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Hurry Up! Big Obamacare Deadline Coming Monday

Jeffrey Young   |   December 12, 2014    7:30 AM ET

The first Obamacare enrollment deadline for next year is just three days away, meaning Monday is the last day for people in most states who buy their own health insurance to choose a plan they can begin using Jan. 1.

If you're already a customer of a plan selected from a health insurance exchange marketplace or directly from an insurance provider, or if you're uninsured now and looking for coverage for the beginning of the year, there's no more time to waste. Here's are some don't's and do's that last-minute health insurance consumers should consider before the deadline in your home states.

"Don't wait until Sunday. Don't wait until Monday after work," said DeAnn Friedholm, the health care reform campaign director at Consumers Union. "It is complicated."

Don't delay!

If you're one of these people and don't visit HealthCare.gov or your state's exchange, you won't be able to get a new plan until February, and the last chance to choose a plan for any part of next year is Feb. 15 (except under special circumstances). Five state's exchanges have different deadlines: Dec. 18 in Maryland and Dec. 23 in Idaho, Massachusetts, Rhode Island and Washington state. These deadlines only apply to people who buy health insurance through an exchange, a broker or directly from an insurer -- not those who get health benefits from their jobs or a government program like Medicare or Medicaid.

There are a lot of factors to consider, like what doctors and hospitals you can access, what drugs and medical services are covered, how much you'll have to pay out of pocket when you get health care, and what the monthly premium is. Sorry -- there will be some math.

To prepare, you should have some information and documentation handy, like your family members' Social Security numbers and last year's tax returns or something else to verify your income, which is how subsidies are calculated.

Don't Stand Pat!

Maybe you got a really good deal on the health insurance you have now, and you like it, so you figure you're all set. While it's true that the health insurance exchanges in most states (check with the exchange to find out about where you live) will automatically roll you into the same plan for next year if it's still available, there are a lot of good reasons shop around.

"Don't assume because you have something from last year that it's still the best value for you," Friedholm said. "There are real savings here to be had for many, many people." The Department of Health and Human Services estimates that more than 70 percent of current Obamacare enrollees could save money next year by switching to a new plan with a similar level of coverage.

Monthly premiums for exchange policies are going up and down all over the place and there are new plans on the marketplaces. It's smart to check whether you can find something more affordable.

Don't assume you don't qualify for financial assistance: 85 percent of this year's Obamacare enrollees did, and tax credits are available to people who earn up to four times the federal poverty level, or about $94,000 for a family of four.

For those who get subsidies, shopping is crucial because of the complicated way the tax credits are calculated. The value of the subsidy is linked to the cost of the so-called benchmark plan in every geographic area, and those prices went down in many places. These lower premiums mean smaller subsidies. Even if the sticker price for your current plan isn't going up much, you could end up paying much more by not finding a less expensive alternative because your tax credits will be worth less. (Read a more detailed explanation here.)

If you are automatically renewed into your existing plan and get a scary bill for January, you can switch to something else for the rest of the year, but you're stuck with that plan for at least a month (unless you cancel it outright and go without coverage).

It's also vital to visit HealthCare.gov or a state exchange to update your household's income information. If you expect your income to rise and you and don't notify the exchange, you may have to pay back part of your subsidy.

Do Your Research!

The plan you have now may have changed in ways other than price. Your doctor or hospital may not be in the network anymore, or may be available through a different plan. The amount you pay when you get health care may be different, as might the services the policy covers. The journalism nonprofit ProPublica created a useful tool that helps you compare benefits in this year's insurance plans with next year's. Find it here.

The trickiest thing about choosing insurance is finding a balance between a decent monthly premium while not exposing yourself to out-of-pocket costs like deductibles and copayments you can't afford. For example, if you know you'll have frequent or big-ticket health care needs next year, it may make sense to pay a higher monthly premium so your out-of-pocket costs are lower, Friedholm said.

Do Ask For Help!

To get information about the basics, like what health insurance jargon means or what factors you should consider when choosing a plan, try the Consumer Reports Health Law Helper. The exchanges also have telephone hotlines, and can direct you to in-person help at no cost in your community. Private insurance brokers also can assist consumers at no charge.

To see an estimate of how much your health insurance might cost, use this calculator from the Henry J. Kaiser Family Foundation:

CORRECTION: An earlier version of this story misreported the deadlines in five states. The post has been updated.

Grubergate Hearing Is Gamechanger For Obamacare. Just Kidding

Jeffrey Young   |   December 9, 2014    6:22 PM ET

It took nearly four hours, but the House Oversight and Government Reform Committee finally settled the question once and for all about whether Obamacare was a good idea or a bad idea.

Yeah, right. Of course that’s not what happened.

The committee came together for a hearing on Tuesday that was intended to make Massachusetts Institute of Technology economist and Obamacare consultant Jonathan Gruber answer for his demeaning comments about American voters and his assertions that President Barack Obama’s administration and Democratic lawmakers designed the Affordable Care Act in a convoluted way to fool the public.

Gruber's comments sparked controversy last month after videos of them surfaced online. "Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical to get anything to pass," he said of the health care overhaul.

Rep. Elijah Cummings (Md.), the senior Democrat on the committee, summed up the purpose of the hearing this way: “As far as I can tell, we are here today to beat up on Jonathan Gruber for stupid -- I mean absolutely stupid -- comments he made over the past few years.” He was only partly right.

Beyond the nominal focus on an uncharacteristically diffident Gruber, the hearing was also about providing Republicans on the committee a chance to remind everyone how terrible Obamacare is and how much they hate it, helping them make the case that it’s OK for the Supreme Court to gut it.

“The history of design, passage and implementation with the law is fraught with half-truths and deception,” committee Chairman Darrell Issa (R-Calif.) said at the top of the hearing, in case anyone watching was unfamiliar with the GOP position on Obamacare.

Meanwhile, Democrats emphasized things like how the law has signed up millions of people into health coverage, including 10 million who had none before. They also noted that Congress debated the Affordable Care Act for more than a year, holding dozens of hearings, as opposed to engaging in a shadowy conspiracy to dupe the public.

This went on for hours -- four more hours in a campaign of more than four years by Republicans to undermine the Affordable Care Act, and the less-effective Democratic efforts to counter it. The net result: The law is still in place, and public opinion on it has barely changed since 2010. One poll this month found that 80 percent of Americans aren't even paying attention to the Gruber situation anyway.

The speeches and questions from GOP panelists amounted to a greatest hits compilation of anti-Obamacare talking points. The list of grievances included: Obama’s broken promise that no one would lose their health plan when the law took effect, the cost of the law, the false “death panel” claim that Obamacare will cut off old people from health care, the early failure of HealthCare.gov and the administration misreporting how many people enrolled.

Rep. Paul Gosar (R-Ariz.) even brought up Benghazi for good measure.

The Gruber videos gave the GOP fresh fodder for their anti-Obamacare campaign, and the Harvard-educated professor himself proved an irresistible target -- a personification of conservative distaste for liberals, eggheads and the Democrats who wrote the Affordable Care Act.

“You said what they were all thinking when they wrote Obamacare, that they knew what was best for my constituents,” said Thomas Massie (R-Ky.).

And that’s why Cummings chastised Gruber for bringing the negative attention to Obama’s signature domestic initiative, which already isn’t very popular. “Dr. Gruber’s statements gave Republicans a public relations gift in their relentless political campaign to tear down the ACA,” he said.

Ever-present in the hearing room was the upcoming Supreme Court consideration of a lawsuit that would take away coverage from more than 4 million people. The plaintiffs in that lawsuit contend that the wording of one line in the law means the federal government can’t issue tax credit subsidies to people in states that didn’t create their own health insurance exchanges (which is about two-thirds of them).

Some Republicans, including incoming Senate Majority Leader Mitch McConnell (Ky.), see this lawsuit as the best chance to crush Obamacare. And when one of the Gruber videos featured him seemingly agreeing with the plaintiffs' argument in 2012, conservatives seized on it as the only piece of available evidence that Obamacare’s framers intended this to be the case, apart from that ambiguous phrase in the law.

At the hearing, Gruber stressed that he always calculated that tax credits would be available in every state, and couldn’t remember why he’d said the opposite. His best explanation in hindsight, he said, is that maybe he thought the federal government wouldn’t finish its exchanges in time, depriving people in those states of subsidies. “It’s a very clear reading of the law that tax credits should be available to citizens in all states, regardless runs the exchange,” he said.

“It’s not clear. That’s where there’s a Supreme Court case,” said Rep. Scott Desjarlais (R-Tenn.), one of several Republicans including Issa whose comments on the subject assumed the plaintiffs in the Supreme Court case to be right.

Gruber attempted to draw a distinction between his role as a policy adviser and his lack of role as a political or legislative strategist. Republicans, who have been promoting Gruber as the most important person behind a law nicknamed after another person, didn’t accept that.

“Professor Jonathan Gruber is considered by many as the architect of Obamacare,” Issa said.

“I was not the architect of President Obama’s health care plan,” Gruber said. Obama agrees.

Gruber also apologized over and over for his previous remarks, which didn’t do much to satisfy anyone on the committee.

It didn’t help Gruber’s case that he repeatedly dodged demands from GOP lawmakers that he fully disclose how much money he made from government contracts. “The committee can take that up with my counsel,” he said a bunch of times. Lawmakers really don’t like when you do that, and Issa said he’d subpoena Gruber if he needed to.

Gruber said it again when Rep. Jason Chaffetz (R-Utah) pressed Gruber to produce documentation of the health care reform work he did for government agencies. “Do you have documents?” Chaffetz asked during an exchange that pretty well demonstrated how little actual information would come out of this hearing.

“Do I own documents?” Gruber replied. “I have all sorts of documents. I have a piece of paper in front of me.”

U.S. Experiences Unprecedented Slowdown In Health Care Spending

Jeffrey Young   |   December 3, 2014    4:01 PM ET

The amount the United States spent on health care went up last year by the smallest amount since federal scorekeepers started tracking these dollars half a century ago, according to an audit issued Wednesday. The news might come as a shock to Americans struggling to keep up with rising costs.

Combined spending on health care by households, businesses and the government rose 3.6 percent to $2.9 trillion in 2013, the fifth straight year it increased by less than 5 percent following decades of faster growth, the Office of the Actuary, an independent office within the federal Centers for Medicare and Medicaid Services, reported in the journal Health Affairs. Health care accounted for 17.4 percent of the whole economy, the same as in 2012.

To Americans facing ever-higher health insurance premiums and bigger out-of-pocket costs at the doctor’s office, hospital and pharmacy, however, these promising trends may seem at odds with their own lives and household budgets.

There’s a disconnect between the big-picture numbers and people’s perceptions because Americans’ wages aren’t rising, meaning health care costs eat up more of people's incomes, and because insurance plans increasingly require patients to pay a bigger share of the bill when they use the health care system, said Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation.

“The fact that health care spending growth has been so low for a number of years now does trickle down to what people themselves are actually paying out of their own pockets,” Levitt said. “The problem is, even when health care spending is growing so slowly like this, when people’s incomes are stagnating, it still doesn’t necessarily feel so good.”

Even as the national numbers look rosier, the conditions for consumers seem about the same. Last year, households were responsible for 28 percent of health care spending -- like insurance premiums and out-of-pocket costs -- the same share as in 2010, the new audit shows.

Still, the broad benefits of less health care spending growth to the U.S. economy and the federal budget are clear: Less of the economy devoted to health care means more money that can be spent on other things consumers and businesses want. Lower growth in spending also eases the burden on taxpayers funding programs like Medicare and Medicaid.

The lower rise in national health care spending in 2013 was the result of a mix of factors, the Centers for Medicare and Medicaid Services actuaries report. These figures account for the prices paid for health care and the amount of services and products people used.

Spending on health insurance, Medicare, hospitals, physicians and patients’ out-of-pocket expenses rose more slowly than in 2012, as did overall prices for medical care and products. But spending on prescription drugs and Medicaid grew faster in 2013 than the year before.

The Office of the Actuary expects these record-low rates of increase won’t continue forever. Spending is projected go up faster this year and in the near future, though it’s still expected to be slower than during prior decades. U.S. health care spending more than doubled from 2000 to 2013, and it increased more than by a factor of more than 100 since 1960.

Health Care And The Economy Grow Together, And Apart

us health care spending

This year, the agency projects health care spending will increase more than 5 percent to $3.1 trillion, driven in part by faster economic growth and in part by new Obamacare spending on subsidized health insurance and Medicaid coverage for millions of people, according to a separate report published in September.

The causes of the slowdown and what the future holds for health care spending overall and individual consumers can’t be precisely pinned down with the information available, Levitt said. “Everyone’s crystal ball is fuzzy, so there’s no telling for sure what’s going to happen,” he said.

The Office of the Actuary maintains, as it has for several years, that slower growth is mostly the result of hangover from the Great Recession that ended in 2009 and the sluggish recovery that followed, and that the spending growth will tick back up when the economy strengthens. During economic downturns, workers lose jobs -- and with them, pay and insurance -- and use less health care. When those jobs and benefits return, past experience shows health care spending tends to increase more quickly again.

But that explanation can’t account for major changes occurring in the U.S. health care system, starting with the Affordable Care Act, also known as Obamacare, which became law in 2010. Although the report issued Wednesday doesn’t account for the millions who gained health coverage this year because of Obamacare and the spending that resulted, the law had direct and indirect effects on the health care system before 2014.

President Barack Obama credits the law that bears his name with part of the slowdown in health care spending increases, and the government actuaries partly agree. According to the report, cuts in Medicare payments to health care providers and insurers and other policies in the law helped constrain spending last year. But the actuaries also note other parts of the ACA, like improved Medicare prescription drug coverage, increased some spending.

The effects of Obamacare and of health care companies operating more efficiently are hard to measure, making it impossible to prove whether the current period of slow spending growth is just a dip related to the recession or a more promising development, Levitt said.

“There is something else going on here,” Levitt said. “It sounds like a cop-out to say that we can’t quantify the effects of the Affordable Care Act or changes in health care delivery, but that doesn’t mean it’s not true,” he said. “There’s reason to be cautiously optimistic that the kinds of structural changes that have occurred in health care will help keep cost increases lower in the future, even if the economy improves.”

Who Spends All That Money?

us health care spending

Who Gets All That Money?

us health care spending

Obamacare Sign-Ups Near 500,000 After First Week

Jeffrey Young   |   November 26, 2014   10:50 AM ET

More than 460,000 people enrolled in a private health insurance plan on the federally run Obamacare exchanges in 37 states during the first week of the sign-up period for 2015 coverage, the Department of Health and Human Services announced Wednesday.

These enrollments are almost evenly split between renewals of existing customers and new sign-ups, according to a report issued by the department. More than 1 million people have submitted applications for financial assistance and coverage and almost 1.6 million have reviewed prices for insurance using HealthCare.gov's window-shopping feature between Nov. 15, the opening day of the three-month health insurance exchange enrollment period, and Nov. 21, the department disclosed.

President Barack Obama's administration aims to sign up more than 9 million people for private health insurance via these exchange marketplaces by the close of the enrollment period on Feb. 15, including renewing most of the approximately 7 million people who already have insurance policies obtained through the federally operated exchanges and those run by 13 states and the District of Columbia.

"We had a solid start, but we have a lot of work to do every day between now and February 15," Health and Human Services Secretary Sylvia Matthews Burwell said in a press release.

Last week, the Department of Health and Human Services was forced to acknowledge it overcounted Obamacare health insurance enrollments for this year by hundreds of thousands by including people who purchased dental plans, after a report by Bloomberg News revealed the error, which was uncovered by the House Oversight and Government Reform Committee.

During a conference call Wednesday with reporters, Burwell pledged greater transparency about the Obamacare exchanges. The Department of Health and Human Services will issue weekly and monthly reports on health insurance exchange enrollment, Burwell said.

The number of enrollees during the first week of the current sign-up push is more than four times the number who selected health insurance plans during all of October 2013, when the exchanges launched amid crippling technical problems.

States including Kentucky, Maryland and California that have their own exchanges also have reported strong enrollments so far.

Half a million enrollees in a week puts federal Obamacare officials on pace to sign up close to 1.8 million people during the first month, but the system remains far from the 9.1 million target for 2015 enrollees, which Burwell established earlier this month. The administration is standing by that aspiration, however, she said.

"We are staying with that number," Burwell said. "We have a lot of work before us, and we're going to continue focusing on that."

As of last month, nearly 7 million people had health insurance policies purchased through an exchange. The federal marketplaces and most state-run exchanges will automatically renew customers into their same plans for next year if they don't choose a different one. But with health insurance premium increases and decreases varying widely across the nation -- especially for the least costly and most popular policies on the market in 2014 -- consumers who fail to shop around could wind up paying much more by standing pat instead of seeking more affordable plans for next year.

"We are strongly urging and encouraging everyone to come back, make sure your information is the most up-to-date," Burwell said. "For many, many people it is very important to come back and shop."

The deadline to choose a health insurance plan that will be in place on Jan. 1 is Dec. 15. Current enrollees who automatically are renewed into their policies can still switch to a new one for the rest of next year after that date, up to the final deadline for 2015 coverage on Feb. 15.

This post has been updated with details from a conference call Burwell had with reporters.

Obamacare Penalty Could Cost More Than You Expect

Jeffrey Young   |   November 21, 2014    7:32 AM ET

Considering going without health insurance next year? Be careful -- it could cost more than you think.

As you’ve probably heard, Obamacare requires most U.S. residents to obtain some form of health coverage, either from a job, a private insurance company or a government program like Medicaid.

Failing to do so could mean taking a hit on your taxes. There’s been a lot of attention paid to the $95 tax penalty for people who are uninsured this year. But in reality, few people will pay that little, and high-income households could owe thousands of dollars when they file their 2014 taxes. Plus, the minimum penalty more than triples for the 2015 tax year.

Don’t expect to hear much about the mandate during the big enrollment push under way. Although the individual mandate is a critical part of Obamacare, it’s politically toxic. Plus, focusing on the positive benefits of the law has proven more effective at increasing enrollment -- and decreasing the number of people who’d be penalized -- than emphasizing the negative parts of it, said Anne Filipic, president of Enroll America, a nonprofit promoting Obamacare sign-ups.

“We are continuing to lead with the facts about what’s available to consumers, and especially the message about financial assistance,” Filipic said. “We want to be careful not to talk about it in a threatening way.” Information about the mandate and penalties will be secondary, and the group plans to emphasize it closer to the February deadline to use the the health insurance exchanges to sign up for coverage that will be in effect next year, she said.

An April Enroll America survey found that the mandate motivated some people who signed up during the first Obamacare enrollment period, which ended in April. Nineteen percent said they wouldn’t have enrolled without it, and another 21 percent said they weren’t sure if they would have.

Still, President Barack Obama’s administration believes promoting the subsidies available to low- and middle-income families and emphasizing the cut-off date is a better way to boost sign-ups. “Our primary focus is going to be on affordability and deadlines. That’s what we know really works and drives people,” a senior administration official told The Huffington Post.

But the individual mandate is a big and complex change in the law, and taxpayers need to understand how it affects them. That’s especially true now. Enrollment on the Affordable Care Act’s health insurance exchanges began Saturday and runs through Feb. 15. Except under special circumstances, like having a baby, consumers who want to use these online marketplaces will have to sign up now or wait until next year to get for private insurance. (However, there’s no deadline for Medicaid and Children’s Health Insurance Program applications.)

Considering an estimated 87 percent of Americans already have health coverage and the slew of exemptions from the individual mandate, not many people actually will owe penalties if they aren’t covered. For those who do owe, the penalty will likely cost less than health insurance -- but they'll be exposed to potentially unlimited expenses in the event of a serious injury or illness.

The individual mandate penalty is calculated as the greater of either a set dollar amount or a percentage of income, and it varies from $95 to about $11,000.

To protect lower-income families from big expenses, and to more strongly push higher-income people to get covered rather than pay the extra taxes, there are two methods for figuring out the penalty. You would pay either as a set dollar amount per person -- $95 per adult and $47.50 per child, up to $285 this year -- or a percentage of household income, whichever is higher.

For the 2014 tax year, higher-income people who are uninsured probably would wind up paying 1 percent of their taxable income minus $10,000 to $22,400, depending on family size and other factors. That could be as much as $11,000, which is the maximum possible penalty, and is based on the national average price for a "bronze" insurance plan available on the Obamacare exchanges.

The minimum penalties get a lot higher next year. They start out at $325 per adult and $162.50 per child, up to a maximum of $975 per household, or 2 percent of household income (after subtracting that $10,000 or more), whichever is more. The maximum penalty for 2015 will be about the same as the maximum penalty for 2014.

A family of four with an income of three times the federal poverty level -- about $70,650 -- would owe around $500 this year, and more than double that in 2015, according to a calculator created by the Tax Policy Center.

People who owe these penalties will see them deducted from their income tax refunds or added to their tax bills. Unlike other taxes owed, though, not paying isn’t a crime, and the IRS can’t garnish the wages or put liens on the property of people who don’t pay it.

Plus, there are a whole lot of exemptions from the individual mandate.

They include if you earn too little to file federal income taxes or if the cheapest plan you can find costs more than 8 percent of your income. People with religious objections to insurance also don’t have to get covered. Undocumented immigrants aren’t allowed to use the Obamacare exchanges, so they also don’t have to comply with the individual mandate. People who live in states that didn't adopt Obamacare’s expansion of Medicaid are exempt if they would have qualified for the program. What’s more, there’s a “hardship” exemption the federal government has defined very broadly.

Obamacare includes the individual mandate as a way to nudge people into health coverage and discourage “free riders” who use health services when they could afford insurance. Being insured for at least nine months a year fulfills the mandate.

Obamacare’s authors call it the “individual shared responsibility provision.” As the theory goes, a health insurance market that’s open to everyone, including those with pre-existing conditions, must include as many people as possible, especially those who don’t have high medical bills and will pay into the pool without drawing down much. As healthy people age or become unlucky enough to get sick, this is supposed guarantee there’s a health insurance system in place to take care of them.

In addition, more people covered means fewer people getting treated at emergency rooms and not paying the bills, which costs taxpayers billions in the form of special Medicare and Medicaid funding that goes to hospitals treating large numbers of people who can’t afford the care they received. So people either get covered, or pay the penalty to offset the costs they incur when they get sick.

“Those who can afford health care but choose to go without are required to make a payment to help cover their medical costs and keep coverage affordable for others,” the Treasury spokesperson wrote.

Sam Stein contributed reporting.

Obamacare Train Not Wrecking As Sign-Up Period Kicks Off

Jeffrey Young   |   November 15, 2014    4:56 PM ET

MANASSAS, Virginia -- The website hasn't crashed, government officials aren't scrambling, and Americans are actually using the Obamacare exchanges to shop for health insurance. What a difference a year makes.

Open enrollment for the private health plans sold on HealthCare.gov, the online portal to exchanges for 37 states (including Virginia), and on the state-run exchanges for the other states started Saturday. Compared to Oct. 1, 2013, when the federal website and numerous state sites launched and immediately crashed -- frustrating consumers and giving Obamacare a black eye that still hasn't faded -- the beginning of the second sign-up period appears to be going smoothly.

"I am quite happy that we are where we are this morning," Health and Human Services Secretary Sylvia Mathews Burwell said during a brief news conference at Evergreen Health Center in Manassas, Virginia, on Saturday. "We are up and running."

In the eight hours since HealthCare.gov had re-opened for the three-month enrollment period at around 1:30 a.m. Eastern Time, the system had completed applications for 23,000 households, Burwell said at the press conference. Some consumers took the next step and selected a health insurance plan to use next year, but others still have to shop now that they have finished their applications for financial assistance, a department spokeswoman told reporters.

Burwell also noted that since HealthCare.gov's anonymous window-shopping tool went online last week, more than 1.2 million people had accessed it to obtain estimates of how much their insurance may cost.

Saturday did see some glitches on HealthCare.gov. Some new users experienced problems logging into their accounts, USA Today reported.

Given that HHS aims to sign up more than 9 million people for private health plans through the federally run exchange, 23,000 doesn't make a big dent either. But the deadline to buy coverage isn't until Feb. 15, and the deadline for plans that take effect on New Year's Day is still a month way. And approaching deadlines sparked huge surges in enrollments during the previous sign-up period.

Compared to last year, 23,000 is a huge number for Day 1. Just six people were able to enroll on the first day of the inaugural enrollment period because of technological failures that crippled the system. Only 106,000 enrolled during the whole month of October 2013. By April 2014, 8 million people had used health insurance exchanges to choose a health plan. More than 7 million were fully enrolled a month ago, as some consumers had given up their Obamacare plans either to switch to a different form of coverage or to go without, HHS announced earlier this month.

Jason Shriner said he enrolled in a plan for next year at Evergreen Health Center without much difficulty. "For the most part, it was fairly easy to use," said the 28-year-old from nearby Nokesville, who teaches baking classes for a living.

Shriner's current health plan isn't being offered next year, so he had to find something new -- and less expensive, because his income has gone down. He chose a "Silver" plan that's cheaper than the coverage he has now, he said.

"I'm super-excited about it. I mean, I'm going to be saving $100 a month. That's going to go a long way," said Shriner. Including a $219 monthly tax credit based on his income, he will pay about $25 a month for his insurance, which includes medical, dental and vision benefits, Shriner said.

The first year of Obamacare's health coverage expansion had a positive impact here in Northern Virginia, said Frank Principi, executive director of the Greater Prince William Community Health Center, which operates Evergreen Health Center in Manassas and Ridgewood Health Center in Woodbridge.

Before last year's enrollment period, 60 percent of the clinics' patients -- primarily Hispanic and African-American, Principi said -- had no health insurance. This year, that number is down to 52 percent, despite the problems with HealthCare.gov and despite the failure of Virginia to adopt the Affordable Care Act's expansion of Medicaid to more poor residents, Principi said.

"The first thing we say to the patient when they register in the waiting room is, 'Can we help you pay your medical bills?'" said Principi, who also is a Democratic member of the local county board of supervisors. Enrollment counselors working in the clinics helped 1,400 people sign up for coverage this year, Principi said, and he aims to get another 1,800 covered for 2015.

On Saturday, dozens of people occupied the waiting room and meeting rooms at the Manassas clinic to meet with enrollment counselors, and Principi expected 500 visitors by the end of the day's event. The health center had promoted the assistance in English and Spanish on local TV, radio and newspapers, as well as through social media channels and texts to patients, he said.

The people who visited Evergreen Health Center were a mix of those who need to renew existing coverage or switch to a new plan next year and those who currently have no health insurance, said Jabnia Murgado, of Woodbridge, who was one of the 14 enrollment counselors on hand. By mid-afternoon, Murgado had helped more than 10 people, though none who completed the process and enrolled in a plan.

Last time, clinic employees were forced to resort to filling out paper applications that they later entered into HealthCare.gov, but they weren't having serious issues on Saturday, Murgado said.

"The website is going great. I mean, there's always a little bit of glitches here and there, but the website is moving along. It has not stalled -- not as of yet, of course," she said. At times, the website ran slowly, and one consumer had to call the exchange's telephone hotline to get his password reset, she added.

In his weekly radio address on Saturday, President Barack Obama urged current exchange customers and the uninsured to visit HealthCare.gov.

"If you already buy insurance through the online marketplace, now is the time to take a look at some new options for next year. You might be able to save more money or find a plan that fits your family's needs better than the one you've got now," Obama said. "If you haven't signed up for insurance yet, this is your chance."

Obamacare officials at the federal and state level are strongly encouraging existing customers to review the health plans offered on the exchanges to avoid sticker shock. Although health insurance premium increases are in the single digits on average, there's a lot of variation. In particular, some of the least expensive and most popular plans in use now are those seeing the largest price hikes for next year, while other plans have reduced prices and more companies have entered this market.

HealthCare.gov now must cope with even greater loads than last year, as millions of consumers seek to renew their coverage and millions more attempt to sign up for the first time. Moreover, the sign-up period for 2015 runs only half as long as the initial enrollment period, which ran from October 2013 into April 2014.

The Obama administration has spent the time since that first round enhancing the system in anticipation of the next wave, adding new features and streamlining the application. States with poorly functioning websites, including Maryland and Massachusetts, also revamped their technology.

That doesn't mean officials expect this time around to be perfect, Burwell said Saturday.

"I will still always have some tension, certainly, for the next three months," the HHS secretary said. "We're going to continue to watch everything and monitor everything. As I've said all along, there will be places where we'll find things. What we're to do is quickly work to take care of anything we find."

Problems did arise Saturday. Washington Healthplanfinder, which serves Washington state residents, was miscalculating applicants' subsidies, forcing the entire system to be taken down, the state-run exchange announced in a press release just hours after enrollment began. A similar problem plagued Washington's exchange last time.

Burwell did not provide information about how many of the 23,000 applications were made by people renewing coverage versus potential new enrollees, about how many people were telephoning the federal exchange's call center and how long they waited to speak to a representative, or about how many users have visited the website.

It's Obamacare Season! Here's What You Need To Know To Sign Up

Jeffrey Young   |   November 14, 2014    4:33 PM ET

Obamacare enrollment begins again on Saturday, and there's a lot for consumers to figure out.

President Barack Obama aims to enroll about 9 million people into private health insurance plans for 2015 through the online exchanges. The federal government and some states, along with a slew of private organizations, are kicking off campaigns this weekend to get the word out about the three-month sign-up period.

It won't be easy. The Affordable Care Act has been law since March 2010, yet Americans remain poorly informed about Obamacare. Almost 9 in 10 uninsured individuals didn't even know enrollment was starting again, a poll from the Henry J. Kaiser Family Foundation found last month.

Health insurance is complicated, and so is Obamacare. Here are the basic facts you need to know to be a better-informed consumer:

Who is supposed to use an Obamacare exchange?

The exchanges are for people who don't have health coverage through their jobs or under programs like Medicare and Medicaid. You're not actually required to use an exchange because the insurance companies and private sector websites also will sell you health insurance directly. But the exchanges are the only place where you can apply for the financial assistance provided by Obamacare.

HealthCare.gov is the website for insurance shoppers in 37 states, while 13 states and the District of Columbia have their own exchanges. If you don't know where to go based on your home state, HealthCare.gov will direct you to the right place.

How much is it going to cost?

Health insurance premiums vary a lot for a number of reasons. Where you live, how old you are, how many people are in your family and whether you use tobacco all go into the equation. Prices on the exchanges range widely too, even for health plans with very similar benefits, so shopping around is crucial.

Compared to this year, premiums nationwide are going up just 5.6 percent on average in 2015, and the average monthly premium will be $344, according to PricewaterhouseCoopers. But those numbers aren't really important. What's important are the prices for the plans sold where you live and whether your insurer is raising rates, or even lowering them. Especially if you receive tax credits, failing to look for better deals could wind up costing you a lot more, while shopping around could save you money (it's complicated).

Is there help available to make insurance more affordable?

Yes, for some people. The Affordable Care Act established tax credits to cut the cost of coverage. These are provided on a sliding scale to households with incomes between the federal poverty level (about $23,500 for a family of four) and four times that amount (about $94,000). In addition, families that earn up to 250 percent of the poverty level (about $59,000 for a family of four) receive extra subsidies that reduce out-of-pocket costs such as deductibles and copayments for medical care and prescriptions.

The law also expanded Medicaid to people who earn up to 133 percent of the poverty level (around $31,300 for a family of four), and Medicaid generally comes at no monthly cost. But this expansion is only available in 27 states and the District of Columbia. The other states opted against a bigger Medicaid pool after the Supreme Court in 2012 said they could, which means millions of their residents remain uninsured. Those tax credits for private insurance go only to people who make at least poverty wages, so contrary to what the Affordable Care Act intended, some people are too poor for Obamacare.

What's the deadline to sign up?

There are two important deadlines, so don't delay. The first is Dec. 15, 2014. If you're a new enrollee, that's the last day you can enroll in a private health insurance plan that will be in place on Jan. 1, 2015. If you already have an exchange plan and don't act by that date, you'll automatically be renewed into your current plan.

The other deadline is Feb. 15, 2015. That is the final day to pick or change your plan for all of next year -- with a few exceptions. If your life circumstances change during the course of the year -- if you have a baby, for example, or move to a different state -- you can access the exchange again. And there is no deadline to enroll in Medicaid or the Children's Health Insurance Program.

Am I supposed to figure out this stuff all on my own?

You don't have to. Insurance agents and brokers make their livings helping people choose a plan. They get paid by the insurance companies, so there's no cost to you. There are also armies of enrollment counselors in communities across the country who have been trained and certified to assist consumers at enrollment fairs, libraries, pharmacies and other locations. They don't charge fees either.

Don't put off finding out what help is available where you live and making an appointment. HealthCare.gov has a page where you can find local help. The organization Get Covered America also has one.

Is the website going to crash again and drive me crazy?

Probably not? As practically everyone knows, HealthCare.gov started in October 2013 as a terrible mess, and people could barely use it for months. The websites for some of the state-run exchanges were as bad or even worse.

That shouldn't happen again, although don't expect an Amazon-like level of performance. HealthCare.gov was patched up with the digital equivalents of duct tape and chewing gum last year and worked well enough for more than 8 million people to sign up. Since then, its caretakers have beefed it up even more, added a number of new features and shortened the application. Meanwhile, states with bad websites last year, like Maryland and Massachusetts, have built new ones that supposedly will function.

Am I really required by law to buy health insurance now?

Sort of. The Affordable Care Act's individual mandate says that most people who can afford it (as the law defines that, anyway) must obtain some form of health coverage or pay a penalty at tax time. For this year, the minimum penalty is just $95 per person. If you've been uninsured for more than three months this year, you'll owe money to the Internal Revenue Service when you file your taxes next April.

The penalty gets much bigger for 2015: $325 per adult and $162.50 per child (up to a total of $975 per household), or 2 percent of your household income (after subtracting about $10,000), whichever is higher. The maximum penalty you could pay is the same as the average national annual price for a "Bronze" insurance plan in 2015 (a figure that's currently unavailable, but it has been $2,448 per person this year). The penalty goes up to $695 or 2.5 percent of income in 2016 and future years.

Another very important aspect of the mandate is that it has exemptions. Lots of them. For instance, people who live in a state that didn't expand Medicaid and who earn too little to quality for subsidized private insurance don't have to buy coverage with the money they don't have. People with religious objections to insurance also don't have to get covered if they don't want to.

Isn't the Supreme Court going to take my subsidies away?

Maybe! The Supreme Court agreed this month to hear a case arguing that the federal government isn't allowed to give tax credits to people in states that don't have their own health insurance exchanges. If the court agrees, those subsidies will go away. But you can't do anything about it, so it shouldn't be a reason to not take advantage of what's available now -- or to risk having to pay a tax penalty for being uninsured.

Didn't the Republicans who won Congress on Election Day say they were going to repeal all this?

They did. But they pretty much can't. The guy mentioned in the law's nickname is still president.

To see an estimate of how much your health insurance might cost, use this calculator from the Henry J. Kaiser Family Foundation:

How To Avoid Paying More For Obamacare Next Year

Jeffrey Young   |   November 13, 2014    3:36 PM ET

So you signed up for an Obamacare health insurance plan, and you're figuring you'll just keep it next year and skip the hassle of shopping around again.

You might want to reconsider -- your wallet may thank you.

Consumer advocates and Obamacare officials are urging the more than 7 million people who enrolled into health insurance for this year using one of the health insurance exchanges created by the Affordable Care Act to come back and look for a better deal. The enrollment period for health insurance that takes effect next year begins Saturday and goes through Feb. 15.

Why bother if you like your health plan? Because there's a pretty good chance keeping your current policy will squeeze your budget, even though premiums nationwide are rising by a small amount on average. Plus, if your family's income went up or down, your subsidy will be adjusted. It's especially important to log back into the exchange because in most states, your plan automatically will be renewed for next year if you don't act. Standing pat could mean a big financial hit, while shopping around could lead to savings.

"There may be something that would work better for you," Health and Human Services Secretary Sylvia Mathews Burwell said Monday at the Center for American Progress. "Most of them that come back in will be able to find something that may be a better choice for them in terms of affordability," she said.

Health insurance premiums for Obamacare plans are changing next year, and the cheapest or best policy on the market now probably isn't the cheapest or best for 2015. In fact, the least expensive and most popular plans this year often are the ones seeing the biggest price increases, while others are cutting prices. And new plans are becoming available: There are about 25 percent more health insurance companies selling policies on the exchanges, and they want your business.

Nationally, the average premium increase is 5.6 percent, according to information released by states and analyzed by the consulting firm PricewaterhouseCoopers. But that average includes a huge range of new prices. In Colorado, for example, the company found one plan that's raising rates 35 percent and another lowering the price 22 percent. And if your rates are going up a lot, there's a good chance you can find something else that's more affordable.

Due to the way health insurance prices are going up, and down, and the way Obamacare tax credits are calculated, keeping this year's plan could be costly. How costly? A 5 percent increase in the sticker price your insurer charges before subsidies could translate into a 30 percent or even 100 percent increase in what you actually pay every month, according to the consulting firm Milliman.

How is this possible? In a weird way, it's a byproduct of the competition between health insurance companies the exchanges were supposed to stoke, as many plans are coming in with lower prices. And because this is health insurance and because it's Obamacare, the reasoning behind that is somewhat complicated.

The monthly premium you wind up paying for Obamacare is a dollar amount arrived at by weighing a few factors: the sticker price of the health insurance, your household income and the cost of the "benchmark" insurance plan in your local area that's used to set the subsidy you receive.

When one of those factors changes, the price you actually pay for subsidized health insurance does, too. Since 85 percent of Obamacare enrollees received tax credits, this affects a lot of people. These tax credits aren't set as a flat dollar amount -- they're based on your earnings, and the law sets a cap on what percentage of your income you can be made to pay for insurance from 2 percent to 9.5 percent, depending on what you make a year. The price for the benchmark plan is the other part of the equation for those who get subsidies, which are available to people whose income is up to four times the poverty level, or about $94,000 for a family of four.

These benchmark plans -- which always are the second-cheapest "Silver" policy available where you live -- are getting cheaper in a lot of places, either because a different plan now has that designation or because the company reduced its premiums. If the price of the local benchmark plan is lower next year than it is this year, that means the subsidy you can get also will be lower. You can see for yourself what your tax credit might be using a calculator created by the Henry J. Kaiser Family Foundation or using the window-shopping feature on HealthCare.gov.

In 48 cities, the cost of the benchmark plan is actually going down next year by 0.2 percent before subsidies, according to data analyzed by the Kaiser Family Foundation.

But what really matters isn't some national average, it's the prices in your hometown, and changes to those are all over the place. In Anchorage, Alaska, for example, the benchmark plan for a 40-year-old nonsmoker next year will cost $488 a month, which is 28 percent higher than this year's benchmark policy. But in Jackson, Mississippi, the price of the benchmark plan for that hypothetical customer is going down 24 percent, to $309.

You may not be able to avoid getting hit with a higher price tag while holding on to a similar level of coverage, no matter what you do. But the only way to find out is to tap into the health insurance exchange and shop around.

The good news is, HealthCare.gov, which serves 37 states, and the exchange websites for the other 13 states and the District of Columbia will do the math for you. And local assisters and insurance brokers are available to walk you through the process.

So the question for health insurance exchange customers is this: What's worse, the headache of shopping for a plan or the pain of paying too much? How people feel about the second year of Obamacare enrollment could depend on how millions of them answer it.

Obamacare Enrollment Goal For 2015 Is 9 Million, Lower Than Expected

Jeffrey Young   |   November 10, 2014    1:14 PM ET

Just days ahead of the next Obamacare sign-up period, the Department of Health and Human Services is scaling back projections of how many people will be enrolled by the end of next year.

An analysis released by HHS on Monday projects between 9 million and 9.9 million individuals will be enrolled in health insurance plans obtained via an Affordable Care Act exchange by the end of 2015. That's up to 4 million fewer people than estimated by the Congressional Budget Office in April. HHS also reported that 7.1 million people were fully enrolled as of Oct. 15, a decline of about 200,000 from August.

Health and Human Services Secretary Sylvia Mathews Burwell said the department's target for 2015 is on the lower end of the range outlined in the report. "The number that we are going to aim for is 9.1 million," she said during an event at the Center for American Progress in Washington. "Probably the market will grow between 25 and 30 percent."

On net, the projection amounts to just 2 million additional customers in private health insurance obtained through an Obamacare exchange by the end of 2015, compared to this year.

After a rocky start in October of last year, the first Obamacare sign-up period resulted in 8 million people choosing health plans from an exchange marketplace, including those who have since given up that coverage. Surveys show the number of uninsured Americans declined by 10.3 million this year as a result of exchange enrollment, new Medicaid beneficiaries and people gaining coverage through other means.

HHS officials, speaking to reporters on condition of anonymity Monday, attributed the reduced projection for 2015 Obamacare enrollment mainly to the expectation that fewer consumers than previously estimated would move away from job-based insurance or private plans purchased outside the exchanges from insurers or brokers.

"We think that the evidence points to a longer ramp-up rate than the CBO projections had, and that is based on what we've learned over the last year from looking at our own data and from examining the experiences of other, similar types of programs," one HHS official said. The CBO had predicted 24 million consumers would be purchasing private insurance on an exchange by the end of 2016. HHS maintains exchange enrollment still will rise to the 25 million CBO projected for 2017 and future years, but that it may take until 2019 instead.

Burwell outlined the new challenges facing Obamacare enrollment, emphasizing that the coming sign-up period will be the first time the exchanges handle new customers and existing policyholders seeking to renew, and that it will last half as long as the six-month enrollment phase that began last October. In addition, the next wave of uninsured people who gain coverage may be smaller because the people who were easiest to find already signed up. "The next group of people will be harder to reach," Burwell said.

Still, the majority of new Obamacare customers next year will come from the ranks of the currently uninsured, the department's report concludes. "HHS’s analysis implies that most of the new marketplace enrollment for 2015 is likely to come from the ranks of the uninsured, with approximately three or four previously uninsured new enrollees for each new enrollee drawn from the ranks of those who previously had off-marketplace individual coverage," the report says.

HHS estimates that the population potentially eligible to use a health insurance exchange to buy private coverage is 23 million to 27 million people, including 15 million uninsured who qualify for subsidized private coverage and 8 million to 12 million who now buy plans directly from an insurer or through an agent or broker. Subsidies are only available via an exchange, and 85 percent of this year's enrollees received the financial assistance.

Federal officials think that 83 percent of the 7.1 million currently covered by insurance purchased on an exchange, or 5.9 million individuals, will still be covered by insurance purchased on an exchange by the end of next year, based on information from surveys, state-run exchanges and one unnamed insurance company, which show a range of 70 percent to 90 percent retain this type of insurance over the course of a year.

For the three-month 2015 enrollment period, HHS expects that 10.3 million to 11.7 million people will select an insurance plan on an exchange and that 9 million to 9.9 million will still have this coverage at the end of the year.

One HHS official stressed that the department does not believe that many of the individuals giving up exchange insurance plans this year or next are becoming uninsured. Officials did not provide estimates of how many have become insured or how many have switched to another form of health coverage. Surveys by Gallup and others show the uninsured rate is lower this year than in 2013.

"A number of things happen in that population. Some folks are getting jobs, so they go into their employers' insurance. Some folks may be eligible for Medicaid. There's a natural churn to a population in a marketplace, and so this type of retention number is not unexpected," the official said.

The decline in enrollments from August to October was largely the result of 112,000 households, representing an undisclosed number of people, losing coverage because they failed to provide up-to-date information about their incomes or their citizenship and immigration status, officials said.

The open enrollment period for private health insurance available to individuals who do not receive coverage through an employer or a government program like Medicare or Medicaid begins Saturday, Nov. 15, and runs through Feb. 15.

This article was updated after publication with remarks from Health and Human Services Secretary Sylvia Mathews Burwell.

Obamacare Shoppers Get Sneak Peek At New Prices

Jeffrey Young   |   November 9, 2014    2:07 PM ET

Health insurance consumers using HealthCare.gov will get their first look at the prices for 2015 coverage starting Sunday night, when window shopping goes live on the website, federal officials announced Sunday.

Shoppers won't be able to choose a health plan for 2015 until Nov. 15, when the three-month enrollment period begins. But the Centers for Medicare and Medicaid Services is providing early access to estimated health insurance premiums and the value of subsidies available to low- and moderate-income households. The window-shopping tool proved to be the most-visited part of HealthCare.gov during the first Obamacare enrollment period, officials said.

HealthCare.gov, which serves insurance consumers in more than 30 states, debuted Oct. 1, 2013, without the ability for people to window shop, which forced users to create accounts and begin applications for coverage before they could view prices. And since the website was barely functional for the first two months of the six-month sign-up period last year, the absence of this tool made it nearly impossible for people to gauge whether they could afford coverage -- and put greater strain on the system -- until the feature was added.

Obamacare officials said they would release an analysis of the health insurance premiums for 2015 later this week.

"We think the news is largely positive," said Kevin Counihan, the CEO of HealthCare.gov and the director of the Center for Consumer and Information and Insurance Oversight within the Centers for Medicare and Medicaid Services.

Independent analyses based on health insurance pricing information made public by state regulators have shown modest average premium increases for Obamacare plans across the nation. According to the consulting firm PricewaterhouseCoopers, rates will rise an average of 6 percent in states that have reported 2015 prices. The changes vary greatly, however, so some consumers will see double-digit increases while others will see prices go down if they keep their current coverage. The number of health insurers selling plans on the exchanges also is increasing by about 25 percent.

Consumers will be automatically re-enrolled into the plans they have this year if they are still being sold by their insurance carriers, but Counihan stressed that federal officials want individuals who already have coverage through the exchanges to revisit the website to ensure they're getting the best deal based on the new prices and the subsidies they can receive based on their incomes.

"The majority of our customers will be able to save money by shopping and comparing," Counihan said during a conference call with reporters Sunday. "We are strongly encouraging our customers to return back to HealthCare.gov, update their income and eligibility information, shop and compare, and see if there are better values out there for them."

Next year's prices will be available Sunday night on both HealthCare.gov and CuidadoDeSalud.gov, the Spanish-language portal to the federally run exchanges. Thirteen states and the District of Columbia operate their own exchanges and will provide premium information on their own schedules, the federal officials said.

The health insurance exchanges will open on time next Saturday, said Andy Slavitt, principal deputy administrator at the Centers for Medicare and Medicaid Services. "We've hit all the critical deadlines," he said. "We're not contemplating anything unusual or out of the ordinary, regarding Nov. 15."

The HealthCare.gov team has streamlined the application process most consumers will use, and has completed more than a month of testing to ensure the website functions this time. The website also will be able to serve more users at a time than it did during the first enrollment period.

Officials said it will be easier than it was last year for visitors to HealthCare.gov to access the window-shopping tool and view estimates of the price and benefits of plans available in their local area before this sign-up period.

Shoppers can provide their zip codes, approximate income and information about the make-up of their households to get a look at what's available and what it costs, including the effects of tax credits to reduce premiums, and subsidies to reduce out-of-pocket costs. Then users can sort health insurance plans by price and level of benefits, view information on what services are covered or not covered, and see how much they will pay when they receive medical care. When consumers find a plan they may want to purchase during the enrollment period, they can print out or email the information to themselves or save the link to that plan.

Obama Pledges To Protect Health Care Law From Republican Assaults

Jeffrey Young   |   November 5, 2014    5:44 PM ET

WASHINGTON -- President Barack Obama vowed to protect the core elements of his health care reform law after Senate Republican leader Mitch McConnell (Ky.) pledged to attack it anew next year, in light of big Republican gains in Tuesday’s midterm elections.

Republicans will take control of the Senate in January, adding it to the majority they have had in the House since 2011 -- during which time they voted in more than 50 instances to kill Obamacare. The party's opposition to Obamacare is virtually unanimous.

In remarks at a White House press conference Wednesday, Obama expressed openness to small changes to the Affordable Care Act, but pre-emptively rejected any Republican proposals that would undermine the law, which remade the health insurance market and has extended health coverage to millions of previously uninsured people.

"On health care, there are certainly some lines I'm going to draw," Obama said. "Repeal of the law I won't sign. Efforts that would take away health care from the 10 million people who now have it and the millions more who are now eligible to get it, we're not going to support. "

Obama specifically declared he would not consider doing away with the law's individual mandate, which requires most Americans to obtain health care coverage or face tax penalties. Polls show this to be the most unpopular part of the Affordable Care Act, and it was the subject of a constitutional challenge that went all the way to the Supreme Court, which upheld the policy in 2012.

"The individual mandate is a line I can't cross," Obama said.

Obama's comments appear to leave only a small opening for soon-to-be Senate Majority Leader McConnell and House Speaker John Boehner (R-Ohio) to make modifications to the Affordable Care Act over the next two years, and they won't squelch Republican zeal for undoing or severely damaging the law.

"We are, I think, really proud of the work that's been done," Obama said. "If, in fact, one of the items on Mitch McConnell's agenda and John Boehner's agenda is to make responsible changes to the Affordable Care Act to make it work better, I'm going to be very open and receptive to hearing those ideas. But what I will remind them is that, despite all the contention, we now know that the law works."

The tea party wing of the Republican Party will settle for nothing less than a complete repeal of Obamacare, an objective McConnell acknowledged is all but impossible so long as the man whose name it carries is president.

"He's still there," McConnell said at a news conference in Louisville, Kentucky, on Wednesday. "The veto pen is a pretty big thing." Before the elections, McConnell suggested he may employ a parliamentary tactic known as budget reconciliation to dismantle Obamacare, which would require only 51 votes as opposed to the 60 needed to overcome a Democratic filibuster. Congressional Democrats used this mechanism to pass Obamacare in 2010 with zero GOP votes.

McConnell nevertheless emphasized he favors repealing the law outright, and said Republicans stand united in opposition to Obamacare. "It's no secret that every one of my members thinks that Obamacare was a huge legislative mistake," he said.

Short of achieving repeal, McConnell promised to take aim at a handful of specific provisions of the Affordable Care Act. "There are pieces of it that are deeply, deeply unpopular with the American people," he said.

McConnell said Republicans would seek to scrap the individual mandate -- which Obama won't support -- a tax on medical device sales, and a rule requiring companies with 50 or more employees to offer health benefits to anyone who works at least 30 hours a week or pay penalties to the government. Other elements of the law also could be targeted for changes.

Obama wouldn't comment on a reporter's question about whether he would agree to eliminating the medical device tax. Obama also hasn't said whether he would be willing to accept changes to the so-called employer mandate, but he has twice delayed implementation of this part of Obamacare, which was supposed to take effect this year but now won't fully be in place until 2016.

More people oppose the Affordable Care Act than support it, with 43 percent holding an unfavorable view of the law compared with 36 percent who see it favorably, according to an October poll by the Henry J. Kaiser Family Foundation. The same survey, however, revealed more than two-thirds of Americans believe Congress should work to improve Obamacare.

5 New GOP Governors Could Undercut Medicaid Expansion

Jeffrey Young   |   November 5, 2014    3:44 PM ET

The Republican wave at the polls Tuesday didn't just give the GOP more power to obstruct Obamacare in Congress and block Medicaid expansion in more than 20 states. It also could jeopardize health benefits already extended to Americans living near the poverty level.

Republican governors will replace Democrats in four states -- Arkansas, Illinois, Maryland and Massachusetts -- that have expanded Medicaid under the Affordable Care Act. And the Republican succeeding Arizona Gov. Jan Brewer (R) is dubious about that state's expansion.

Heading into Election Day, advocates for more Medicaid were hopeful that Democrats would win gubernatorial races in Florida, Maine, Wisconsin and other states where Republican governors have blocked the policy, leaving millions uninsured. Instead, the only place where the tide could turn in favor of Medicaid expansion, which the Supreme Court made optional for the states in 2012, is Alaska. The race there remains undecided between independent Bill Walker, who supports the policy, and Gov. Sean Parnell (R).

Moreover, the new Republican governors in Arizona, Arkansas, Illinois, Maryland and Massachusetts will have the power to threaten health coverage for hundreds of thousands who have enrolled in expanded Medicaid. None has publicly threatened to do so, but the program has become more vulnerable in those states. Here's what the governors-elect have said about Medicaid.

Doug Ducey, Arizona

Gov. Brewer infuriated Republican lawmakers when she strong-armed the Medicaid expansion through the Arizona legislature last year. More than 230,000 Arizonans enrolled under the new rules as of last month, the state reported.

Ducey isn't making noise about undoing the expansion, but he wants the state to seek federal approval to alter the program, including adding a requirement that beneficiaries deposit money in health savings accounts. Ducey has also vowed to constrain Arizona's spending on Medicaid as federal funding for the expansion drops from 100 percent through 2016 to 90 percent by 2022.

In a statement on DougDucey.com, he said:

I will lead the effort to negotiate a Medicaid waiver for Arizona and to protect our state from Obamacare, one of the worst laws ever signed by any American president. ... The expansion of Medicaid as part of Obamacare receives significant federal money ... for the first three years. After that the rules will change, and Arizona taxpayers may need to pay considerably more. As governor I will prepare for all scenarios, and I will not allow a massive new entitlement to grow into a huge financial burden for future generations of Arizonans. We will keep a lid on health care costs, period.

Asa Hutchinson, Arkansas

Arkansas led the nation in creating an alternative model for expanding Medicaid that uses private insurance plans to provide health coverage. Gov. Mike Beebe (D) devised the so-called private option with the GOP-controlled state legislature. More than 200,000 people enrolled in Arkansas, and states with Republican governors like Ohio and Pennsylvania adopted similar policies. But the private option was nearly defunded this year because Arkansas law requires spending bills to receive a 75 percent vote in both houses of the legislature.

After Hutchinson's gubernatorial victory on Tuesday and gains by Republicans in the state legislature, winning that 75 percent will be even harder next year. Hutchinson has said he wouldn't have signed the bill creating the private option had he been governor at the time, but he has stopped short of calling for its repeal. Here's what he said in March after the legislature voted to keep the program alive:

Ultimately, I would have designed the health care plan for Arkansas differently. But as Governor, I will inherit the decisions the Governor and General Assembly made in the fiscal session. ... I view the Private Option as a pilot project; a pilot project that can be ended if needed. As Governor, I will assess the benefit of the Private Option and measure the long-term costs to the state taxpayers. As Governor, I will weigh the cost and benefits of the program and determine whether the program should be terminated or continued.

Bruce Rauner, Illinois

Rauner's position on the Land of Lincoln's Medicaid expansion, which has covered nearly 470,000 people, is clear: He's not going to fight the Democratic-controlled legislature over it, even though he wouldn't have adopted it in the first place.

According to the Chicago Tribune, Rauner said:

I would not have accepted expansion of Medicaid. ... It's been done now and I'm not advocating a rollback. But what I am advocating and always have and always will is we've got to restructure Medicaid in Illinois. It is filled with waste and fraud.

Larry Hogan, Maryland

Hogan's stance on the Medicaid expansion is difficult to parse, and his campaign didn't immediately respond to an email requesting clarification. Although he hammered his Democratic opponent, Lt. Gov. Anthony Brown, over Maryland's botched health insurance exchange, Medicaid expansion -- which has covered about 377,000 Marylanders -- wasn't a notable issue during the gubernatorial campaign. Hogan also faces a Democratic-led state legislature.

In an October interview with the Washington Times, Hogan seemed to indicate that he won't pick a fight over Medicaid:

He said that trying to take on Medicaid or powerful labor unions, as Republican governors have done in other states, would be a “fool’s errand.”

“We’re going to try to win the battles we can win. That’s tough enough as it is,” said Mr. Hogan. “It’s baby steps in Maryland.”

Charlie Baker, Massachusetts

Baker, a former health insurance executive, is one of the many, many Bay Staters frustrated by the bungled marriage of Massachusett's pre-Obamacare health care reforms with the federal Affordable Care Act. Problems included a poorly functioning website and people forced to accept temporary coverage under government programs instead of the private insurance they wanted. The issue of Medicaid expansion, however, wasn't part of Baker's platform, and his campaign didn't immediately reply to an email requesting comment.

Baker has pledged to cut the Massachusetts health care program loose from Obamacare. But given that generous Medicaid coverage was available in the state before the Affordable Care Act, scrapping the expansion would seem incompatible with protecting the program signed by then-Gov. Mitt Romney (R) in 2006. Moreover, the state legislature remains in the hands of Democrats.

According to CharlieBaker2014.com:

Massachusetts should be able to return to its own system that worked and as governor Charlie will aggressively pursue a waiver for Massachusetts from the ACA.

To date, 27 states and the District of Columbia have adopted the Medicaid expansion under Obamacare, which makes Medicaid available to anyone who earns up to 133 percent of the federal poverty level -- or about $15,300 for a single person.

CORRECTION: An earlier version of this story misstated how much a single person making 133 percent of the federal poverty level earns. The correct figure is about $15,300.

A Republican Senate Can't Repeal Obamacare. That Won't Stop Them From Trying

Jeffrey Young   |   November 4, 2014    6:24 PM ET

Republicans have been chomping at the bit to repeal Obamacare since the instant President Barack Obama signed it into law on March 23, 2010. With control of the Senate assured after Tuesday's elections, is the GOP poised to undo the Affordable Care Act "root and branch," as soon-to-be Senate Majority Leader Mitch McConnell (R-Ky.) is fond of saying?

In a word: no. Even McConnell has admitted as much. And as McConnell knows from the hundreds of thousands of Obamacare enrollees his home state, repealing the law would snatch health coverage from millions, something Republicans might not want to actually have to answer for.

But that won't stop a Republican-controlled Senate from joining the GOP-led House -- which has voted to repeal, defund or otherwise derail the law more than 50 times -- in bringing up repeal for at least one vote. Obama would then swiftly veto it, but not before Democratic senators were forced to cast a vote very directly in support of Obamacare, which remains generally unpopular.

There are also some elements of the Affordable Care Act a Republican Congress could target, either symbolically to highlight Obamacare's real and perceived shortcomings, or as a means to erase or amend parts of the law they may believe are vulnerable. Some Senate Democrats likely would even join them on some votes, like to repeal a tax on medical devices.

That would leave Obama with a tough decision to make, especially if alterations to Obamacare are included as part of larger legislation he supports. And it's not as though Obama is totally opposed to changing the health care law. His administration has unilaterally postponed or modified big parts of the law, such as delaying its requirement that large employers offer health benefits to workers or pay tax penalties. And Obama has signed more than a dozen bills that made changes to the Affordable Care Act, according to the Congressional Research Service.

Of course, if the GOP Senate behaves anything like the GOP House has (and like Republicans in the Senate did while in the minority), it could attempt all manner of shenanigans to disrupt the implementation of the law, including withholding funding. And it certainly wouldn't be interested in helping Obama fix real problems with the law to make it function better. Plus, there will be hearings. So many hearings.

Hey, maybe Republicans will finally unveil their long-awaited Obamacare alternative at some point!

No matter what, there's virtually zero chance Obamacare will go away while its namesake occupies the Oval Office. But that doesn't mean the Affordable Care Act will look exactly the same when the next president is sworn in as it does today.

Here are some of the most likely provisions of Obamacare a fully Republican Congress could take aim at.

Individual Mandate
The requirement that nearly all Americans obtain some form of health coverage or face a tax penalty is the granddaddy of them all. Sure, this idea originated with the conservative Heritage Foundation back in the '90s, but it's the least popular part of Obamacare and is an affront to liberty in the eyes of tea party types. It also was the subject of a lawsuit that went all the way to the Supreme Court, which upheld it. Undoing the mandate would devastate the rest of the law because it would take away a big incentive for healthy people to buy insurance, leaving the companies with more costly customers and forcing them to jack up prices to unaffordable levels.

Employer Mandate
The Affordable Care Act requires all companies with at least 50 employees to offer health benefits to everyone who works at least 30 hours a week. Businesses hate it. Republicans hate it. Even some leading liberal advocates for Obamacare wouldn't mind seeing it go. Obama himself delayed full implementation of this provision from 2014 to 2016, and scraping it would have a negligible effect on how many Americans have health insurance.

Medical Device Tax
Somehow, a 2.3 percent sales tax on medical devices like pacemakers became a cause célèbre among Republicans -- and Democrats from states like Minnesota that are home to big device manufacturers. Getting rid of the tax has almost happened a few times, and 32 Democratic Senators joined all Republicans voting in favor of repealing it in March 2013. Eliminating the device tax wouldn't change any of the major parts of Obamacare, either.

Independent Payment Advisory Board
One of the many things falsely dubbed a death panel by Republicans, the so-called IPAB was supposed to be a key tool to reduce health care costs. The 15-member, presidentially appointed and Senate-confirmed panel is tasked with issuing recommendations to cut Medicare fees to medical providers to keep the program's spending in check. If Congress doesn't override those plans with cuts of its own, IPAB's become law. To Republicans, it's tyranny. To Obamacare, so far it's been pointless. Obama never named anyone to the board, and Medicare spending has been so low lately, they wouldn't have had anything to do anyway.

"Insurer Bailout"
The Affordable Care Act includes provisions designed to protect health insurance companies that get unlucky and sign up too many expensive, sick customers. Wonks call these policies the "three Rs" -- reinsurance, risk corridors and risk adjustment -- but Republicans call them an insurer bailout, because of course they do. (President George W. Bush had no such qualms about these things when he made them part of his Medicare prescription drug law in 2003). Doing away with this protection could destabilize Obamacare's health insurance exchanges by forcing insurers to eat big losses, and maybe scaring them away entirely.

This Election IS About Obamacare For These Uninsured People

Sam Stein   |   November 4, 2014   12:00 AM ET

WASHINGTON -- The last few years of Tarika Collins’ life have been a series of horrendous medical complications. Four separate car accidents in 2012 left her with nerve damage in her back. That same year, she was diagnosed with an aortic valve leak, which, over time, led to heart disease. In 2013, she had a heart attack, which resulted in the installation of a stent in her coronary artery. Months later, she had to have neck surgery. She was told that without it, she may end up paralyzed.

Collins is just 45. But the parade of horribles leaves her with intense anxiety. She has been unable to work since leaving her job as a corporate travel agent following her heart attack. Today, she says, “It is very rare that I leave the house.”

Collins is among the nearly 5 million Americans estimated to be too poor for Obamacare, because of actions by the Supreme Court and Republican politicians in 23 states.

Collins estimates she has made a dozen trips to the hospital emergency room in the past few years. Having sold all her assets to pay for her care, she's now about $500,000 in debt and is hosting Internet fundraising drives to help with the bills. Absent a breakthrough with disability insurance (she has a court date in December), Collins has one last hope: That on Tuesday, voters in her state of Florida send a message through the ballot box that they want an expansion of Medicaid.

“It would get me in the system,” Collins, of Clearwater, said. “I would be able to get some health care. For me, it would mean a longer lifespan.”

“Mostly, the emotions I feel are scared,” she said of her wait for the outcome of the race between Gov. Rick Scott, a Republican, and former Gov. Charlie Crist, a Democrat. “Scared that it could go either way. I’m scared I’m going to die before [Medicaid expansion] comes.”

There are two threads of conventional wisdom heading into Tuesday's midterm election. The first is that the election doesn't much matter. Regardless which party controls the Senate, President Barack Obama will still occupy the White House, which means gridlock will remain, if not escalate. The second is that, when it comes to Obamacare, the status quo will remain in place for at least the next two years. Senate Republicans may push for repeal votes. But Obama will veto them. Smaller reforms may pass. But the law will mostly remain intact.

What these threads ignore is that for millions of Americans, Tuesday's election may have life-altering consequences on the issue of Obamacare. At least six states have close gubernatorial elections featuring an incumbent Republican who has resisted expanding Medicaid -- an option states were given by the Supreme Court in 2012. Avalere Health, a strategic advisory services firm, has estimated that in Florida, Georgia, Kansas, Maine, and Wisconsin, almost 2.3 million people have been left uninsured because of that resistance.

"As we looked at it, we came to the conclusion that this is a very important election for the future of Medicaid," said Dan Mendelson, founder and CEO of Avalere Health. "And these six gubernatorial elections are the best examples of that. There are a number of other states where if the balance shifts even subtly, the balance will shift toward Medicaid expansion."

GOP governors and legislators say they base their opposition to Medicaid expansion on the potential cost to their state, despite the availability of generous federal funding. The result of their refusal to approve expansion are clear: The uninsured rate has declined much more in states that adopted the policy than in those that haven't, surveys show.

Denise Sock, of Presque Isle, Maine, sees Tuesday as potentially life-altering for her medical care. Sock, 51, has been unemployed and uninsured since October 2012, when she lost her job after being sidelined by a work-related injury. She suffers from a slew of chronic health problems, including diabetes and very high cholesterol and triglyceride numbers, she says. Her conditions worsened because she couldn't afford care, and she has thousands of dollars in medical debt she can't pay.

"I have fought depression. I have figured, you know, maybe the world was better off if I wasn't around. Why am I even trying to keep fighting?" Sock says.

Sock's husband has been without a job since 2009, so their 27-year-old daughter, Tasha Stetson, moved home with her own 2-year-old daughter, and is covering the family's household expenses while she can.

Medicaid expansion would "make a huge difference," Sock says. "It would alleviate a lot of the burden off my daughter."

Standing in the way is Maine's governor, Paul LePage (R), who has blocked the state legislature's five attempts to expand Medicaid. Maine is the only New England state that hasn't accepted the mostly federally funded expansion of the benefit to more poor residents.

Sock's health coverage predicament is tied to two decisions LePage made. In addition to rejecting the Obamacare Medicaid expansion, LePage actually scaled back Medicaid eligibility this year, taking away benefits from tens of thousands and denying it to people like Sock, who might have qualified under the state's old rules.

Six months ago, the women at Sock's church pooled money so she could see her doctor, have blood tests, and get her prescriptions renewed. The results confirmed what she already felt: She had gotten much sicker.

"I was basically among the walking dead. My blood work was so bad because I hadn't had most of my medication in two years because I couldn't afford them," Sock says.

Sock tried signing up for Obamacare, only to learn she fell into the coverage gap. The federally run health insurance exchange sent her to MaineCare, the state's Medicaid program, which sent her back to the exchange.

"It's a vicious cycle, and I'm not getting anywhere," Sock says.

For Sock and others, the coverage gap seems like an Obamacare promise unfulfilled. Athena Ford Smith, advocacy director for the Florida Community Health Action Information Network, also known as Florida CHAIN, says people are often crestfallen when they learn they're actually too poor to get covered.

"The most painful part of my work and of our work as health care advocates is looking somebody in the eye and saying, 'I'm sorry. There's no help for you,'" Ford Smith says. "A lot of consumers do think that it's the health care law that created that coverage gap."

In fact, the Affordable Care Act intended the Medicaid expansion to be national. But the Supreme Court ruling and resistance from Republican policymakers have shortened its reach, leaving the poorest uninsured Americans with no coverage. Because Congress didn't anticipate Medicaid wouldn't be available to everyone with earnings below poverty, tax credits for private insurance only are available to people who make more than that, which is about $11,500 for a single person.

While Tuesday's elections may spark the process that can close the coverage gap in up to six states, simply electing a new governor doesn't guarantee it will happen. State legislatures have resisted Medicaid expansion, even in states where the governor is supportive (see: Virginia, Terry McAuliffe, or Missouri, Jay Nixon). Even in Florida, Gov. Scott nominally supported the expansion, but has not persuaded lawmakers to follow through. Advocates say Scott has barely tried.

Those same advocates argue that an election win for a Medicaid-backing governor candidate would send a powerful message to state lawmakers. And it may accelerate the existing trend of Republican-run or Republican-leaning states softening their opposition to the expansion, as have Pennsylvania Gov. Tom Corbett and other Republican governors who have taken up the Medicaid expansion.

"We hope on Jan. 1 that our leaders will move immediately to close the coverage gap. This must be a priority," Ford Smith says.

In Kansas, state Rep. Jim Ward (D) says he will reintroduce legislation to expand Medicaid in the next session, regardless of who wins the governor's race. He recognizes that it remains a challenge, even if Gov. Sam Brownback (R) is to lose on Tuesday. The state remains Republican-leaning. And the statehouse has a big say in the matter. But the tide of public opinion in turning, Ward adds.

"It is not over with the change in governor, but it changes the whole discussion from, 'We don't even talk about it,' to 'It is something we will be talking about every day, it is something we would be pushing every day,'" Ward says. "I hate to speak for Paul [Davis, the Democratic candidate] because he speaks so well for himself. But his win changes the whole conversation.

"For about 150,000 to 180,000 Kansans," Ward adds, "the stakes couldn't be higher."