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Obamacare Sign-Ups Hit 8 Million In Remarkable Turnaround

Jeffrey Young   |   April 17, 2014    3:54 PM ET

In a remarkable rebound from the botched rollout of Obamacare, 8 million people have signed up for private health insurance via the exchanges created by the Affordable Care Act since October, President Barack Obama announced during a press briefing at the White House Thursday.

March and April saw an uptick in the share of young people signing up for private plans using the exchanges. These people, who are presumably healthier, are needed to balance out the medical costs of older, sicker consumers. About 35 percent of people who signed up throughout the open enrollment period were under 35 years old, including children, Obama said. Twenty-eight percent were between the ages of 18 and 34, according to a White House fact sheet.

The official six-month enrollment period ended March 31, but the federal government and most states accommodated people trying to complete applications in April amid a last-minute surge for subsidized private coverage and Medicaid benefits.

"This law is working," Obama said. "This law won't solve all the problems in our health care system. We know we've got more work to do, but we now know for a fact that repealing the Affordable Care Act would increase the deficit, raise premiums for millions of Americans, and take insurance away from millions more."

Obama urged Republicans, who remain almost universally opposed to the health care law, to move on. "I find it strange that the Republican position on this law is still stuck in the same place that is has always been. They still can't bring themselves to admit that the Affordable Care Act is working," he said.

With the congressional GOP continuing its nationwide anti-Obamacare campaign heading into this fall's congressional elections, Obama's exhortations are in vain. “The president may want to silence any further debate about Obamacare, but in doing so he betrays a lack of confidence in his own policies and scant regard for those most affected by the law,” Senate Minority Leader Mitch McConnell (R-Ky.) said in a written statement.

Nevertheless, the inaugural Obamacare sign-up period managed to exceed expectations in the end, despite the disastrous rollout of and troubles with state-run exchanges in Oregon, Maryland and elsewhere. The Congressional Budget Office originally predicted that 7 million people would enroll in private coverage via the exchanges, and later downgraded it to 6 million to reflect the troubled enrollment websites.

On Oct. 1, only 6 people were able to enroll using the federally run health insurance exchanges, and just 106,000 enrolled nationwide in all of October.

By contrast, 3.7 million people have signed up since March 1, reflecting a massive influx of new customers into the system as the March 31 deadline to get private coverage -- and avoid paying tax penalties for violating the law's individual mandate -- loomed. The Obama administration and most states permitted enrollments to continue into April for those who had started applications or whose applications were snarled by technical problems.

The share of young adults who signed up over the six-plus months of enrollment represents an increase from the first half of the sign-up period, when less than one-fourth of private plan customers were younger than 35. The White House originally hoped that around 40 percent of private insurance customers would be younger, and presumably healthier. The proportion of younger customers who signed up this year is nearly identical to the first year of Massachusetts' health care reform program in 2007, which served as a model for the Affordable Care Act.

The ratio of young to old -- being used as an imperfect proxy for the ratio of sick to healthy -- will help determine premiums for plans sold on the exchanges next year. Although health insurance companies like WellPoint already are speculating about rate hikes that exceed 10 percent, price increases on that scale may not be in the offing, and other insurers are more bullish on Obamacare.

The Society of Actuaries, which analyzes insurance, predicts average premiums will increase 6 percent to 8.5 percent next year, compared to 7 percent to 10 percent in previous years. Rate increases will vary by state and locality, as well.

The Obama administration hasn't yet released a breakdown of the enrollment figures that would allow for a full analysis of the first year of sign-ups through the exchange marketplaces.

The 8 million figure touted by the president Thursday doesn't include what likely is millions of consumers who purchased plans directly from health insurance companies or through a private agent or broker.

Those policyholders are as important to the insurance systems in each state as those who signed up via an exchange because their medical costs will be pooled together, which will determine how much premiums will rise next year. According to a Gallup poll, this segment of the market disproportionately avoided the exchanges and obtained coverage directly from an insurer, a finding supported by previous data released by eHealth, an online insurance broker.

The latest numbers also don't fully account for the effects of the Affordable Care Act's expansion of Medicaid to more low-income people, which 26 states and the District of Columbia adopted. Between October and February, total enrollment in those programs increased by 3 million people, according to the White House. The number may increase, however, as federal and state authorities sort through incomplete and stalled enrollments in these programs.

Moreover, crucial information remains unavailable, such as what proportion of customers secured their coverage by paying premiums to their health insurance providers, and how many of the private plan and Medicaid enrollees previously were uninsured.

Polling, estimates from outside groups, and leading indicators from sources beyond the Obama administration hint at the answers to some of these vital questions.

Survey data from Gallup and others indicates the share of Americans without health insurance has declined since the exchanges opened for business in October. According to Gallup, the uninsured rate went down from 18 percent in the fourth quarter of last year to 15.6 percent in the first three months of 2014. The rate declined further in states that adopted the Medicaid expansion, created their own health insurance exchanges, or both, Gallup reported.

The Congressional Budget Office expects the number of uninsured to decline by 12 million during 2014, according to a report issued this week. The CBO maintains that 6 million, not 8 million, people will secure private coverage via a health insurance exchange, largely because some customers won't pay their first premium or will let coverage lapse during the year, and because some will cycle out of the exchanges into other forms of insurance. The CBO also reduced its estimates for the cost of the Affordable Care Act.

Most, but not all, of those who enrolled using a health insurance exchange seem to have paid premiums, with estimates cited by former Health and Human Services Secretary Kathleen Sebelius, health insurance companies and some state officials at 80 percent and higher. That share may rise in the coming weeks as bills become due for those who signed up near or after the March 31 deadline for coverage that begins May 1.

The enrollment numbers will continue to be fluid throughout the year. People who experience "qualifying life events," such as getting married or moving to a new state, can shop for health insurance on the exchanges year-round, and enrollment in Medicaid and the Children's Health Insurance Program can be done at any time. The next open enrollment period begins Nov. 15, 2014, and ends Feb. 15, 2015.

Americans Pay Way More For This Than People In Other Countries

Jeffrey Young   |   April 17, 2014    8:00 AM ET

As anyone who's ever paid a health insurance premium or a hospital bill knows, medical care is expensive. What Americans may not know is that residents of other countries don't pay nearly as much for the same things.

The latest data from the International Federation of Health Plans, an industry group representing health insurers from 28 countries including the United States, once again illustrates that American patients pay the highest prices in the world for a variety of prescription drugs and common procedures like childbirth and hospital stays.

And despite the persistent claims by nearly anyone holding or seeking public office in the U.S. that America has the best health care system in the world, there's scant evidence that we're getting higher-quality medical treatment or enjoying healthier lives than our counterparts abroad. What's more, the U.S. still leaves tens of millions of its own citizens without health coverage, and will continue to do so even a decade into the implementation of Obamacare.

To illustrate just how much more Americans pay for health care, the International Federation of Health Plans compared the prices for common medicines and services around the world in a report released on Thursday.

A prescription for Nexium, a popular remedy for acid reflux disease and other stomach ailments, costs $215 on average in the U.S., which is more than 3.5 times the cost in Switzerland, the second-most-expensive nation for Nexium prescriptions, and almost 10 times more than what Dutch people pay.

health care costs

Prescription drugs are particularly expensive in the U.S. relative to elsewhere in large part because most other countries set prices for medicines through their universal health care programs, which the U.S. doesn't have. This can hit hardest for people, even those with health insurance, when they need the latest medicines to treat serious diseases.

Look at the price differences in the U.S. for these big-ticket prescription drugs, which are about twice as expensive in America as in the next-highest country and much more so than in the lowest-cost nations.

health care costs

health care costs

health care costs

Sticker shock isn't just due at the pharmacy counter. U.S. hospitals, which took in the largest share of the $2.79 trillion Americans spent on health care in 2012, also charge more for many procedures than hospitals overseas, the report shows. The average daily cost of just being in a hospital is almost twice as expensive in the United States as it is in New Zealand, and almost 10 times as costly as stay in a Spanish hospital.

health care costs

Likewise, the average price for heart bypass surgery in the U.S. is quite a bit higher than what the rest of the world pays, especially people in the Netherlands, who get off comparatively cheaply.

health care costs

Being born in the United States has loads of advantages, but the cost of doing so isn't one of them, the report shows. A normal delivery is more expensive in the U.S. than in any of the other countries studied, and a Cesarean section is even costlier.

health care costs

health care costs

Read the entire International Federation of Health Plans report below:

International Federation of Health Plans 2013 Comparative Price Report

CORRECTION:An earlier version of this story incorrectly stated that the drug Nexium is available over the counter.

5 Things The Obamacare Enrollment Numbers Won't Tell You

Jeffrey Young   |   April 2, 2014   10:19 AM ET

So is Obamacare a success? Has President Barack Obama's signature health reform law revolutionized our broken health care system?

More than 7 million people used the Affordable Care Act's health insurance exchanges to buy private coverage through Monday, the end of the first sign-up period. Certainly the Obama administration is touting this as a huge victory.

"In these first six months, we've taken a big step forward," Obama said in the White House Rose Garden Tuesday. "The Affordable Care Act hasn't completely fixed our long-broken health care system, but this law has made our health care system a lot better."

Yet, there's still much we don't know about what the law has accomplished. Until we have answers to these five questions, it's still early to assess the full impact of Obamacare.

1. How many people really signed up for health insurance?

The 7.1 million figure the White House cited may be too low. The raw number doesn't include all of the most recent updates from 14 states and the District of Columbia, which have their own websites and saw a flurry of activity leading up to the open enrollment deadline. Nor does it include the applications still pending at the exchanges. Also missing: those who will sign up throughout the year when they become eligible because of a major life change, like marriage or moving to another state.

People who bought Obamacare-compliant insurance directly from a carrier aren't counted either.

Confusingly, the 7 million number may also be too high: We don't know how many of those people took the crucial final step and actually paid their first month's insurance premium to lock in coverage. Based on anecdotal reports from individual insurance companies, Health and Human Services Secretary Kathleen Sebelius said 80 percent to 90 percent of consumers thus far had paid up. There also will surely be people who let their policies lapse during the rest of the year.

2. How many uninsured people gained coverage?

It's logical to assume that the Affordable Care Act reduced the ranks of the uninsured. There's a legal mandate to most people get covered or face tax penalties, and the law expands Medicaid and offers generous subsidies to low-income households. But logic isn't the same as data, and the Census survey many consider the gold standard won't even come out until September 2015.

Although the federal government can't or won't say how many enrollees from and state exchanges used to be uninsured, some states are reporting those figures. In Kentucky, 270,000 of the 370,000 people who enrolled via Kynect, the state's exchange, were uninsured -- meaning 43 percent of the Kentuckians without coverage are now enrolled. Likewise, more 70 percent of the 865,000 enrollees on New York State of Health previously were uninsured.

And an unknown number of uninsured people bought private insurance outside the exchanges. From Jan. 1 to mid-March, for example, 51 percent of those buying unsubsidized coverage via online broker eHealth reported they were uninsured. In addition, as many as 3 million young adults are now covered because of the 2010 Obamacare rule letting them remain on their parents' plans until they turn 26, according to the Department of Health and Human Services.

There are signs that the impact is real. According to unpublished survey data from the Rand Corp. obtained by the Los Angeles Times, the rate of uninsured working adults fell from 20.9 percent last fall to 16.6 percent on March 22, which the newspaper calculates as 9.5 million people gaining coverage via Medicaid and private insurance. Gallup also has reported a decline in the uninsured rate.

There were 48 million uninsured people in America in 2012, according to the most recent Census report. The Congressional Budget Office projects the share of legal U.S. residents without health coverage will decline from 14 percent this year to 8 percent by 2024.

But even these survey data are open to some degree of doubt. People transition on and off insurance for a variety of reasons that predate Obamacare, like getting or losing a job and its health benefits, so it's difficult to tease what's happening because of the law.

And despite persistent claims from Republican Obamacare critics, the several million people whose policies got canceled last year because they didn't meet the law's standards aren't now uninsured. Nearly all replaced that coverage with other plans, according to the Rand Corp.

3. Did enough healthy, young people get private insurance to balance out the costs of sicker people?

As of March 1, about one-quarter of nationwide private insurance enrollees were between the ages of 18 and 34, according to the Department of Health and Human Services. This matters because if only those who are heavy users of health care get covered, their medical bills will drive up future premiums. The White House originally hoped that 40 percent of those who bought the insurance would be young people, using age as an imperfect proxy for health.

The final share may or may not tick up much higher than 25 percent, but several health insurance companies recently have said their new customers were trending younger near the end of the enrollment period. EHealth reported the share of customers aged 18-34 rose from 39 percent during the first half to 45 percent during the second half.

And the impact on next year's premiums will be mitigated by Affordable Care Act funding mechanisms designed to limit the losses for insurers that attract a larger-than-normal share of sick customers.

4. How many people enrolled in Medicaid coverage?

This one should be easy to answer, but it isn't.

According to the March HHS report, 4.4 million people were deemed eligible for Medicaid or the Children's Health Insurance Program via the health insurance exchanges, including individuals who qualified because the law expanded Medicaid and those who were entitled under the old rules but weren't signed up. That figure doesn't count anyone who signed up for the programs directly through a state agency.

A February report from the Centers for Medicare and Medicaid Services revealing that state agencies deemed 8.9 million people eligible for these programs also is problematic. That figure includes a mix of people gaining access because of Obamacare, people who previously were eligible but not enrolled and people who are simply renewing their existing benefits.

Finally, Medicaid and CHIP enrollment are open year-round, so more people will sign up while others drop out over the remainder of 2014. Twenty-four states haven't adopted Obamacare's Medicaid expansion, however, which will suppress enrollment.

5. How much more is health insurance going to cost next year?

Health insurance companies like WellPoint already are making noises about "double digit" premium hikes for 2015. That reflects their concern that the new customers they gained via the exchanges are sicker than the customers they had last year, since the law now requires them to accept anyone regardless of pre-existing conditions.

There's virtually no doubt that health insurance rates will rise on average next year, because they always do. The questions are: How much will they rise, for whom and where?

The overall enrollment figures and the proportion of healthy and sick aren't what matter here. Under the Affordable Care Act, every state is its own health insurance risk pool, and sometimes it goes down to the county and local levels.

That means insurance companies will base their rates on the medical expenses they incur in each geographic location, not nationwide. The proportion of private insurance exchange customers under 35 years old varies a lot from state to state, as does the health of those populations. So consumers in some regions may get hit with big rate hikes next year, while consumers in others may see much smaller increases, or even decreases.

Obamacare Deadline Safety Valve Comes In Handy As Website Buckles

Jeffrey Young   |   March 31, 2014   10:12 PM ET

The latest tweak to the Obamacare deadline came in handy Monday when buckled during the rush by millions to sign up for health insurance by the original midnight cutoff.

Americans seeking to obtain health coverage at the last minute, and avoid tax penalties for remaining uninsured, flooded exchange websites and telephone lines Monday, with a record 3 million visits to and 1 million phone calls as of 8 p.m., according to the Department of Health and Human Services.

Federal officials said last week that people who couldn't enroll because of problems with would have more time to sign up. Some state-run health insurance exchanges offered similar flexibility for people who started applications prior to the March 31 deadline.

"There will be an opportunity for those who have initiated the process but aren’t able to finish it by midnight tonight to ensure that they get signed up for health insurance," White House press secretary Jay Carney said Monday. "If they start, they’ll be able to finish."

The intense interest in getting covered before the midnight deadline exposed the vulnerability of and exchange websites like Covered California and Maryland Health Connection throughout the day. went down early Monday, its account-creation system failed during the afternoon and a "virtual waiting room" deployed several times when users stretched the website's capacity.

Although the President Barack Obama's administration and authorities in states such as California and Connecticut didn't technically extend the deadline for the end of the six-month sign-up period for private insurance via the exchanges, would-be enrollees snarled by technical problems can continue to enroll over the coming weeks, the administration said Wednesday.

Glitches on Monday were a far cry from the disaster that occured from when launched Oct. 1 through late November, and multiple readers told The Huffington Post that they'd successfully signed up. Others, however, were left without the coverage they sought.

Kelly O'Donnell, 35, of Greensboro, N.C., has been struggling to get an application filed for nearly a week and had no more luck Monday than before. When O'Donnell visited Monday, she was greeted by the virtual waiting room and opted to enter her email address to get notified when the website was ready to take on more users. But when the message arrived, the website still didn't work.

"I have used three different browsers and every time I am able to login but it takes me to a blank page," O'Donnell wrote in an email to HuffPost. Initially, O'Donnell worried she'd be subject to tax penalties for violating the Affordable Care Act's individual mandate that most Americans obtain health coverage, but now will give it another shot after the deadline.

"We're trying to start a family this year, so I definitely need health insurance," O'Donnell said by telephone.

The Obama administration hasn't said when the "special enrollment period" will end for people in the 36 states using the federal health insurance exchanges. State-run exchange policies vary and the extra time will extend as late as April 30 in Oregon. Health insurance exchanges like New York State of Health, Vermont Health Connect, Maryland Health Connection, AccessHealth CT in Connecticut, and Covered California took to social media to promote the extra time for those who couldn't complete their applications by midnight.

In spite of the problems, others reported the website and enrollment process functioned smoothly.

Oklahoma City resident Louis Dollarhide, 62, spent 45 minutes on Monday morning and encountered no difficulties, he told HuffPost in a telephone interview. "It just clicks right through. I thought it was very straightforward, and I'm not a tech geek at all," he said.

Dollarhide has been uninsured since his previous employer closed four years ago. Now self-employed, he has been unable to afford new coverage because he has a condition called hereditary hemochromatosis that causes high levels of iron in the blood. "It's very easy to manage but it freaks these insurance companies out."

"I had a pre-existing condition, and so when I would get quotes for insurance, it was just astronomical. And I've always been in good health, even though I have this strange deal. It never causes any problems," Dollarhide said. An insurer once quoted him a $800 monthly premium, which was more than he could pay, he said. Health insurance companies can neither turn down people with pre-existing conditions nor charge them higher rates than healthy people under the Affordable Care Act.

Using, Dollarhide signed up for a "silver" plan, the second-lowest level of coverage available on the exchanges, for $289 a month, including tax credits that reduced his costs. Asked why he waited until the last day of the enrollment period to shop, Dollarhide replied: "Laziness and procrastination."

Obamacare Enrollment Surging With Last-Minute Sign-Ups

Jeffrey Young   |   March 31, 2014   12:27 PM ET

On the last day to sign up for Obamacare, evidence appears to be mounting that what started as a disaster may turn out a success.

Monday is the deadline to enroll in health insurance for 2014 via the health insurance exchanges created by President Barack Obama's Affordable Care Act, and it's clear that many waited until the last minute. The looming deadline and fear of the penalty for not getting covered has driven millions of people to the exchange websites, enrollment events and health insurance companies over the past few days. and some state-run health insurance exchanges suffered software glitches and buckled under heavy demand Monday.

The final rush could push the total number of private insurance enrollments well past the 6 million figure touted by the Obama administration last week. Obamacare sign-ups may wind up closer to the 7 million originally predicted for the first year.

"It's kind of the lead-up to Christmas right now, and all the last-minute shoppers are out," said Brian Lobley, senior vice president for marketing and consumer business at Independence Blue Cross in Philadelphia.

The company, which serves the city and its surrounding suburbs, signed up 28,000 customers in less than three weeks in March. It signed up 90,000 in the five months prior.

Edward Patton, 43, became one of those last-minute sign-ups Saturday afternoon. Patton, who works at a gas station, stumbled onto an enrollment event at a ShopRite grocery store near his home in Philadelphia.

"I just came to pick up a couple things," said Patton, who has never had health coverage before. He also picked up a "silver" level health insurance plan, the second-lowest level of coverage available on the exchanges, for $77.49 a month, including tax credits, which was far less than he expected to pay, he said. "This is good, just in case, because I barely get sick," he said.

obamacare deadline day
Paydon Miller of Enroll America, left, and enrollment counselor Francine Piesto at a ShopRite in Philadelphia Saturday.

Signing up the healthy and the young is critical to the health of the healthcare law. And based on anecdotal accounts from health insurance companies, the surge is also bringing along young adults in greater numbers.

"We're definitely seeing some younger consumers, as our average age of an applicant is going down," said Kurt Kossen, the vice president for retail marketing at Chicago-based Health Care Service Corp., which operates Blue Cross and Blue Shield companies in Illinois, Montana, New Mexico, Oklahoma and Texas. Online insurance broker eHealth reported a similar trend last week.

obamacare deadline day
Insurance agents working for Independence Blue Cross assist customers signing up for health coverage at the company's Philadelphia headquarters Saturday.

In order to make premiums affordable in future years, insurers need healthier people to offset the high medical costs of older, sicker people who now have guaranteed access to coverage. Adults 18 to 34 years old made up one-quarter of nationwide enrollments through March 1, according to the Department of Health and Human Services, a proportion lower than the roughly 40 percent the White House is seeking.

Not everyone is so pleased with their new health plans. Households with incomes above four times the poverty limit, or about $95,400 for a family of four, don't qualify for financial assistance and can face hundreds of dollars in premiums every month for even basic coverage. And many people who previously purchased their own coverage directly from insurance companies saw their policies canceled last year because they didn't meet ACA standards, and had to replace them with plans that are often costlier because the mandated benefits are more generous.

The vulnerability of Obama's signature domestic policy achievement was evident during the early hours of Monday morning, when went down due to what the White House described as a software error not related to traffic on the website. The outage echoed the technical failures that marred the debut of the health insurance exchanges on Oct. 1 and hampered the first two months of the six-month enrollment period. also drew record demand Monday when 1.2 million users visited the website by noon Eastern Time. First-time users of the website weren't able to create accounts for about an hour Monday afternoon and administrators twice activated the site's "virtual waiting room" when the number of people trying to log in surpassed its capacity, which is estimated at 100,000 users at once. State-run exchange websites in places like California and Maryland also experienced some difficulties. Telephone call centers for the exchanges were swamped by consumers seeking help, as well.

Although Monday is the nominal deadline for anyone who doesn't have health coverage to get insured this year, enrollments will continue through the coming weeks, since the Obama administration and most state-run health insurance exchanges are leaving the systems open for those who already started their applications but have not completed them by the end of the day.

Consumers in states using federally managed exchanges via can self-attest that they began the process prior to the deadline to qualify for a so-called special enrollment period. Across the remaining states, the rules vary. For example, in Connecticut, Monday remains the hard deadline, while Oregon residents have until the end of April.

Those who don't get health benefits from their jobs or through a government program won't be able to purchase private health insurance until the next open enrollment period begins Nov. 15 for policies that will take effect on Jan. 1, 2015.

Most people who fail to enroll in coverage for this year will face tax penalties under the ACA's individual mandate. There are a slew of exemptions from the mandate, however, and the health insurance exchanges will remain open for people who experience "qualifying life events," such as moving to a new state or losing their current health insurance plan. In addition, individuals eligible for Medicaid and the Children's Health Insurance Program can enroll year-round.

Despite the apparent turnaround since the disastrous October launch of the exchanges, the future of Obamacare is uncertain. Comprehensive data on how many people fully enrolled by paying their insurance premiums and how many of the previously uninsured gained coverage because of the law won't be available for some time, nor will information about the medical costs of those who purchased private insurance via the exchange or directly from an insurer.

The process of preparing for the 2015 enrollment period will start almost immediately after the inaugural sign-up period ends, as health insurance companies must begin making projections about how much their new customers will cost them, and therefore how much to raise rates for next year. The federal government and states like Oregon and Maryland, which faced major technical problems, also must decide how to improve their performance so that next year's enrollment period goes more smoothly than this year's.

This post has been updated with information on traffic to on Monday afternoon.

What You Need To Know About Obamacare's Individual Mandate

Jeffrey Young   |   March 25, 2014    8:41 AM ET

The big Obamacare deadline looming on March 31 isn't just the last chance for most Americans to buy health insurance this year. It's also the last chance to avoid paying penalties under the Affordable Care Act's dreaded "individual mandate."

The individual mandate is one of the best-known but least-understood parts of President Barack Obama's signature health-care reform law. Here's how the mandate works, how much it costs to ignore the rule, and how you may be able to get out of it.

Who must have health insurance under Obamacare?

Practically everybody. But most Americans won't have to do anything on March 31. That's because about 80 percent of Americans already have health coverage -- through their jobs, a government program like Medicare or Medicaid, or directly from an insurance company. The small percentage of Americans who aren't insured risk having to pay a penalty under Obamacare. The complicated official name for this is the "individual shared responsibility payment." The IRS has more information, in case you thirst for still more complicated official language.

Who is exempt?

Many people are exempt from the mandate. Undocumented immigrants don't have to comply because they're not even allowed to use Obamacare's new insurance exchanges to buy coverage. Many Native Americans also don't have to comply, nor do those whose religious beliefs reject health insurance, people who don't make enough money to file federal income taxes, and people who can't find a health plan that costs less than 8 percent of their incomes. There's a full list here.

Then there's the "hardship exemption." The Obama administration is interpreting this part of the ACA very broadly, opening the door for lots and lots of people to potentially qualify.

There are 14 different categories of hardship exemption, including things like being homeless, experiencing a death in the family, and filing for bankruptcy. And the administration is letting anyone whose old insurance policy was canceled because it didn't meet Obamacare standards apply for an exemption. The vaguest exemption, and therefore potentially the most useful to people who don't want to get health coverage, is described as: "You experienced another hardship in obtaining health insurance." And for some of these 14 reasons, you're not even required to show documentation of your hardship.

What's the penalty for not having health insurance?

People who go without coverage for more than three months this year will owe the IRS money for each additional month they are uninsured when they file their federal income taxes next year. The minimum penalty is $95 for each adult in a household and $47.50 for each child younger than 18 years old, capped at $285 no matter how large a family is. There's also some wiggle room regarding the three-month grace period: Anyone who enrolls by the end of this month won't owe a penalty even though their benefits may not kick until May 1.

Most taxpayers subject to the penalty will owe more than that, though. Under the law, the amount is the higher of $95 or 1 percent of household income minus the first $10,150 for a single person or $20,300 for a married couple filing jointly. So a married couple with two minor children and $50,000 in taxable income would owe $297, according to a calculator created by the Tax Policy Center at the Brookings Institution.

But there's a limit to how much anyone would ever pay. The penalty is capped at the national average annual price for a "bronze" health insurance plan on the Obamacare exchanges, the lowest-level plan available to everyone. The IRS hasn't calculated what that amount is yet, but the Tax Policy Center estimates that it's $3,600 for a single person and $11,000 for a family of four.

The penalties start getting bigger next year and will be $695 or 2.5 percent of income by 2016. So being uninsured when you can afford coverage -- according to Obamacare, anyway -- will get expensive. While it's cheaper than health insurance, you don't get anything in return and are still responsible for paying your own medical bills.

How is the individual mandate enforced?

In a word? Lightly. The ACA doesn't let the IRS come after you if you don't pay the penalty. Failing to pay isn't a crime. The government can't garnish your wages or put liens on your property to collect the money. Basically, the only way the IRS can get the dough against your will is to deduct it from your tax refund.

What's more, the IRS really doesn't have any way of checking whether you're really insured if you say so when you file taxes.

Why are we doing all of this anyway again?

The theory behind the individual mandate is that the way to create an insurance market that lets people with pre-existing conditions get covered at reasonable prices is to make everyone participate.

Without some way to push healthy people into the insurance market, the fear is that it'll fall apart. Mostly sick people would get insurance, which would drive up prices, which would lead to healthier people deciding not to buy any, which would force insurers to raise rates to cover their expenses, which would lead to even more healthy people opting out. That cycle is called a "death spiral" in insurancespeak.

The individual mandate is not a popular policy at all for obvious reasons (Obama himself even used to oppose it). But the Supreme Court ruled two years ago that it's Constitutional, so we have to deal with it. Massachusetts has had an individual mandate since 2007, and it's worked out pretty well there.

What's Up With Matt Drudge's Weird Tweet About Obamacare?

Jeffrey Young   |   March 21, 2014    4:43 PM ET

That Matt Drudge, proprietor of The Drudge Report, is a lusty hater of Obamacare isn't a revelation. And the mercurial man behind the mammoth aggregator of right-leaning news has already declared he will go without health insurance for the rest of his life just to prove a point of some kind.

Even knowing all that, this tweet from Drudge on Friday was a little head-scratching:

Liberty tax! The whole thing is weird, considering that the tax penalty that adds bite to the the "individual mandate" -- the Affordable Care Act's diktat that most Americans have some form of health coverage -- isn't even due until more than a year from now, when people file their 2014 federal income-tax returns.

The White House jumped right on Drudge, in the form of a tweet from spokesman Jesse Lee.

Briefly, here's how the individual mandate works: If you lack health insurance for more than three months in a year, you have to pay the IRS a penalty. (There are a whole slew of exemptions from this rule, however.) The penalty will be assessed on your tax return and taken out of whatever refund you're owed. Again, that won't happen until 2015 for people who aren't covered this year.

For 2014, the minimum penalty for an individual is $95 or 1 percent of your taxable income minus the first $10,150, whichever is higher. The penalty is capped at $3,600 for a single person this year, according to an estimate from the Tax Policy Center at the Brookings Institution. Families pay more depending on the number of people in the household. And the penalty is bigger in future years.

Of course, Drudge doesn't think the cost of the mandate penalty is any more real than President Barack Obama's birth certificate.

So is Drudge lying, as Lee asserted? Maybe! There does, however, appear to be one possible explanation that would make Drudge's statement truthful, albeit still curious.

If Drudge pays estimated income taxes every quarter -- a common practice for someone who is self-employed or is the sole proprietor of a business -- he could have guesstimated what his penalty will be and added that amount to the check he apparently cut to the IRS on Friday.

"That's perplexing," said Brian Haile, the senior vice president for health-care policy at Jackson Hewitt Tax Service, a tax-preparation company. The IRS has no mechanism in place yet to even accept individual mandate penalties and hasn't even published the tables taxpayers will use to work out how much they owe. Plus, any money sent in can't be earmarked especially for that, he explained. The IRS didn't respond to a request for additional information about collecting mandate penalties. Drudge didn't respond to an email asking him to elaborate on his tweet.

"For whatever reason, Matt Drudge has decided to give the government an interest-free loan," Haile said.

Odd move for a small-government, anti-tax guy to make.

UPDATE: Drudge followed up on his earlier tweet and seems to confirm that he paid estimated taxes for the first quarter of this year on Friday. The mandate penalty nevertheless is separate from income taxes and isn't due until 2015.

How This Anti-Obamacare Ad Misses The Big Picture On Health Care

Jeffrey Young   |   March 18, 2014    1:39 PM ET

Beneath all the partisan fury about Obamacare lies a surprisingly fundamental question: Just what exactly counts as health insurance?

A recent ad produced by an anti-Obamacare organization illustrates the issue. The Americans for Prosperity video features a Tennessee woman named Emilie Lamb whose monthly health insurance premium under Obamacare rose to $373 from $52.

Lamb, a 40-year-old accountant from Lawrenceburg who suffers from the chronic, incurable auto-immune disease lupus, is unhappy about the price hike. "I thought that Obamacare was going to be a good thing. Instead of helping, Obamacare has made my life almost impossible," she says in the Americans for Prosperity video.

To pay for the increase, Lamb took a second job doing bookkeeping on weekends and now works more than 50 hours a week, she wrote in an email to The Huffington Post. She's also published an op-ed in the New York Post, was the subject of another anti-Obamacare op-ed by Rep. Marsha Blackburn (R-Tenn.) in The Hill, and was Blackburn's guest at the State of the Union address in Washington, D.C., last month.

Yet, it's debatable whether Lamb was ever really "insured" under her old plan, a subsidized Tennessee state program called CoverTN, for people who earn up to $55,000 a year.

That policy only covered Lamb's medical costs up to $25,000 a year. Had she gone over that amount and incurred thousands of dollars in hospitalization costs -- a real possibility for someone with her condition -- she would've been thrown into debt like so many other Americans in the pre-Obamacare landscape. Her old plan also limited how many times she could see a doctor in a year and capped hospitalization benefits.

If real health insurance were available for $52 a month, that's what everyone would have. BlueCross BlueShield of Tennessee, which administered Lamb's policy, didn't even call it "insurance," instead describing it as a "limited-benefit plan," the pro-Obamacare group Families USA noted in a 2009 report critical of CoverTN.

Lamb's new insurance, a top-notch "platinum" plan from the health insurance exchange, offers unlimited annual coverage, has no deductible, limits out-of-pocket expenses to $1,500 a year and comes with a rich benefits package as mandated by the Affordable Care Act. Lamb qualified for a tax credit that reduces her premiums by about $15 a month.

Her old plan is now illegal under Obamacare and is off the market. Much in the way that it's no longer legal to buy a car with no seat belts, it's no longer possible to buy health insurance that doesn't provide basic access to health care services and a high level of security against medical debt. Likewise, most states require a car owner to carry a minimum level of liability coverage -- not for the sake of that driver, but to protect anyone who might be harmed in a crash.

While consumers like Lamb are opposed to the changes forced by the law, larger societal and economic factors are at work. If patients are free to choose health policies that won't cover major medical expenses, that affects everyone else. Doctors and hospitals won't get paid, and those costs get spread throughout the health care system -- and passed on to taxpayers, who pick up a share of the cost of unpaid hospital bills every year through funding streams built into Medicare and Medicaid.

But this is a complex, difficult reality of the health care system that's not easy to simplify for a 60-second political advertisement set to sad music, and not as compelling as the personal story of a sick woman with limited means who's angry about changes she can't control.

Another person in Lamb's position could reasonably come to the opposite conclusion: that the Affordable Care Act's guarantee of coverage for people with pre-existing conditions, its comprehensive benefits package and the financial assistance it provides are tailor-made for a low- to middle-income person with a chronic medical condition like lupus. Under the old rules, a lupus patient could have been turned down for coverage or kicked off their plans when they got sick, and could have been charged higher prices than a healthier person.

It's worth noting that Lamb opted for a high-value and higher-cost platinum plan, instead of a cheaper bronze, silver or gold plan. She did so because a patient with ongoing health needs can save money by spending more on premiums and less on out-of-pocket costs, she told the Washington Post. A cheaper premium might well result in higher annual costs when deductibles and co-payments are figured in.

By Lamb's estimate, her annual costs will be about $4,500 higher with her new coverage, although she originally wrote in the New York Post and told other news outlets that number was $6,000. Is it worth it? Not in her opinion.

But consider a hypothetical alternative situation in which CoverTN still existed and Lamb still had its benefits. Depending on the severity of the disease and therapies prescribed, the average annual cost of lupus treatments ranges from $13,735 to $62,651, according to the Lupus Foundation of America. A bad year could drive her medical bills above $25,000.

"I am sure that my health care needs will change over the years. I know that I am not getting any younger, and every day I feel the effects of lupus a little more," Lamb wrote to HuffPost. Her current symptoms include patchy skin, fatigue, chronic joint and muscle pain, and kidney infections and stones, she wrote.

Lamb isn't worried about excess costs, though. When she racked up a $125,000 in medical costs after a horseback riding accident in 2007, CoverTN wound up footing most of her bills and keeping her below the $25,000 cap. She speculates that her medical providers would be willing to slash her bills again or set up a payment plan.

Philanthropy from an insurance company and a hospital isn't something most Americans would expect to rely on, though.

Ask anyone whose medical bills are in the hands of a collections agency, or who had to file for bankruptcy. What if the insurer couldn't drive the price down or the hospital refused to accept less than it was owed? Odds are Lamb would be financially devastated by medical bills that she'd never be able pay off, leaving health care providers and taxpayers holding the bag.

Walking The Uninsured Through Obamacare Sign-Ups Is Tiring And Tedious. It Also Works

Jeffrey Young   |   March 17, 2014    2:32 PM ET

SALISBURY, Md. -- If you're wondering why the Obama administration is still so far from its goal of enrolling 6 million Americans into Obamacare, look no further than Maryland's Lower Eastern Shore.

The area is home to Ocean City, a local beach getaway. But beyond the sand, the three counties that make up the Lower Eastern Shore -- Somerset, Wicomico and Worcester -- also are known as some of the poorest areas in Maryland, with high rates of poverty, unemployment and uninsurance. In 2011, about 20,000 of the counties' 178,000 residents lacked health insurance, according to the most recent census data. That 14 percent rate was the fourth-worst in Maryland that year, and above the 2011 statewide uninsurance rate of 12 percent.

It is now up to a team of just 15 county health workers to get those people covered under the Affordable Care Act, President Barack Obama's signature health care reform law.

Convincing this poor, Republican-leaning population -- the area elected the state's only GOP member of the House and voted for Mitt Romney in 2012 -- to sign up for health insurance under Obamacare is painstaking work done at the individual level. A health worker must sit down with someone and guide them through the process -- that is, if they can find the uninsured.

"The uninsured are really hard to pinpoint. I mean, they're working families and individuals, and we have so many people who are self-employed, under-employed, contractors, farmers, watermen, service-sector Ocean City resort employees, small-business employees," said Katherine Gunby, the coordinator for the outreach program here.

"It's just a matter of making it clear to them that most of them are eligible for some type of assistance, and this is how they can get help signing up," Gunby, a 30-year-old from Salisbury, said.

On a recent Saturday, Gunby and her team from the Lower Shore Health Insurance Assistance Program set up shop in a local arena for one of the largest Obamacare enrollment events the area had yet seen.

obamacare enrollment marylandStickers at the event in Maryland.

Gunby's small crew, which operates out of the Worcester County Health Department with state funds of about $1.2 million, is responsible for spreading the word about the availability of the Affordable Care Act's two main components: subsidized private health insurance and Medicaid, a health benefit that's been expanded to include more poor Americans in half of the states, including Maryland. They have a huge swath of the state to cover -- three counties spread across 1,100 square miles.

The Maryland-run Obamacare website is making Gunby's job harder. The Maryland Health Connection has proved one of the worst health insurance exchanges in the nation thanks to its unreliable website and overwhelmed call center.

At the March 8 enrollment event, Gunby, her team of 10 Obamacare "connectors," and four health insurance brokers were joined by two information technology technicians from the state, who were on hand to deal with website issues. Carolyn Quattrocki, the interim director of Maryland's troubled exchange, also attended to oversee the event in person.

During the five-hour event, people streamed into the Wicomico Youth & Civic Center in Salisbury to sign up for health insurance. Some waited more than a half-hour to be seen and more than an hour to get through their applications, seeking help applying for private insurance or Medicaid.

Attendees interviewed by The Huffington Post left happy. Amanda Weaver, a 33-year-old self-employed wedding photographer from Salisbury, signed up her family for coverage that's cheaper and more comprehensive than the plan she gave up in November when she left Starbucks, where she worked for the health benefits, to focus on growing a business. Lamont Morton, a 27-year-old from Fruitland who'd been unemployed and uninsured for three years after being laid off by Coca-Cola, left the civic center enrolled in a Medicaid plan from a private insurer.

"We finally got a plan," said Sheila Fisher, a two-time cancer survivor from Westover who had been unable to afford health insurance before Obamacare's passage prohibited health insurers from charging astronomical rates to those with "pre-existing conditions." For $271 a month including tax credits that cut the cost, Sheila and her husband, Samuel, got a low-level "bronze" plan plus dental coverage. The couple had been uninsured for three years.

obamacare enrollment maryland
Samuel and Sheila Fisher of Westover, Md., enrolled in a health plan at a Lower Shore Health Insurance Assistance Program event in Salisbury, Md., on March 8.

"We've seen just what can happen when you run up hospital bills and you own property," said Samuel Fisher, who works three hours away in a Washington, D.C., restaurant. Medical debts left after the death of Shelia Fisher's mother last year have been an issue for their family, he said.

The Fishers tried to sign up online and over the phone, but Maryland Health Connection failed them, he said. Technical problems with their application kept them at the civic center for more than an hour and half.

As is well-known, technological glitches have hampered both, the online portal to the health care exchanges in 36 states, and state-run marketplaces in locations like Oregon, Hawaii and Massachusetts. As improvements have rolled out at the federal and state levels, enrollments on the exchanges have continued to mount, topping 4.2 million in February.

Now that the March 31 deadline for private insurance enrollment is nearing and workers are figuring out ways around glitches, the pace of enrollment seems to be speeding up, according to one Lower Shore Health Insurance Assistance Program worker.

"We've gotten very busy over the last couple of weeks or so, and we're kind of expecting things to stay strong up until the end," said Jalissa Worthy, 25, of Salisbury.

So-called connectors like Worthy travel the surrounding counties each day spreading the word about how to sign up for health coverage. The 15 workers on Gunby's team typically visit a total of 30 locations every day, she said. That includes many events held across the area every week at county health departments, libraries, pharmacies, religious institutions, community health centers and other gathering places.

"We're 100 percent mobile. On my busiest day, I move between three locations," Worthy said.

Worthy grew up on the Lower Eastern Shore and understands that the need is great. "I remember as a kid, lots of family members and lots of people in my local community who did work out on the water or who did work in the crab houses and the seafood places. And over the years, those have kind of dwindled down to nothing," she said.

obamacare enrollment maryland
Lamont Morton, who signed up for insurance at the March event in Maryland.

Other local industries have also shed jobs over the last decade or two, said Sue Gray, the CEO of Three Lower Counties Community Services in Salisbury, which operates community health centers in the area. "I've lived here 30 years, and we lost a lot of industry. Since we moved here, we lost Campbell's Soup, we lost Crown Cork and Seal, we lost Wayne Pumps," said Gray, a nurse by training.

Poultry conglomerates like Perdue Farms and Tyson Foods still provide a lot of jobs in the area, but not enough to go around. When jobs go, often so does access to affordable health insurance.

Unemployment, poverty and a lack of insurance aren't the only reasons why many people in this area need assistance with their health care, Gray said. "We have, as you could imagine, a large amount of people with comorbid conditions, where they are diabetic, hypertensive, overweight, have cardiac diseases," she said.

Not that every eligible person on the Lower Eastern Shore is clamoring to enroll. The team has to overcome misconceptions -- like the idea that there aren't any options for insurance, just one big program called "Obamacare" that everyone must join, Worthy said.

And some people still don't feel like they can afford health insurance even with subsidies, especially those for whom work is unsteady and income hard to predict, Worthy said. Poor people are forced to concentrate on their immediate needs, so committing to a bill they're not sure they can pay every month isn't always the obvious choice, she said.

"They only thing you can do is present the benefits to people and really try to have an honest conversation with them," she said. "I just try to get them to think of the long-term consequences."

OF COURSE Health Insurance Will Cost More Next Year ... It Does Every Year

Jeffrey Young   |   March 13, 2014    5:22 PM ET

Health and Human Services Secretary Kathleen Sebelius let loose a bombshell during her appearance before a congressional committee Wednesday: Health insurance will cost more next year than it does this year!

Enter House Speaker John Boehner (R-Ohio).

Here are some other things that are "likely" to happen in 2015: The sun will rise every morning, "The Big Bang Theory" will be popular, and the Chicago Cubs will not win the World Series.

Health insurance premiums go up. That's what they do. Health insurance gets more expensive every year, like pretty much everything else. In fact, health insurance gets more expensive faster than lots of things, such as wages and overall economic growth.

This chart from the Henry J. Kaiser Foundation and the Health Research and Educational Trust, based on a survey of employers, shows just how much costlier health insurance has become. Since 1999, premiums for a single worker rose almost 270 percent.

health insurance premiums 2015 Source: Henry J. Kaiser Family Foundation

Those figures refer to job-based health insurance, so prices are different than the cost of individual coverage available via Obamacare's health insurance exchanges, which are for people who don't get coverage from employers. Comprehensive data on the individual market are harder to come by, but a report from online insurance broker eHealth about the products they provide shows rate increases are the norm for these plans, too.

The average premium for an individual rose 32 percent between 2005 and 2012, according to the company's report.

The Wall Street Journal article Boehner tweeted starts like this:

Health and Human Services Secretary Kathleen Sebelius said health-insurance premiums are "likely to go up" in 2015, an acknowledgment that the Obama administration doesn't believe the sweeping changes to the health-insurance marketplace will end premium increases in the near term.

Here, the newspaper appears to take President Barack Obama's administration to task for not believing something it never claimed to believe in the first place: That, within the remarkably short period of 24 months, decades of health insurance rate hikes would suddenly reverse themselves.

And here's how the Daily Mail characterized the Health and Human Services secretary's banal statement: "Sebelius admits Obamacare will raise health insurance premiums in 2015."

Granted, Obama and his deputies shoulder blame for making it easy for people to believe that acknowledging something as obvious as increasing health insurance premiums constitutes news.

The health care reform law is called "the Affordable Care Act," for one thing. And the administration routinely cites the lower prices that some people will pay for coverage bought on the health insurance exchanges, chiefly those with low incomes now getting subsidized rates, and those whose pre-existing conditions, gender or age subjected them to higher rates under the old system. What they don't spend much time talking about are the people whose premiums rose this year as a result of the law's benefit mandates and the fact that those other folks are paying less.

And then there's the lingering aroma of Obama's implausible 2008 campaign pledge that his health care policies would save every household $2,500 a year on insurance. Obama's campaign platform isn't the same as the Affordable Care Act, but PolitiFact still rates this a "broken promise."

But the more salient question for the millions of people who've used the health insurance exchanges to buy coverage, and the millions more who buy directly from insurers, and the millions on top of that who are eligible to use the exchanges is: How much will premiums go up in 2015?

Sebelius has a guess, via the Wall Street Journal:

"I think premiums are likely to go up, but at a smaller pace than what we've seen since 2010," Mrs. Sebelius said, adding that she thought the likely increases would be less significant than they had been in the years before the federal health-care law was enacted.

Of course, Sebelius is only speculating. No one knows what health insurance premiums will look like on the exchanges next year.

The relatively small number of younger (and presumably healthier) people who've signed up so far is a cause for concern that mostly sick people bought this coverage, and that they'll run up big medical bills. That would lead insurers to raise rates for 2015 to make up the money. There are guardrails built into the law to mitigate this problem, so the effects on premiums may be modest anyway.

Even health insurance companies don't know what's going to happen because they don't yet know how their new customers will behave, and won't have much time to figure it out before they propose next year's rates to federal and state regulators.

But Sebelius isn't making her rosy prediction in the absence of at least some evidence.

Overall national health care spending has been growing at historically low rates over the last few years, for a start. Whether that's related to the Affordable Care Act is debatable, but the trend isn't. Furthermore, health insurance premiums for job-based plans also have been rising more slowly than usual, as the Kaiser Family Foundation and Health Research and Educational Trust data show. If things continue along this trajectory -- a very big if -- then future annual premium increases could be smaller than what consumers have gotten used to.

John Boehner didn't tweet about any of that, though.

The Uninsured Are Turning Against Obamacare. That's A Problem

Jeffrey Young   |   February 26, 2014    4:30 PM ET

The Obama administration is running into a somewhat surprising roadblock in its final push to get Americans enrolled in Obamacare ahead of the March 31 deadline: The nation's uninsured are increasingly suspicious of the law.

Fifty-six percent of those who identified as uninsured in a new poll conducted in February by the Henry J. Kaiser Family Foundation, a research institution, had an unfavorable view of the health care reform law, compared to just 22 percent who said they view it favorably. The uninsured now see Obamacare less favorably than they did when the enrollment period began in October. As recently as September, more uninsured approved of the law than disapproved.

The survey results illustrate just how deep a hole the Obama administration is in when it comes to gaining the support of those the law is most intended to benefit. Indeed, the new findings show the uninsured feel worse about the law than the public at large. Thirty-five percent of Americans approve of Obamacare and 47 percent are against it, according to Kaiser.

(Story continues below chart.)
uninsured obamacare

Now President Barack Obama and his allies are once again promising to ramp up their outreach efforts to get as many uninsured Americans as possible signed up for coverage.

"We’ve got more work to do. The fact is that we want everybody covered, not just some. That was always the intention and everybody now has the opportunity to get covered," Obama said at an Organizing for Action event Tuesday. "Right now, we’ve only got a few weeks left. March 31, that's the last call."

In addition to Obama personally promoting the law and the Affordable Care Act's health insurance exchanges offering an easy way for people to comparison shop, Vice President Joe Biden appeared on ABC's The View Tuesday, Health and Human Services Secretary Kathleen Sebelius is traveling the country to get the word out, and Democratic members of Congress are pushing back after Republican efforts to repeal the law.

At the same time, organizations supportive of health care reform like Enroll America and Organizing for Action are vowing a big, final push to boost enrollment numbers past the 4 million already signed up for private coverage.

An unfavorable opinion of Obamacare among a majority of the uninsured arose in spite of ballyhooed "microtargeting" campaigns to reach that part of the population, including those run out of the White House and those carried out by Enroll America, a nonprofit led by Obama campaign veterans. Using census data and other information, the idea was to target education, outreach and enrollment efforts in geographic areas with large concentrations of low-income, uninsured people who could benefit from the law's subsidized or no-cost health insurance, including cities like Houston and Miami located in states resisting the implementation of the Affordable Care Act.

The skepticism among the uninsured revealed by this survey isn't reflective of what Enroll America workers and volunteers hear from the people they contact, Anne Filipic, the group's president, said during a conference call with reporters Wednesday. The emphasis during those interactions is on practical concerns, not politics, she said. "The focus is on the opportunities that are available to consumers."

Enroll America announced its final push for 2014 enrollment Wednesday, calling it "Countdown to Get Covered." The organization, boosted by allied groups including the Service Employees International Union and the Planned Parenthood Federation of America, will stage more than 3,000 events across the country, including a bus tour through Ohio and Texas that will include local elected officials and leaders of religious organizations. The bus will visit Austin, Texas, during the South By Southwest music festival. Special emphasis will be placed on reaching out to African-Americans and Latinos and to students at community colleges.

"We know that people are hungry for these new options and eager to enroll when they find out what is available to them," Filipic said. "We will be pushing right up until the March 31 deadline to make sure as many Americans as possible are able to get covered."

The relatively small impact of these kinds of campaigns so far, however, is evident in another finding from the Kaiser Family Foundation poll: just 15 percent of the uninsured and 13 percent of respondents overall said they'd been personally contacted about the Affordable Care Act by telephone, email, text message, or door-to-door visit.

Combined with a relentlessly contentious political debate and overwhelmingly negative news media coverage of the troubled rollout of the health insurance exchanges, it's not surprising that uninsured Americans continue to have poor knowledge of the Affordable Care Act.

More than one-quarter of the uninsured report knowing nothing at all about the health insurance exchanges, with 37 percent more saying they know only a little. That compares with 24 percent who claim some knowledge and 12 percent who told pollsters they know a lot.

And 60 percent of the uninsured didn't know (or refused to respond) that March 31 is the last day to obtain health coverage for 2014 and to avoid financial penalties for violating the law's individual mandate requiring most Americans get covered. Less than a quarter of the uninsured knew about the March 31 deadline. In spite of all the outreach work and the publicity about Obamacare, lack of awareness remains a major obstacle, just as it did in September before enrollment began.

uninsured obamacare

Here's Why The Richest Nation In The World Still Can't Get Health Care Right

Jeffrey Young   |   February 13, 2014    7:16 AM ET

WASHINGTON -- Five years ago, U.S. President Barack Obama and his Democratic Party had a crazy idea that maybe the richest nation in the history of the world should do something to make its fragmented, inequitable and very expensive health care system a little better.

So you Yanks finally got around to establishing universal health care? Welcome to the mid-20th century!

Thanks, but that's not quite right. Even after the Affordable Care Act is more than a decade old, there will still be 31 million people who don't have health insurance. That's 25 million fewer uninsured than there would have been without the new law, but it's still a lot of people. Undocumented immigrants are left out of the health insurance exchanges and Medicaid. Some Americans can't afford insurance even when it's subsidized. Others will simply go without and choose to pay a tax penalty for remaining uninsured.

But people must be happy and relieved to have guaranteed access to health coverage now, especially those too poor to afford it, right?

Er, no. Pretty much from the start, the American public hasn't been happy about what's come to be known as Obamacare. The botched rollout last year of the biggest part of the law -- online marketplaces where people can shop for health insurance and receive government subsidies to help pay for it -- didn't help matters.

There's a big partisan divide, with liberals viewing the law more favorably and conservatives viewing it as, well, the worst thing that's ever happened. Overall, it's just not very popular, as these survey results show.

January Continues Post-Rollout Shift In Opinion

Source: Henry J. Kaiser Family Foundation

Worse, it's not popular among the very people it's supposed to help: those with no health insurance.

Among Uninsured, Unfavorable Views Outnumber Favorable By Two-To-One

Source: Henry J. Kaiser Family Foundation

The Republican Party in Congress has made repealing the law a top priority since winning control of the House of Representatives in the 2010 elections, and Republican officials in individual states have fought the law at every turn, including filing a constitutional challenge that went all the way to the Supreme Court, which ultimately upheld the law.

Then the American health care system must have been pretty amazing before Obama started mucking with it -- with high quality and low costs, right?

Are you running for Congress? American politicians love saying the United States has the best health care system in the world. And it's partly true. American pharmaceutical and medical device companies as well as premier medical institutions develop groundbreaking treatments all the time. That's why rich foreigners come to places like the Mayo Clinic in Rochester, Minn., and Johns Hopkins Hospital in Baltimore (it's hard to imagine rich foreigners going to those places for any other reason).

But American exceptionalism has a dark side. A U.S. Census Bureau report found that in 2012, more than 15 percent of the population -- 48 million people -- had no health insurance, which means they had limited access to medical care and were at risk of facing crippling debt if they got sick or injured. African Americans and Hispanics lack health insurance at disproportionate rates, and the uninsured are more likely to be poor, under 35 years old and living in the south of the United States.

So those are your have-nots. It's not a perfectly pretty picture for the haves, either. America spends a ton of money on health care, and that spending has risen faster than the U.S. economy for decades, though it's slowed a bit in recent years -- which might have something to do with Obamacare.

health care spending

Source: Health Affairs

Study after study demonstrates that Americans pay higher prices -- sometimes a lot higher -- for medical care than do residents of other developed countries.

health care costs

Source: International Federation of Health Plans

And what do we get for all the extra money we spend? Not better quality health care. The U.S. has worse life expectancy and infant mortality rates than other nations, and Americans are more likely to be obese and have diabetes. We don't talk about that at our Fourth of July cookouts.

Now I'm stumped. Why is everyone so upset? Is Obamacare disrupting the health care enjoyed by those already covered?

The truth is, most of the reforms affect only a tiny sliver of the health insurance market. Although the U.S. has a large number of uninsured residents, a majority of the population already had coverage, and nearly all of those people are going to keep the same coverage.

Where Americans Get Health Insurance

american health care

Source: U.S. Census Bureau data via U.S. Department of Health and Human Services

The Affordable Care Act will predominantly affect people who buy health coverage directly from an insurance carrier. About 3 percent to 5 percent of people -- or what amounts to 10 to 15 million people -- fall into this category. Insurers used to be allowed to reject applicants who had pre-existing medical conditions and charge higher prices for sick people, middle-aged customers and women. They can't do that anymore. However, these changes have unsettled those already participating in this market, in some cases by raising prices and in others by limiting the number of doctors and hospitals patients can use. So those folks are pretty angry.

The most common source of health insurance for Americans is employers, which provide benefits to more than 170 million workers and their dependents. Companies pick up the lion's share of the cost in most cases, and although workers forego higher wages in exchange for those benefits, it's also totally tax-free.

And despite the heated rhetoric from conservatives about the horrors of socialized medicine, more than one-in-five Americans are covered by government health care programs, according to the U.S. Census Bureau. Medicaid and the Children's Health Insurance Program cover about 60 million low-income people, and Medicaid is poised to grow by millions more under Obamacare.

Then there's Medicare, the health benefit for about 50 million retirees and people with disabilities. It's a single-payer, socialized, government-financed health care program. And yet, Americans revere it -- even those same conservatives who claim the (mostly private-sector-based) Obamacare will destroy the fabric of the nation.

american health care explained
Republicans like 2012 vice presidential nominee Paul Ryan love nothing more than socialized medicine -- when its name is Medicare.

This seems like a big mess. What's going to happen?

Republicans continue to assail the law and will likely use its shortcomings to hammer at Obama's Democratic Party in this year's congressional elections and the presidential contest just two years away.

The thing is, though, it'd be extremely difficult to put the toothpaste back in the tube. As of Jan. 1, millions of people are enrolled in private health insurance through Obamacare, and most are receiving federal subsidies. The soonest Republicans could gain control of the White House is January 2017 -- by which time even more Americans will be getting their health coverage from Obamacare. In the meantime, Obama certainly won't go along with ploys to gut the program. It is called "Obamacare," after all.

Millions Are Now Realizing They're Too Poor For Obamacare

Jeffrey Young   |   January 31, 2014    8:58 AM ET

Thanks to a Supreme Court ruling and staunch Republican resistance, Marc Alphonse, an unemployed 40-year-old Marine veteran who is essentially homeless, cannot get health insurance under Obamacare.

Three years ago, Alphonse learned he has a kidney disorder that will deteriorate into kidney failure, and possibly prove fatal, if left untreated. As it stands now, he suffers from bouts of nausea caused by his dysfunctional kidneys, and he's dogged by an old knee injury that limits his job prospects. He gets by on $400 a month in unemployment benefits, and his family can no longer afford housing in their home city of Miami. Alphonse's 28-year-old wife, Danielle, and three young children are staying with relatives while Alphonse couch surfs.

"I live from family to family until I'm able to get myself situated," he told The Huffington Post.

Alphonse is one of nearly 5 million uninsured Americans caught in a cruel gap that renders some Americans "too poor for Obamacare."

Broken Promise

Obamacare was supposed to make health coverage affordable, or even free, for low-income Americans. The law's official name is the Affordable Care Act. However, the Supreme Court tossed a huge obstacle in the path of that goal in 2012, ruling that the states could opt out of one of Obamacare's crucial provisions: The expansion of Medicaid coverage to anyone making less than 133 percent of the federal poverty level, or about $15,300 a year for a single person. Since the court's ruling, 24 states, including Florida, chose not to expand the program.

Under the pre-Obamacare rules, eligibility for the program typically was limited to low-income children, pregnant women, parents caring for children at home, and adults with disabilities. Without the law's expansion, an adult without a disability who isn't living with their children -- like Alphonse -- doesn't qualify for Medicaid, no matter how poor he or she is.

For those who don't qualify for Medicaid coverage, Obamacare offers tax credits for private health plans sold through the law's health insurance exchange marketplaces. But those subsidies are available only to those making between the poverty level, or about $11,500 for an individual, and four times that amount. In states not expanding Medicaid, people who earn less than poverty wages get nothing.

In Alphonse's case, his family is trying to survive on his unemployment insurance. It amounts to $4,800 a year -- far below the poverty level, which is $27,570 for a family of five. Even the unemployment benefits will run out in March.

'People Break Down In Tears'

Florida Gov. Rick Scott (R) launched his political career in 2009 as a health care reform antagonist. Originally, he opposed the Medicaid expansion, but he then changed his mind. Last year, Scott and the majority-Republican state Senate backed a plan to accept federal dollars to expand the program. The GOP-led state House of Representatives refused to go along.

Now, 764,000 low-income adults in Florida will remain without insurance because of the coverage gap, according to the Henry J. Kaiser Family Foundation. And they're beginning to understand the tragic consequences of that public battle. At Miami's Borinquen Medical Centers for low-income and uninsured patients, Jason Connor sees hopes crushed as people who thought Obamacare could help them at long last learn otherwise.

"We've had people break down in tears at our desk," said Connor, who is under contract with the community health centers to do Affordable Care Act outreach and enrollment activities through his company, Choice Returns.

Seventy-eight percent of the 50,000 patients that Borinquen Medical Centers treat every year are uninsured, Connor said. About 20 percent of those who visit their facilities looking to apply for benefits fall into the coverage gap, he added.

"Folks are frustrated and they're angry, and they'll curse at you even though you have nothing to do with it," he said.

GOP Revolts

When the Supreme Court ruled that states could opt out of the Medicaid expansion, Florida, Texas and nearly the entire South turned away billions in federal dollars offered for broadening the program, citing budgetary concerns and resistance to Obamacare itself. The federal government will pay the full cost of the Medicaid expansion through 2016, after which its share will be no less than 90 percent.

These decisions by governors and legislators essentially consigned a huge swath of the very poor to a life of extreme insecurity.

"It's very frustrating," said Alphonse, who last worked as a security guard until being laid off 10 months ago. "It's kind of odd where an individual that has an opportunity to help millions of people in their own state, and they just totally refuse to do it."

Florida's legislature is poised to take up the Medicaid expansion again during this year's session, but the political dynamics don't appear to have changed much since last year. Meanwhile, one-quarter of Florida's population (under the age of 65) is without health insurance -- the second-highest of all the states behind Texas. In Miami-Dade County, where Alphonse lives, the uninsured rate was an astonishing 34 percent in 2011, the most recent year county-level data were available.

Where Are The Uninsured? florida medicaid uninsured This map shows the percent of uninsured in each U.S. county in 2011. The data includes all incomes, races, and both sexes for people under age 65. Source: U.S. Census Bureau

'I Just Try To Live Every Day'

Unable to afford medical care or insurance, Alphonse hasn't followed up on the warning he received about his kidneys from a doctor treating a knee injury he suffered in 2011 while working as a security guard. Alphonse was told he needed to see a kidney specialist and start getting treatments, or he'd risk the condition worsening to the point he'd need dialysis or a transplant.

"It's extremely scary, but I try not to think about it. I just try to live every day because it's what you have to do to survive," Alphonse said.

A few years ago, Alphonse broke his hand and faced a $1,000 emergency room bill that destroyed his credit. He's afraid to rack up medical bills now. Even copayments as low as $20 at community health centers, which charge low-income patients on a sliding scale, are unaffordable, he said. He's applying for health benefits through the Department of Veterans Affairs, but he may not meet the program's eligibility rules.

While hospitals can't turn away patients in need of emergency treatments, they aren't required to provide the kind of comprehensive care needed for someone with a serious medical condition.

"If you're really sick, you can fall through the cracks of the safety net system," said Lise Federman, a health policy specialist at Florida Legal Services in Miami. "People who have chronic conditions who need specialist services do suffer." (Florida Legal Services referred HuffPost to Alphonse.)

Taxpayers Still Foot The Bill

Keeping people like Alphonse off the Medicaid rolls doesn't shield American or Floridian taxpayers from the cost of whatever treatments he eventually may receive, like at a hospital emergency room or a government-funded community health center. Unpaid medical bills totaled $57.4 billion in 2008 -- and taxpayers picked up about three-quarters of the tab, according to a study published in the journal Health Affairs. Expanding health coverage via Obamacare was supposed to reduce that burden, but the patchwork Medicaid expansion limits the law's reach.

And if Alphonse's condition deteriorates into what's known as end-stage renal disease, or permanent kidney failure, he automatically would qualify for Medicare coverage paid for by the federal government. Although Medicare mainly is for people over 65 or those with disabilities, people who need dialysis or a kidney transplant are eligible under a special rule enacted in 1972.

For those too poor for Obamacare in Miami, watching neighbors who make more money receive subsidized health insurance makes the experience even more painful, said Mayte Canino, a field and volunteer coordinator for Planned Parenthood of South Florida and the Treasure Coast. Uninsured people are skeptical of Obamacare and unaware of many provisions, and only 49 percent know that states have the option to expand Medicaid, according to a poll conducted by the Kaiser Family Foundation this month.

"That even affects them more, when they see that other people are getting help and they're not," said Canino, who helps people sign up for insurance. "Many of them are very unhappy. They blame the law, some of them, for it. They just walk away from it, and they think that's it. They're defeated."

HuffPost Readers: Did you try to sign up for health insurance coverage, but were told that you're not eligible for Medicaid because your state didn't adopt the program expansion, and you make too little to qualify for help paying for private insurance? We want to hear from you. If you're willing to discuss your health care with a reporter, email us here, and tell us if you're facing any medical issues, what your current coverage situation is, and what Medicaid coverage would have meant for you. Please let us know the following information: your name, your age, your city, and whether we have permission to quote you by name. Please enclose a photo if you're willing to have one published.

GOP Response To State Of The Union Missing Key Words: Repeal Obamacare

Jeffrey Young   |   January 29, 2014   12:12 AM ET

WASHINGTON -- Rep. Cathy McMorris-Rodgers (R-Wash.) delivered harsh criticisms of President Barack Obama's health care reform law during the official GOP response to his State of the Union address Tuesday, but stopped short of explicitly demanding its repeal.

McMorris-Rodgers highlighted the negative effects of the Affordable Care Act on consumers whose premiums rose, whose previous health insurance policies were canceled because they didn't meet the law's benefit standards and whose physicians aren't covered by the new plans available on Obamacare's health insurance exchanges. But while McMorris-Rodgers declared Obama's reforms a failure, she didn't vow that congressional Republicans would continue their push to repeal the law, for which the GOP-led House has vote dozens of times.

"No, we shouldn't go back to the way things were, but this law is not working. Republicans believe health care choices should be yours, not the government's," McMorris-Rodgers said. House Speaker John Boehner (R-Ohio) made no mention of Obamacare in the written statement he issued following the speaches by Obama and McMorris-Rodgers.

Despite her criticisms, McMorris-Rodgers' remarks reflected the post-Obamacare reality that took root on Jan. 1, when the first wave of Americans gained new benefits and protections from the Affordable Care Act, and many received financial assistance for the first time to help pay for health insurance. Any Republican proposal to repeal the law, or even replace it, would have to account for those consumers or risk a backlash that would rival the ire provoked by the health insurance policy cancelations that landed in the mailboxes of millions of Americans last year.

In contrast to McMorris-Rodgers, Sen. Mike Lee (R-Utah) made a clear call for undoing the Affordable Care Act in the tea party response to the State of the Union.

"When it comes to health care, we know the best way to repeal Obamacare is to deliver better solutions," Lee said.

Like McMorris-Rodgers', however, Lee's comments acknowledged that going backward isn't an option. "We can't just return to the old system. Health care policy used to give too much power to insurance companies. Obamacare now gives too much power to the government," Lee said.

Republican voters overwhelmingly oppose the Affordable Care Act, polls consistently have shown, and GOP lawmakers remain politically united against the law. But differences persist over how much emphasis to place on health care reform and how hard to fight its implementation. Efforts by tea party-affiliated lawmakers like Lee and Sen. Ted Cruz (R-Texas) to defund Obamacare led to a government shutdown and pushed the nation to the brink of default last year against the stated wishes of GOP congressional leaders.

Republicans have yet to come to consensus on another critical aspect of their anti-Obamacare agenda: Whether to propose a comprehensive health care overhaul of their own. Although individual GOP lawmakers have introduced numerous health care bills over the past five years -- including Sens. Orrin Hatch (Utah), Richard Burr (N.C.) and Tom Coburn (Okla.) this week -- the party hasn't coalesced around an alternative.

Obama mocked Republicans in Congress for their relentless attempts to repeal the Affordable Care Act, and challenged them to propose ways to achieve the goals of his law through different means.

"I do not expect to convince my Republican friends on the merits of this law, but I know that the American people are not interested in refighting old battles," Obama said. "So again, if you have specific plans to cut costs, cover more people, increase choice -- tell America what you’d do differently. Let’s see if the numbers add up. But let’s not have another 40-something votes to repeal a law that’s already helping millions of Americans."

Neither Republican lawmaker who spoke Tuesday offered anything like that, and the plethora of legislative vehicles introduced by GOP lawmakers in recent years would fail that standard.

Republicans don't share Obama's aims, and generally oppose spending additional federal dollars to provide health coverage to low-income uninsured people or imposing stringent regulations on health insurance companies that would ban them from rejecting individuals with pre-existing conditions, charging women higher rates than men or covering a proscribed set of benefits, all of which the Affordable Care Act does.

The gulf between what the Affordable Care Act seeks to accomplish and what Republicans can support, evidenced by the Hatch-Burr-Coburn proposal, as is a recognition that the status quo has changed and some of Obamacare's reforms can't fully be dialed back.

The Senate Republicans' plan would offer some protection for people with pre-existing conditions, but only if they remain continuously insured, so any gap in coverage would subject those individuals to higher rates or outright rejection by health insurance companies. The proposal would provide tax credits to cut the cost of health insurance, but they would be less generous and be available to fewer people than those offered by Obamacare. The Hatch-Burr-Coburn plan also would scale back the full tax deduction for job-based health insurance, which has been in place since World War II, further than Obamacare does, and would reduce funding for Medicaid, the federal-state health program for low-income people, which Obamacare expands.