent. In Texas, it dropped to 24 percent, a 3-percentage-point difference. And in Louisiana, 18.4 percent of residents are now uninsured, 3.3 percentage points lower than before Obamacare enrollment. Three states actually recorded an increase in the uninsured rate since September: Kansas, by 5.1 percentage points to 17.6 percent, Iowa, by 0.6 percentage points to 10.3 percent, and Virginia, by 0.1 percentage points to 13.4 percent Gallup found.

For 2014 enrollment, 26 states and the District of Columbia adopted the Medicaid expansion, 16 states and the District of Columbia fully operated exchanges, seven states opted for partnership exchanges and the remainder allowed HHS to run their exchanges. The breakdown of state and federal exchanges may be different for the enrollment period for 2015 health coverage that begins Nov. 15. For example, Idaho plans to switch to a state-run exchange, while Oregon will allow the federal government to handle enrollment.

For its study, Gallup interviewed almost 89,000 adults in all 50 states and the District of Columbia by phone. The margin of error ranges from plus or minus 1 percentage point to 3.5 percentage points in states with small populations, such as Delaware, Hawaii, North Dakota, South Dakota and Wyoming.

CORRECTION: An earlier version of this article incorrectly reported two states, Kansas and Iowa, recorded an increase in the uninsured rate. Virginia also experienced a rise in the share of uninsured residents.

Congress Could Easily Fix A Huge Obamacare Problem. It Won't

Jeffrey Young   |   August 5, 2014    7:39 AM ET

WASHINGTON -- A handful of simple words in a piece of legislation could prevent more than 4 million people losing their health insurance, but Congress isn't going to write them.

At issue are several lawsuits against Obamacare moving through the legal system that may go all the way to the Supreme Court. Among other things, the suits contend the precise phrasing of the Affordable Care Act means that low- and moderate-income health insurance consumers in most states can't receive subsidies to make coverage more affordable.

Lawmakers could end that threat any time by changing the law's wording to make it clear subsidies are available nationwide. But in today's take-no-prisoners Congress, Republicans won't let it happen and Democrats won't even try.

"The political point has been very clearly made by Democrats: Let's fix it," said Rep. Henry Waxman (D-Calif.), who was chairman of the the House Energy and Commerce Committee, one of five panels that wrote the law in 2009 and 2010, and is now its ranking Democrat. "The Republicans won't allow it. The only thing they want to pass is repeal."

It's a sign not just of the unruly politics of President Barack Obama's health care reform law, but of the dysfunction that has taken root in a national legislature that used to routinely pass so-called technical corrections bills to clear up legislative ambiguity and assert Congress' authority.

"In the past, when you had even highly charged or controversial legislation, the attitude that members had, for the most part, was 'What's done is done. It's the law now. Let's make it work as best we can,'" said Norman Ornstein, resident scholar at the American Enterprise Institute and co-author of a book about Congress and contemporary politics entitled It's Even Worse Than It Looks.

"We're seeing this play out on a larger stage, on issue after issue after issue," such as this year's failure to pass an immigration and border security bill and the near-failure to keep highway funding flowing, Ornstein said. This follows other self-imposed crises, like last year's government shutdown.

Even confined to health care, there are numerous examples of Congress addressing problems in laws already enacted. Medicare itself has underdone many changes since 1965. The 2003 Medicare drug benefit law has been amended. The Balanced Budget Act of 1997 was followed by the Balanced Budget Refinement Act of 1999. And that's not including the countless small corrections to legislative errors that become part of larger bills.

Instead, this is where we are on Obamacare. The day two federal appeals courts offered divergent opinions last month on whether subsidies could be given individuals purchasing coverage on a federally run health insurance exchange, critics of the law didn't move to clear any ambiguity. They jumped to kill the entire bill.

“Today’s ruling is also further proof that President Obama’s health care law is completely unworkable. It cannot be fixed," House Speaker John Boehner (R-Ohio) said in a statement July 22.

These lawsuits come down to the phrase "exchange established by the state,” which appears in the Affordable Care Act. In a nutshell, the plaintiffs argue this means the tax credits available to people who earn up to four times the poverty level, which is $94,200 for a family of four this year, only can go to people who bought their health insurance in one of the 15 state-run health insurance exchanges, not the federal exchanges in 36 states.

Like other Democrats, Waxman rejects the contention that the law doesn't intend subsidies to be granted nationally. But he does acknowledge the Affordable Care Act language needs to be cleaned up in places.

Public opinion supports the Democrats' point of view, sort of. A majority of Americans disapprove of the Affordable Care Act, as illustrated by a poll conducted last month by the Henry J. Kaiser Family Foundation, but a larger majority prefers fixing it to repealing it, which Republicans have voted to do dozens of times.

But rather than write a bill that would make those lawsuits disappear and force Republicans to oppose people losing their health insurance, Democrats won't even try. To do so would provide Republicans more ammunition against Obamacare, Waxman said. "We're just giving Republicans an opportunity to say, 'Look at all these problems,'" he said.

So obstruction from Republicans and defeatism, however realistic, from Democrats means that potentially huge problems like these Obamacare lawsuits go unaddressed. And there are other known issues with the law that are undercutting its aims.

Waxman cited another example, known as the "family glitch," which blocks subsidies for spouses and dependents of workers whose employers offer health insurance only to them, and not their families. That means one parent could get health benefits from work, but the rest of the family still couldn't afford coverage.

Sen. Brian Schatz (Hawaii) and four other Democrats actually introduced a bill to fix ambiguous language in one part of Obamacare that could deprive Native Americans of health benefits. A few lawmakers also have floated more fundamental changes to the Affordable Care Act, like a bill from Sen. Ron Wyden (D-Ore.) and then-Sen. Scott Brown (R-Mass.), and a set of proposals from a sextet of moderate Democrats this year. None of them have gone anywhere.

When lawmakers have agreed to changes to Obamacare, it's mainly been to cut funding for things like preventive medicine and nonprofit insurance companies, or to ease tax filing for businesses -- not to make it work better.

And then there are the numerous cases where the Obama administration has stepped in to rectify confounding aspects of the law.

For instance, the Affordable Care Act requires members of Congress and their aides to get their benefits from the health insurance exchange in the District of Columbia, rather than from the federal employees' plan. But this part of the law wasn't clear whether the federal government would help pay for Capitol Hill employees' insurance, as it does for other government workers. So the administration wrote regulations saying it could. Some Republicans freaked out over the fix. Sen. Ron Johnson (R-Wis.) is still suing the president over it.

The administration also has postponed a number of Obamacare policies, like the employer mandate, that Congress could have adjusted with legislation. In a more collaborative political universe, the White House would have pushed for a legislative fix. But Republicans made clear that they'd attach amendments delaying the individual mandate as well -- something that would derail the entire law. And so, the president chose to make an administrative delay and Boehner responded by pledging a lawsuit.

"One of the great ironies here is that with the obduracy in the House and among Senate Republicans -- 'All we want to do is focus on repeal' -- they're abdicating their own power," Ornstein said. "They're giving it to the courts. They're giving it, especially, to the executive branch. They're leaving a vacuum here, and that vacuum's going to be filled."

Sabrina Siddiqui and Laura Bassett contributed reporting.

Obamacare Is More Unpopular Than Ever, Poll Shows

Jeffrey Young   |   August 1, 2014   12:00 AM ET

A majority of Americans disapprove of Obamacare, the highest share since President Barack Obama's health care reforms became law more than four years ago, according to survey findings released Friday.

The Henry J. Kaiser Family Foundation's health care tracking poll for July reveals that 53 percent of people view the Affordable Care Act unfavorably, a jump of 8 percentage points since June. July's results mark the fifth time since April 2010, and the first time since January, that at least half of Americans are not supportive of the health care reform law.

The poll found that the share of people who view Obamacare favorably fell slightly, to 37 percent, marking the lowest rating the law has received since its passage. Views about the ACA remain sharply partisan.

Most People Don't Like This Obamacare Thing

obamacare poll

The rising opposition to the Affordable Care Act and the corresponding sinking approval come despite Obamacare's rebound from the disastrous, chaotic launch of HealthCare.gov and the first enrollment period that began last fall.

By April, more than 8 million people had used the law's health insurance exchanges to sign up for private coverage, with 86 percent of enrollees receiving financial assistance. Millions more enrolled into Medicaid or the Children's Health Insurance Program, which offers insurance to children in families with incomes too high for Medicaid.

The law also appears to be significantly reducing the ranks of the uninsured. According to the Department of Health and Human Services, the number of uninsured people in the nation has dropped by 10 million people because of Obamacare enrollment.

But Obamacare has always had weak support among the American public. Previous Kaiser Family Foundation surveys show only three months since Congress passed the law in March 2010 when more people approved than disapproved.

The list of reasons is lengthy. Republicans have been unrelenting in their attacks, such as the lawsuit planned by House Speaker John Boehner (R-Ohio) against Obama for delaying the law's employer mandate. The public has remained strongly opposed to key features of the law, especially its individual mandate that nearly everyone obtain health coverage, and memories linger of Obama's broken promise that people would be able to keep their current insurance policies. Polls also show that many Americans, including the uninsured, believe they can't afford the insurance sold on the Obamacare exchanges, and aren't aware that financial assistance is available.

And alongside bits of good news for Obama, like the falling number of uninsured Americans, is more bad news, like a federal appeals court ruling last week that would devastate Obamacare, and a federal audit this week concluding the HealthCare.gov debacle still isn't fully resolved.

The new Kaiser Family Foundation survey shows how Americans' perceptions of Obamacare are shaped. Less than half of those polled had discussed the Affordable Care Act with family or friends, and just over half had seen TV ads about it. However, what people did talk about or see was negative.

If People Hear About Obamacare, It's Likely To Be Something Bad

obamacare poll

More than half of respondents said they hadn't personally been affected by Obamacare. Of the people who said they had been affected, more were likely to say it had harmed them or their families than helped.

Another Kaiser Family Foundation report, published last month, got markedly different results when polling only those who had enrolled into coverage through the Obamacare exchanges. More than half of the people who used a health insurance exchange, and 60 percent of those who received financial assistance, said they had benefitted from the law.

Even as many people expressed negative opinions about the Affordable Care Act, the poll also found that 60 percent of Americans don't favor repealing it (the GOP's standard take when it comes to the law). Instead, people said they want Congress to improve the law. These views also fell along party lines.

Repair, Not Repeal And Replace

obamacare poll

Moreover, Americans seem to want Obama and Congress to work on subjects other than health care reform, the survey shows.

There's More To Life Than Obamacare

obamacare poll

Obamacare Prices In California Only Going Up A Little Next Year

Jeffrey Young   |   July 31, 2014    4:27 PM ET

Nearly nine in 10 Californians with a plan purchased through the state's health insurance exchange will see price increases of less than 8 percent next year, the exchange, Covered California, announced Thursday.

The weighted average rate across California will be 4.2 percent higher than this year. The new, estimated rate is calculated by factoring in increases and decreases, as well as the number of consumers in each health plan, according to a press release. The new premiums are preliminary, pending review by other state regulators. Ten health insurance companies will offer plans on the exchange, which is three fewer than this year.

"It's good news for California. It's good news for the Affordable Care Act," said Peter Lee, the executive director of Covered California. The 2015 increases are lower than annual hikes in the years before Obamacare, he said. "We've been seeing consumers facing 10 percent or more in rate increases year over year. This year, 4.2 percent is the average increase," Lee said.

Since the enactment of the Affordable Care Act, California has positioned itself as a national leader in health care reform. The state created its own health insurance exchange and participated in the law's expansion of Medicaid to more low-income residents. And California's uninsured rate was more than halved by the end of the first Obamacare enrollment period that ended this spring, as 3.4 million Californians gained coverage, according to the Henry J. Kaiser Family Foundation. Prior to Obamacare, California had one of the highest uninsured rates in the nation.

"We still are at the starting point, and we know we have a long way to go," Lee said.

The low average price increases for 2015 could quell fears of double-digit rate hikes in the state, but individual consumers' experiences will vary.

Thirteen percent of Covered California users are in health plans that will see price increases of more than 8 percent, and more than 35 percent of users will see rate hikes between 5 percent and 8 percent. Another 35 percent will pay less than 5 percent more, while 16 percent of policyholders have plans with prices that will stay roughly flat, or even decrease, according to Covered California. Average increases differ among the state's geographic areas and based on other factors, including age.

"Averages are meaningless. What's meaningful is to talk about a person's circumstances," Lee said. Consumers facing rate increases who shop around on the exchange during the next open enrollment period, which runs nationwide from Nov. 15 to Feb. 15, 2015, may find a comparable plan at a lower price, he said. Californians can review next year's rates for specific health insurance plans on the exchange's website as of today, he said.

These 2015 rate increases follow a significant one-time bump in prices for coverage on California's individual market last year. That increase was caused by Obamacare's benefit mandates and its prohibition against insurers rejecting consumers based on their health.

According to California Insurance Commissioner Dave Jones, prices rose anywhere from 22 percent to 88 percent from 2013 to 2014, although those rates don't factor in the effect of tax credits that reduce what customers pay. For 2014 benefits, 88 percent of Covered California users received such financial assistance. Jones supports a proposition pending on the ballot that would empower his office to reject insurance price increases, while Covered California's leadership has been skeptical. Lee on Thursday called Jones' findings "misleading and distracting."

California's health insurance premium increases appear in line with preliminary information coming from other states, although some consumers will face significant increases if they remain on their current plans next year. State and federal regulators are reviewing companies' proposed rates.