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These 5 Scary Obamacare Predictions Were Dead Wrong

Jeffrey Young   |   October 17, 2014    7:32 AM ET

Predicting the ways in which Obamacare would fail and ruin America has been something of a cottage industry for conservative politicians and talking heads since the Affordable Care Act passed in 2010.

Sometimes the Obamacare haters resolutely held their ground even as the facts disproved their theories. This is known as "Obamacare trutherism".

So let's take a journey down Bonkers Lane and remember together some of the scariest prognostications about Obamacare that turned out to be untrue.

1. Prediction: No One Is Going To Pay For Health Insurance

What happened: Just About Everyone Paid For Health Insurance. After we learned that more than 8 million Americans signed up for health insurance on the Obamacare exchanges by April, it became hard to argue that no one would enroll. So conservatives moved on to a new theory: No one was actually gonna pay for it. The taker-class, 47 percenters who had latched on to the government teat were deadbeats who don't pay their bills, the argument went, basically. "But how many have paid??" they asked. Over and over.

House Energy and Commerce Republicans released a laughable "report" in April asserting only two-thirds of enrollees had paid premiums. Then they held a hearing about it, where health insurance company executives lined up to tell them they were were dead wrong, and the number was more like 80 percent to 90 percent.

Finally, after months of caginess, the Obama administration offered a real answer: 7.3 million enrollees were paid up as of Aug. 15. That's down from the 8 million announced in April, but still more than the 6 million the Congressional Budget Office predicted would sign up.

obamacare fact check
"Thank you for the health insurance. Here is my money." - Most people

2. Prediction: Premiums Are Going To Skyrocket!!

What happened: Premiums Went Up A Smidge. Maybe the loudest, most persistent prediction was that health insurance prices would go through the roof next year because so many sick people would sign up, and so few young people, that insurers would have to jack up prices -- maybe even by as much as 300 percent! And then a "death spiral" would begin and undermine the whole industry!

Back to reality: Forty-six percent of the people who bought plans on the exchanges said the plans were less expensive than the ones they had in 2013, according to a Henry J. Kaiser Family Foundation survey from March and April.

Thirty-nine percent of enrollees surveys did said their new plans were more expensive. These higher rates mainly affected younger, healthier people who earn too much money to qualify for tax credits to help pay for coverage. Eight-five percent of everyone who enrolled got these subsidies. And the increases were likely a one-time bump, mainly caused by rules making the insurance package better, so it isn't relevant to 2015. And yet...

"O-Care premiums to skyrocket," screamed a March headline in The Hill, which remains the only entity that uses the term "O-Care." FOX News was ON IT. Health insurance prices are going to double -- triple even. Trainwreck!

The basis for this shocking report? Anonymous quotes from "health industry officials." Which ones? Who knows! Stop asking questions. From The Hill:

“...I think everybody knows that the way the exchange has rolled out...is going to lead to higher costs,” said one senior insurance executive who requested anonymity.

The insurance official, who hails from a populous swing state, said his company expects to triple its rates next year on the ObamaCare exchange.

Color us rate-shocked! But wait -- what's that, consulting firm PricewaterhouseCoopers? The average premium increase on the exchanges next year will be 6 percent? (That's less than 300 percent, if you don't have a calculator handy.) That doesn't seem so bad, and is lower than typical increases for individual insurance policies before Obamacare.

This Is What's Up With Obamacare Premiums In 2015

obamacare fact check Source: PricewaterhouseCoopers Health Research Institute

3. Prediction: Obamacare Is The Worst Thing To Happen To Young People Since Moms Joined Facebook

What Happened: A Lot Of Young People Are Insured, Pleasing Moms Everywhere. Young adults were urged to "burn their Obamacare cards" by right-wing outfits trying to disrupt Affordable Care Act implementation. Their argument: Obamacare is a bad deal for 20-somethings because they'd be paying a ton just so old people and sick people could go to the doctor. Millennials were better off paying the fine for violating the law's individual mandate than buying health insurance. And anyway, these "young invincibles" didn't even want health insurance (contrary to what they actually said in polls, but whatever).

Obamacare was designed to "screw" young adults, they were told. But in 2010, the law started allowing people to stay on their parents' health insurance policies until they turn 26, and in 2014 it began offering subsidized coverage to people with low and moderate incomes, which includes lots of young people just starting their careers. The result:

The Uninsured Rate

Among 19- to 25-Year-Olds

obamacare young adults Source: Centers for Disease Control and Prevention via White House Council of Economic Advisers

4. Prediction: Obamacare Is INCREASING The Uninsured Rate!

What happened: Obamacare DECREASED The Uninsured Rate. Considering that the Affordable Care Act will spend about $1 trillion over a decade to subsidize health benefits and requires most people to get covered, this idea seems just plain silly. But that hasn't stopped politicians and others from expressing it aloud!

House Speaker John Boehner (R-Ohio) himself got in on the action, saying in March there was a "net loss of people with health insurance." Whoa if true.

All available evidence shows that the uninsured rate is down -- way down. According to Gallup, it hasn't been this low since the 1990s.

obamacare fact check
Source: Gallup

The Department of Health and Human Services and the Harvard School of Public Health concluded in a New England Journal of Medicine article that 10.3 million more people have health insurance this year than did last year.

5. Prediction: Obamacare Will Destroy The Private Health Insurance Industry

What happened: Health Insurance Companies Got A Lot Of New Business. A big part of this claim rests on exploiting public confusion about what "Obamacare" is, and ignoring the fact that private health insurance is what's being sold on the exchanges. (Not to mention that even "single-payer" Medicaid is largely contracted out to private insurance companies.)

Another component of this prediction was that the Affordable Care Act lays too many regulations on health insurers. And there are lots and lots of regulations, like the prohibition against rejecting customers with pre-existing conditions and the mandate for a guaranteed minimum benefits package, that insurers wish they didn't have to follow.

"Look at what we've done to eviscerate the U.S. health insurance industry," Rep. Marsha Blackburn (R-Tenn.) said on FOX News in April.

Yes, look. After the first enrollment period brought in more than 7 million paying customers and the promise of millions more in the future, health insurance companies grew more confident (even some of those, like Aetna, that expect to lose money on the exchanges in 2014).

How confident? There will be 248 more health insurance plans available on the exchanges for 2015 than there were this year, a net increase of 25 percent (including a few companies that bowed out) compared to the first enrollment period.

obamacare fact check
Not a photo of the U.S. health insurance industry

Conservatives Proven Utterly Wrong On Key Aspect Of Obamacare

Jeffrey Young   |   October 9, 2014    4:57 PM ET

Remember when Obamacare was a terrible deal for young adults, and how "young invincibles" didn't even want health insurance? Conservative groups -- acting, no doubt, out of deep concern for the well-being of the nation's 20-somethings -- even staged events where young people burned their "Obamacare cards" (there is no such thing).

The key part of this narrative was that young adults would shun Obamacare. This would then leave health insurance companies and taxpayers holding the bag when only old and sick people got covered under the new program and run up huge medical bills, leading to a catastrophic "death spiral" that would destroy the private health insurance market. What a terrifying nightmare!

Instead, this is what happened:

The Uninsured Rate

Among 19- to 25-Year-Olds

obamacare young adults

Not so scary, after all.

That's right: The share of the population between 19 and 25 years old without health insurance has fallen since the Affordable Care Act passed in 2010. That year, the uninsured rate for that group was more than 30 percent. By the end of this March, it had fallen to 21 percent, according to Centers for Disease Control and Prevention survey data presented in a report the White House Council of Economic Advisors released Wednesday.

In fact, the uninsured rate fell more for young adults than any other age group from the end of 2013 to the close of the first quarter of this year, the CDC survey found. And that doesn't even account for a surge in Obamacare enrollments at the end of March and early April, especially among younger people, for insurance coverage that didn't kick in until April or May. Turns out, people under 30 also think having health insurance is a good idea.

Sort of hard to square these findings with, say, this from February 2013:

obamacare young adults
Source: BuzzFeed

Again, this is what "screwed" looks like:

obamacare young adults

And although young adults don't make up as many of the 7 million-plus people enrolled in private Obamacare plans as the administration wanted, the new health insurance exchange marketplaces seem to look appealing enough to health insurance companies. On average, premiums will rise 6 percent next year, according to PricewaterhouseCoopers, which is in line with or below historical increases. And more insurers are joining the Obamacare exchanges.

Sure, these numbers are being touted by the White House, which has a vested interest in spinning such things. But survey after survey after survey has shown that Obamacare made a big dent in the uninsured rate. According to Gallup, it's the lowest it's been since 1997, at 13.1 percent.

To be fair, it's totally true that Obamacare brought with it big changes in the health insurance market for young adults.

On the plus side, parents can keep their children on their family insurance policies until they turn 26, which appears to have had a real effect on the uninsured rate for young adults starting in 2011. And young adults have access to the same guaranteed benefits, coverage regardless of pre-existing conditions, and financial assistance to obtain health insurance as everyone else.

The big downside is that the Affordable Care Act allows health insurance companies to charge older customers no more than triple what they charge younger policyholders, which would tend to increase premiums for young people, who presumably are healthier and use less medical care. That problem is mitigated at least somewhat by the availability for subsidies for low- and moderate-income people. That's good, because young adults tend to earn less than older people. But price can still be an issue, especially for those who rarely visit the doctor and might not see the value in paying a premium every month.

(Let's compare that situation to job-based health insurance, which is the most common form of health insurance in America. For large-group insurance, everyone pays the same price, no matter how old or young, sick or healthy. If Obamacare is a bad deal for young adults, employer health benefits seem even worse.)

And one study even found that young adults actually were healthier after Obamacare benefits kicked in. That's a funny definition of "screwed."

A Deadly Virus Is Sweeping America. No, Not That One

Jeffrey Young   |   October 8, 2014   11:16 AM ET

A deadly virus is poised to sweep across America and could claim thousands of lives this year. It's especially dangerous for the most vulnerable members of society, and preventing an epidemic will require a coordinated, nationwide effort between the government and the private sector.

No, it's not Ebola, the gruesome viral infection that has killed almost 4,000 Africans in its latest outbreak, the largest in history. It's influenza, otherwise known as the flu. The ailment may seem commonplace, but it costs thousands of lives and billions of dollars when it resurfaces each year.

The very fact that flu season is so routine might seem like a reason to shrug it off. Mild cases bring about symptoms that are similar to colds or other minor ailments, making it seem like less of a big deal.

But that kind of thinking could be dangerous, especially if you or someone in your home is susceptible to the worst effects of the virus. Such people include little kids, senior citizens, pregnant women and people with health conditions like asthma, diabetes and heart disease.

At its worst, influenza can be catastrophic. The Spanish flu outbreak in 1918 and 1919 sickened as much as 40 percent of the world's population and claimed 50 million lives, including 575,000 Americans. The flu is not usually that bad, but its effects vary widely. From 1976 to 2007, between 3,000 and 49,000 Americans per year died from flu-related causes, according to the Centers for Disease Control and Prevention.

Of course, even in years when influenza reaches epidemic or worldwide pandemic proportions, the virus pales in comparison to other leading causes of death, such as heart disease, which kills nearly 600,000 Americans annually, according to the CDC. "Influenza and pneumonia" was listed as the eighth-leading cause of death in 2010, killing almost 54,000 people that year, the agency reported.

For more perspective amid widespread U.S. jitters about Ebola, compare the flu to that virus. The total number of patients diagnosed and killed by Ebola in the United States since the disease was identified nearly 40 years ago: one.

And yet more than one in five Americans say they're afraid they'll catch Ebola, according to a Gallup poll released this week. That's about the same share expressing concern about the "swine flu" strain of influenza, a.k.a. H1N1, a much greater health threat, five years ago. Between April 2009 and April 2010, nearly 61 million Americans contracted the swine flu, and almost 12,500 died from it. Unlike seasonal flu, most of the fatalities from swine flu were adults younger than 65, the CDC estimated.

So if you're one of those Americans quivering in front of the TV's non-stop fear-inducing news coverage of Ebola, maybe your nervous energy should be directed elsewhere.

The worst recent domestic influenza outbreak occurred a decade ago, when the virus was linked to 48,000 deaths during the 2003-2004 flu season, according to the CDC.

During the 2012 and 2013 flu season, 32 million people became ill because of the virus, nearly half of whom needed medical attention and 381,000 of whom were hospitalized, CDC data show. Detailed information isn't available from the agency about the following flu season, or the current one.

The economic costs of the flu are significant, too, totaling more than $87 billion a year, according to a CDC study published in 2007. That includes more than $10 billion in medical costs and more than $16 billion in lost earnings for workers who get sick or die, CDC researchers concluded. Given that medical costs grow faster than the economy does, that tally is likely higher now.

Predicting how mild or severe a flu season will be is tough to do accurately, partly because there are so many strains of the influenza virus. Flu season usually hits its peak some time between December and February.

The good news is that flu typically isn't life-threatening for adults who aren't elderly. But when a new strain of flu emerges, like Spanish flu or swine flu, that is harmful to adults, the death count tends to rise.

The even better news is that getting the flu is extremely preventable through vaccination. Flu vaccines, which change every year based on scientists' assessment of which versions of the flu are most likely to spread, are proven effective, if imperfect.

Vaccines are right now being distributed across the U.S. for patients to get immunized. As of Sept. 26, nearly 88 million doses of influenza vaccine had been shipped around the country, and up to 159 million may be shipped by the end of flu season. The CDC recommends that everyone 6 months old and up get the vaccine, unless there are medical reasons they cannot, which can include being allergic to the vaccine.

And yet, despite the risks of flu and the wide availability of vaccine in most years -- not to mention an Obamacare rule making flu immunizations free in most cases -- a huge swath of the population leaves itself vulnerable.

During the 2013-2014 flu season, just 45 percent of Americans got vaccinated, including just over 56 percent of children from six months to 17 years old. Get those numbers up, and the flu becomes a lot less scary.

Obamacare Officials Swear Website Will Work This Time Around

Jeffrey Young   |   October 8, 2014   11:10 AM ET

HealthCare.gov will be easier to use when Obamacare enrollment starts back up next month -- and not just because the website actually works now, senior health care officials told reporters Wednesday.

The biggest change: the application for insurance is now much more simple. Last year, the application was 76 pages long. This year there will be as few as 16 pages, said Andy Slavitt, principal deputy administrator of the Centers for Medicare and Medicaid Services, the agency that oversees HealthCare.gov.

"The core things that the website needs to do -- getting information where it needs to go, getting people where they need to go, getting people paid -- all that stuff is working fine," said Slavitt, who worked on the HealthCare.gov rescue effort last year as a UnitedHealth Group executive and joined the agency in June.

The enrollment period on HealthCare.gov, the online gateway to Obamacare's health insurance exchanges in more than 30 states, begins on November 15 and runs through February 15.

Strong memories linger of the calamitous debut of HealthCare.gov on Oct. 1, 2013, when the balky system couldn't function, and worked very poorly for two months before a desperate overhaul by federal officials got the website working well enough to enroll more than 8 million customers by early April.

In addition to enduring a technological disaster that nearly derailed President Barack Obama's signature domestic policy achievement, users complained of slow performance and a confusing system that required them to re-enter the same information over and over again and frequently lost data they'd already inputted. Now, the website will save information like names and income when it's entered and not ask for it again. You'll even be able to use the "back" buttons on their browsers like on any normal website, a basic function that wasn't available last time around.

Then-Health and Human Services Secretary Kathleen Sebelius and other senior administration officials made similar declarations shortly before HealthCare.gov flopped last year.

It's going to be different this time, Slavitt said. The Centers for Medicare and Medicaid Services and its contractors have been testing the website and its backend more vigorously and for longer than they did last year, he said. Full testing of the system began Tuesday, which includes linking the system to health insurance companies, he said. Those tests will run for more than five weeks, compared to just 10 days of the same testing before last October, he said. After the fact, administration officials and the private contractors cited inadequate testing as a big reason the website didn't work, and why they were caught off guard when it didn't.

In a possibly telling contrast to the state of HealthCare.gov a year ago, Centers for Medicare and Medicaid Services officials demonstrated the new application using the actual website Wednesday. Last September, Sebelius and her deputies had only a mock-up to show only a day before enrollment began.

By the time the new enrollment period starts next month, HealthCare.gov will be able to handle more users at a time than on its busiest day from the first sign-up period, March 31, when simultaneous visitors peaked at 125,000, Slavitt said. Slavitt wouldn't speculate what the total capacity would be.

One key difference between this year's assurances and last year's is that HealthCare.gov already exists and already has enrolled millions of people. Since July, more than 20,000 people have signed up using the new application, Slavitt said. Outside the annual enrollment period, people are permitted to use the health insurance exchanges if their life circumstances change, like if they get married or lose job-based health benefits.

About 70 percent of HealthCare.gov applicants will use the simplified application when yearly sign-ups begin next month, Slavitt said. The remainder are people whose household situations require them to answer additional questions. Examples could include families where a child qualifies for the federal-state Children's Health Insurance Program while the parents are eligible for subsidized private insurance, or families with mixed immigration status.

Not that HealthCare.gov is about to rival Amazon.com or other commercial websites. It'll still be impossible to search health plans by what doctors they include or what drugs they cover, so consumers will have to seek that information from the insurance companies instead.

The enrollment period for 2015 health insurance begins in just over a month, and the challenges are significant well beyond the website.

There are more than 7 million current paid enrollees in private health plans who must re-enroll. Even though these customers will automatically see their current plans extended, if still available, many consumers will find better deals if they shop around because prices for health insurance on the Obamacare exchanges will vary greatly. Nationwide, the average increase will be 6 percent, but also will range from a 22% decrease to a 35% increase, according to data compiled by the consulting firm PricewaterhouseCoopers. The Congressional Budget Office projects 13 million people will have health insurance obtained via an exchange next year.

See a slideshow demonstration of the new application process on HealthCare.gov

HealthCare.gov Streamlined For New Sign-Ups

Why We Won't Have An Ebola Cure Or Vaccine For Years

Jeffrey Young   |   October 2, 2014   12:23 PM ET

The world has known about Ebola for almost 40 years, yet there's no cure or vaccine on the market.

That could change amid worldwide attention to the ongoing outbreak of the virus in West Africa, which has claimed more than 3,000 lives already, and the first diagnosis of a patient with the disease in the United States. But not for a few more years -- at least.

Why have the scientific community, the pharmaceutical industry and world governments failed so far to come up with a way to treat or prevent this ghastly illness? Because the scientific and economics challenges are stark, and the experimental medicines available, even those already being used to treat Ebola patients, haven't been proved to be effective or safe.

Drug and vaccine development is characterized by failure, a fact that's easy to forget when so many miracle cures exist.

And despite gruesome symptoms including bleeding from the eyes, ears and mouth, and the fact that most Ebola patients die, 33 outbreaks of the virus had killed just over 1,500 people since 1976 before the current crisis, according to the Centers for Disease Control and Prevention.

This not only means that other diseases with broader reaches, such as HIV and AIDS, take precedence in scientific research, but that drug companies have had virtually no financial incentive to spend millions of dollars on medicines and inoculations for so few people -- especially people who lack the means to pay for it.

"There's nothing magical about getting a drug or a vaccine for Ebola. We likely would've had it years ago if there were major investments on the part of a company," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland. "The scientific challenges are not profound."

The scale and horrors of Ebola in West Africa, combined with diagnoses in Western countries such as the U.S., will spur greater interest among drug developers and speed possible treatments to market, Fauci predicted.

"What you'll see now is that this dramatic, highly publicized outbreak of Ebola is going to catalyze a lot of interest in the field of making antivirals for these types of diseases," Fauci said.

A handful of pharmaceutical and biotechnology companies already were working on medicines, vaccinations and tests for Ebola, many of which received funding from the National Institutes of Health.

ZMapp, under development by a California firm called Mapp Biopharmaceutical, has garnered attention since the African outbreak began and the company depleted its stock by shipping medicine overseas. The U.S. government, the Bill & Melinda Gates Foundation and the Wellcome Trust are working with the company and another firm to boost production of the experimental treatment, The New York Times reported.

In addition, a Massachusetts company, Sarepta Therapeutics, is working on another drug, as are Canada's Tekmira Pharmaceuticals and North Carolina's BioCryst Pharmaceuticals. A unit of British pharmaceutical giant GlaxoSmithKline is researching a vaccine, and Japan's Fujifilm is eyeing an existing flu medicine as an Ebola treatment.

ebola cure

Researchers have been working on a vaccine or cure for the Ebola virus, but it will be years before anything could be on the market. (Photo via Corbis)

In spite of these efforts and the intensified push from Western governments -- not to mention newly vigorous interest from investors -- experts cautioned against expecting the kind of quick turnaround of a cure or vaccine performed by scientists in the movies.

"We are certainly not at the beginning of these developments, but we're probably still realistically somewhere between five and 10 years away from having something that's on the market," said Ted Ross, program director for vaccines and viral immunity at the Vaccine and Gene Therapy Institute of Florida in Port Saint Lucie.

The timeline could be shortened to three or four years with a concerted push by governments, amplified by the efforts of wealthy charities and other nongovernmental organizations, Ross said.

Governments have a lot of weight, and money, to throw around, which has enabled scientists and pharmaceutical companies to make relatively rapid strides when the focus is there.

Fauci cited two significant examples as precedent. The massive global push to study HIV and AIDS led not only to treatments for that ailment, but to progress in developing drugs for other diseases, such as Hepatitis C, he said. More recently, concern about new, unpreventable strains of influenza spurred advances in flu research that may lead to the creation of a single shot that can protect against all forms of the virus, he said.

That doesn't mean it's easy, even with all possible support from governments, pharmaceutical companies or anyone else. Inventing medicines and vaccines and diagnostic tests is difficult, takes time and is more likely to fail than succeed, Ross said.

"It really takes almost a decade from concept to finally put the drug into a vial that you're ready to hand to a physician or a nurse," Ross said. "Very few drugs ever make it to market."

Scientists must follow a basic set of procedures throughout that can take an unknown amount of time and pose challenges all along, any one of which could scuttle the entire enterprise, Ross said.

It starts out with the basic, fundamental research of understanding what the disease is, how it works and how it might be counteracted. If those stages are successful and researchers have an idea of a way to attack the disease, they have to test it on animals to see whether it works at all, and whether it's safe.

Before a treatment or vaccine can be tested on living humans, scientists must conduct two rounds of research on human cells and tissue, first for safety and then for effectiveness. If all of that is successful, a drug company then has to get approval from the Food and Drug Administration and regulators in other countries to sell the product, which can take years.

During those painstaking steps, researchers and drugmakers always have to think about money. "It costs millions of dollars to do human trials," Ross said.

"Even if you have a drug that is effective, it really sometimes comes down to the economics of it. If it's going to cost you way more than what a person can afford, they're not going to be able to manufacture it," Ross said. "There won't be a market for it."

ebola cure
Source: Centers for Disease Control and Prevention

Big Pharma's Money Ties To Doctors Revealed. Kind Of

Jeffrey Young   |   September 30, 2014    5:40 PM ET

The Obama administration unveiled a website Tuesday that will shed some much-needed light on Big Pharma's relationship with doctors. Just not quite today.

Called Open Payments, it's a tool authorized by the Affordable Care Act that offers details on payments that drug companies and medical device makers give to physicians and medical school teaching hospitals.

The aim is to enable people to discover whether the doctors and hospitals they visit may have motives other than patients' best interests when they choose one drug or medical device over another that may be better or cheaper. Drugmakers have even been fined for making illegal payments to doctors to promote prescribing their medicines.

It's the largest attempt yet to reveal the financial ties between medical providers and the health care firms peddling their wares, and includes compensation that those companies give to doctors and hospitals in things like speaking and consulting fees, travel to industry conferences, and free meals.

For now, the database only includes a few months' worth of payments, and has other shortcomings that won't allow patients to fully vet their doctors and hospitals.

"This is an opportunity for the public to learn about the relationships among health care providers, and pharmaceutical and device companies,” Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, said in a press release.

This first release of payments information reveals drug and device makers made 4.4 million payments to 546,000 doctors and more than 1,300 teaching hospitals from August through December of last year. In total, the payments were worth about $3.5 billion. The Centers for Medicare and Medicaid Services will add more numbers in the coming weeks, according to a press release. The first full-year accounting of payments won't come out until June. Drug and device companies are required to disclose this information under Obamacare.

The idea for Open Payments originated as the so-called Physician Payment Sunshine Act, the brainchild of lawmakers led by Sen. Chuck Grassley (R-Iowa) and then-Sen. Herb Kohl (D-Wis.) in 2007. Eventually, patients will have a clearer understanding of where their doctors' and hospitals' financial interests may lie.

In addition to promoting transparency in general, making these payments public also may serve to reduce potential conflicts of interest by making health care providers think twice before accepting money from those companies.

But the first set of numbers in this huge new database only includes payments from a five-month period, which limits patients' and researchers' ability to track how closely tied one doctor or teaching hospital may be to the drug and device industries.

What's more, flaws in the data, which forced President Barack Obama's administration to delay the publication of these numbers, persist. As a result, there are payments not included in the database, and other information is listed without the names of the providers.

In short: You can search for your doctor or local teaching hospital, but the information you find might be incomplete, or even inaccurate.

ProPublica, a nonprofit journalism organization that maintains its own database of health care company payments to medical providers, offered a list of important reasons to be cautious about the numbers released Tuesday. The American Medical Association expressed similar misgivings. The AMA had called for the launch of the database to be postponed, as did the drug and device industries.

And if you do decide to start punching names into Open Payments, don't expect a Google-like experience. This is ProPublica's Charles Ornstein, a Pulitzer Prize-winning expert on data journalism and the subject of pharma and device payments to health care providers:

It's Not Your Imagination, Your Health Insurance Has Gotten Worse

Jeffrey Young   |   September 29, 2014    7:15 AM ET

A quiet revolution happened to your job-based health benefits and you may not have noticed. It's happened gradually, but insurance looks a lot different than it did just 15 years ago: Americans are paying more and getting less.

That trend is only getting worse.

Gone are the days of deluxe health plans that simply paid employees' medical bills without questions or problems. Now, faced with their own rising health care expenses, employers are forcing more risk for big medical bills onto workers, and asking them to take a more active role in shopping for lower-cost health care than they have before.

Last year, when Amy Czerwinski learned she had breast cancer and would need a double mastectomy as well as seven months of chemotherapy, she was not in the best place to start bargain-hunting for care.

"This is a life-and-death thing," said Czerwinski, a 38-year-old accountant who lives in Hendersonville, Tennessee. "You go to the specialist, and they tell you who they would suggest. I would be afraid to shop around and get a cheaper oncologist."

And that highlights a key problem with putting the onus on patients to be smart shoppers for doctors: The spread of health insurance that makes us pay more money upfront has outpaced the spread of reliable, accessible information about prices and about the quality of medical services.

Health insurance companies and employers use buzzwords like "consumer-directed health plans" to describe these approaches to health benefits. Higher deductibles and other means of making patients pay more when they receive health care -- like "coinsurance" that requires consumers to cover a percentage of their bills rather than charging a flat copayment -- are a way for employers to save money.

The average annual cost of a single worker's insurance plan more than doubled between 1999 and 2013, rising from about $2,200 to around $5,900, according to a survey of employers published by the Henry J. Kaiser Family Foundation and the Health Research and Educational Trust last month. Over that same time, the average share of that cost paid by single workers inched up from 14 percent to 18 percent -- meaning employers are chipping in less, even as costs rise precipitously.

And in the past five years, another trend has rapidly spread: higher and higher deductibles, which require workers to pay cash upfront for their medical care before the insurance begins picking up a share of the bills. Between 2006 and 2013, the portion of single workers whose plans have deductibles of at least $1,000 jumped from 10 percent to 38 percent, according to the survey.

Deductibles are supposed to give patients a financial motivation -- what insiders call "skin in the game" -- to shop around for less expensive medical providers, and to reconsider treatments they may not need. When you're responsible for paying more of the bill, you're more likely to care about how much something costs.

In some key respects, these changes have been beneficial. In the old days, a patient had no reason to care how much a service or a drug might cost, because their health plan would cover almost all of it. This is one reason U.S. health care spending went up and up over the decades. And the switch to health insurance that requires patients to pay more of the total cost has contributed to a historic slowdown in national health spending and to slower growth in job-based insurance premiums in recent years.

That doesn't mean a whole lot when you get sick, though. Health insurance designed to make workers more cost-conscious also exposes them to big expenses when they need lifesaving care, as Czerwinski learned. "Your insurance won't even touch anything until you hit your deductible," she said.

employee health benefits
Photo courtesy of Amy Czerwinski

Czerwinski racked up more than $15,000 in out-of-pocket costs as she struggled to meet the deductibles for her employer's health insurance while undergoing cancer treatments.

"You pretty much ignore the cost, because you just do," she said. "And then when you finally have to start opening the bills, it's kind of too late because you've already incurred the expenses." Her employer and the Patient Advocate Foundation, which referred HuffPost to Czerwinski, helped cover her expenses, she said.

A key element of the reasoning behind large deductibles and higher cost-sharing is that it will spur patients to become smarter consumers of health care who will do the research on which medical providers charge lower prices or have been proven to offer high-quality treatments.

But the facts that patients need in order to make informed choices are hard to find and complex to evaluate.

"I don't even know how you would do that," Czerwinski said. "I didn't even know that was an option."

And people facing high cost-sharing tend to skip not just expensive care they could do without, but also services they actually need, research shows.

There has been some improvement on this score, as health insurance companies, employers and other organizations are gathering and disseminating cost and quality information for patients to use. A growing number of health insurance companies, for example, are sharing these data with a nonprofit called the Health Care Cost Institute, which will publish them on its website next year.

Yet merely making the information available isn't enough, said David Newman, the institute's executive director. "Transparency in and of itself is not going to be the silver bullet. It can help," he said.

Employers who are shifting more responsibility for managing health care costs to workers should do more to make sure their employees understand how their benefits work and get them invested in the new way of doing things, said Julie Stone, the North America health and group benefits leader at Towers Watson, a consulting firm.

"There is an employer role to keep that front and center, and give examples and illustrate [that] it's in everybody's best interests, it's a win-win for the employer and the employee from a cost-management perspective," Stone said.

Czerwinski is now cancer-free, but she still worries about paying for the doctor visits and drugs she'll need to make sure the disease doesn't come back. And she's not confident her health benefits will keep up with her needs or stay on her family's budget.

"Insurance companies don't pay like they used to. And it's only going to get worse, and that's very scary because our salaries are not increasing at the same rate the insurance costs are increasing," Czerwinski said. "It didn't use to be this bad."

Birth Control Is Free Under Obamacare, But Not Everyone Got The Memo

Jeffrey Young   |   September 26, 2014    4:34 PM ET

One of Obamacare's biggest selling points for women is the guarantee of no-cost birth control, a new benefit that includes all forms of contraception from the pill to tubal ligation.

But two years after the rules eliminating copayments for contraceptives took effect, some women are still forking over cash to the pharmacist when they pick up their pills or at the doctor's office when they obtain other forms of birth control.

Just last week, CVS announced it would send rebates to 11,000 women who were erroneously charged for their birth control pills at the company's stores because of a computer error. The snafu came to light when an aide to Rep. Jackie Speier (D-Calif.) had to pay $20 for birth control at a Washington CVS, which prompted an inquiry by the lawmaker.

So did President Barack Obama break a promise? Are health insurance companies and drugstores picking women's pockets?

The good news is that neither of those things is true, and eventually almost all women with health coverage won't have to pay a dime when they obtain contraceptives. The bad news is that it's a little complicated. Because of course it is. This is the American health care system, after all.

"American women don't really know what all the rules are," said Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center. "All this is relatively new, and it's working fairly well. It just needs to be cleaned up and work better."

Some health insurance plans aren't yet required to comply with this part of Obamacare. Others never will have to cover birth control, such as those plans provided to employees of religious organizations. And as the CVS example illustrates, sometimes insurers and pharmacists just get it wrong, and women have to jump through hoops to set it straight.

"We do hear from women all over the country with what I will call glitches," Waxman said. "Not everybody understands what they're supposed to be doing."

First, the basics: The Affordable Care Act does require health insurance companies to cover all Food and Drug Administration-approved contraceptives -- including the pill, IUDs, the ring and the patch -- without any form of cost-sharing like copayments or deductibles. This requirement comes from the same part of the law that mandates no charges for preventive medicine, such as immunizations and cholesterol tests.

If you receive your health benefits from an employer and you're not sure whether you have to pay out-of-pocket to get contraception, you should ask a manager, the human resources office or the insurance company. If you buy health insurance on your own, check with the plan to find out what your contraceptive coverage is. All health insurance sold on the Obamacare exchanges includes no-cost birth control. If your insurance company still insists you owe copayments, you might have to file an appeal, Waxman said.

If you don't get straight answers from your employer or insurance provider, or if you feel like you're being ripped off, organizations such as the Planned Parenthood Action Fund and the National Women's Law Center can help, as can state insurance commissioners and the U.S. Department of Labor, Waxman said.

Despite its shortcomings and the confusion around how it's supposed to work, the Obamacare birth control mandate has had a huge impact: Many, many more women have access to no-cost contraception than before the law took effect, as this chart from the Guttmacher Institute, a reproductive health research organization, shows.

birth control
Source: The Guttmacher Institute

The share of women who obtained oral contraceptives without copayments rose from 15 percent in 2012 to 67 percent this year, according to a survey by the Guttmacher Institute. Women who used an injectable contraceptive or the ring saw a similarly major improvement in their benefits, and those using IUDs saw a somewhat smaller increase.

The effect on women's pocketbooks is striking: Women using contraceptives saved $483 million in copayments last year, according to IMS Institute for Healthcare Informatics, a branch of IMS Health that tracks pharmaceutical sales. (Obamacare didn't exactly make contraceptives "free," of course, because their cost now just gets included in the overall insurance cost.) The number of prescriptions filled for the pill also increased by 4.6 percent from the year before, IMS reported in April.

obamacare birth controlTop bar in millions of prescriptions. Bottom bar in millions of dollars. Source: IMS Institute for Healthcare Informatics

That's probably a big reason why this part of Obamacare is so popular. In a survey conducted this July, 60 percent of people said they supported mandated no-cost birth control, the Henry J. Kaiser Family Foundation found. Still, one-third of Americans didn't know about the no-cost birth control benefit as recently as March, and only one-fifth said they'd heard a lot about it, another survey by the foundation revealed.

Why do some women still have to pay up at the pharmacy or doctor's office? Because there are types of health insurance plans that currently don't have to provide this benefit.

The main category of such plans is what the Affordable Care Act calls "grandfathered" health insurance, meaning the plans can follow pre-Obamacare rules so long as the insurers don't make more than small changes to the benefits they offered on March 23, 2010, the day the president signed the law. About one-quarter of insured people are enrolled in these grandfathered plans, according to a survey of employers by the Kaiser Family Foundation and the Health Research and Educational Trust released last month.

But fewer and fewer women will have these grandfathered plans in future years as employers who provide health benefits and insurance companies adapt to Obamacare and start following all its rules. More than half of those with insurance had these old plans in 2011, and the share is steadily falling.

Then there are closely held for-profit companies like Hobby Lobby and religiously affiliated nonprofit organizations like Little Sisters of the Poor, which object to at least some forms of birth control. The Supreme Court decided this year that companies like Hobby Lobby can opt out of paying for their employees' contraceptives -- and gave groups like the Little Sisters a temporary reprieve from the mandate while their case moves through the courts. But the Obama administration maintains that women who work for these organizations must still somehow have access to contraception coverage.

These employers and the Obama administration continue to fight about this, so if you work for such an employer, you might have to pay for your birth control.

Hospitals In States That Won't Expand Medicaid Left With More Unpaid Bills

Jeffrey Young   |   September 24, 2014    4:01 PM ET

States that refuse to accept Obamacare's Medicaid expansion aren't just leaving behind poor residents, they're also hurting hospitals' bottom lines.

Because the Affordable Care Act cut the number of people with no health insurance this year, hospitals across the country will see $5.7 billion less in unpaid bills, according to a report issued by the Department of Health and Human Services Wednesday.

But the difference in states that have expanded Medicaid versus those that haven't is stark, the report shows. Hospitals in the 25 states that already have made Medicaid available to more poor residents and the District of Columbia will see $4.2 billion less in unpaid bills and charity care, a decrease of one-quarter. In the other states, the decline will be just $1.5 billion, or 9 percent.

In other words, the reduction in the uninsured brought about by Obamacare has predictably led to a decrease in the number of people turning up at hospitals with no health insurance and no means to pay for their medical care. And that decrease is more substantial in states that allowed their poorest residents access to Medicaid coverage.

"It's actually showing that this provides benefits to states," Health and Human Services Secretary Sylvia Mathews Burwell said at a briefing with reporters prior to the report's release Wednesday.

The findings are a reflection of the fact that the uninsured rate, especially among low-income people, has fallen much more in states that expanded Medicaid than in states that didn't.

In a New England Journal of Medicine article published in July, HHS and the Harvard School of Public Health estimated 10.3 million fewer people are uninsured as a result of Obamacare. HHS also announced this month that 7.9 million more people are enrolled in Medicaid or a related benefit called the Children's Health Insurance Program than before Obamacare enrollment started last October. In addition, 7.3 million people have signed up for private health insurance via the law's exchange marketplaces, Burwell disclosed last week.

The Democrats who wrote the Affordable Care Act intended to expand Medicaid nationwide to anyone earning up to 133 percent of the poverty level, or about $15,300 for a single person. But the Supreme Court ruled in 2012 that states could opt out, enabling Republican governors and state legislators -- mostly in the South -- to refuse generous federal funding to cover low-income residents.


Via: The Advisory Board Company

The failure to expand Medicaid in those states has left 4.8 million people who would have been eligible without coverage, according to the Henry J. Kaiser Family Foundation.

The American Hospital Association, along with other national state hospital groups, endorsed the Affordable Care Act precisely because they wanted more people covered and fewer patients unable to pay for care. That's even though the law also cuts Medicare and Medicaid funding hospitals receive.

In states that haven't expanded Medicaid, hospitals are enduring the funding reductions without the increase in insured patients, though. When the Supreme Court ruling came down, hospital groups in states like Texas and Florida unsuccessfully lobbied in favor of the Medicaid expansion. The figures released by HHS show why they tried.

"Many of the hospitals in these communities feel it already, but I think the data and information will help them make their case more strongly with regard to the importance to their bottom line," Burwell said.

A growing number of states that initially didn't expand Medicaid are signing on, most recently Pennsylvania and New Hampshire, bringing the total up to 27 plus Washington, D.C. Burwell is in discussions with other states, including Utah, about bringing them aboard. "The more that we are able to attract conservative Republican governors, the more that those who have very strong feelings will perhaps listen," she said.

HHS based its analysis on financial reports from hospital chains such as HCA Holdings and LifePoint and on surveys by state-based hospital trade associations. The consulting firm PricewaterhouseCoopers published a similar report this month, and its findings are consistent with HHS's.

Obamacare Critics Just Lost Another Talking Point

Jeffrey Young   |   September 23, 2014    4:31 PM ET

Obamacare's so-called government takeover of health care was supposed to destroy the private insurance market. Somebody forgot to tell the health insurance companies.

More health insurers are signing on to participate in Obamacare, Health and Human Services Secretary Sylvia Mathews Burwell said during a speech Tuesday at the Brookings Institution in Washington.

The number of companies offering plans on the Affordable Care Act's health insurance exchange marketplaces for 2015 will jump to 248, a 25 percent increase over this year, in the 44 states where the numbers are available.

The department offered details in a report published at the time of Burwell's remarks.

The increase in participating companies discredits a line of attack against the 4-year-old health care law that said it would crush competition.

UnitedHealth Group, one of the largest insurers in the country, plans to sell coverage on exchanges in more than 20 states for 2015 after sitting out this year in many states where it offered other plans. The firm will join other big players including WellPoint, which sold more exchange plans than any other insurance carrier; Humana; and Aetna, along with numerous state-based Blue Cross and Blue Shield plans. Some major insurance companies continue to avoid the exchanges, however. Wellmark Blue Cross and Blue Shield, the leading insurer in Iowa and South Dakota, is staying out of the exchanges in those states for the second year of enrollment.

Health insurance premiums tend to be lower in markets where multiple plans compete than in locales where one or two companies dominate. Although full information about premium prices on the Obamacare exchanges next year isn't yet available, the consulting firm PricewaterhouseCoopers estimates the average rise will be 7 percent. That is similar to or smaller than price hikes in the years before Obamacare, and rate increases and decreases will vary greatly across the country.

The 25 percent increase in plans on the exchanges for next year represents 77 new health insurance companies joining and 14 leaving. According to the HHS report, California is the only state where fewer insurers will sell coverage on its exchange. Information wasn't provided about Kentucky, Massachusetts, Minnesota, Nevada, Oregon or Vermont. Underscoring the volatility in this new health insurance market, Minnesota's exchange has lost its most popular insurer, meaning some customers will have to select new coverage for next year.

Nine states included in the HHS report will have the same number of health insurance companies in their exchanges for next year as they did in 2014, but the remaining 34 states will have more. Notably, New Hampshire and West Virginia each had only one insurer selling policies on its exchange for last year; for 2015, the states will have five and two, respectively. Indiana will see the most new insurers, with options rising from four to nine. New York has the most insurers in its exchange with 17.

Open enrollment on the health insurance exchanges begins Nov. 15 and runs through Feb. 15.

An estimated 7.3 million people were fully enrolled in private health insurance plans purchased via the exchanges where people buy health insurance as of Aug. 15, Burwell disclosed last week. In addition, millions have been added to the Medicaid and Children's Health Insurance Program rolls since the first Obamacare sign-up period started last October. As a result, more than 10 million previously uninsured people gained coverage, according to an analysis by HHS and the Harvard School of Public Health that was published in the New England Journal of Medicine in July.

But Obamacare enrollment hasn't reached anywhere near its potential -- particularly in the private market. The Henry J. Kaiser Family Foundation estimates the Obamacare exchanges could ultimately sign up almost 29 million people for private health insurance.

This story has been updated to replace outdated information from PricewaterhouseCoopers about projected health insurance increases next year.

More Proof That Anti-Obamacare States Desperately Need Obamacare

Jeffrey Young   |   September 22, 2014    8:42 AM ET

In a lot of big urban areas where a large share of residents lack health insurance, help isn't on the way.

Seven of the 11 large metro areas where the uninsured rate was higher than the 14.5 percent national average last year are located in states that refused to expand Medicaid under the Affordable Care Act. Two are in Florida, three are in Texas, and the others are Atlanta and Charlotte, North Carolina. The metro area with the highest uninsured rate was Miami, at a staggering 25 percent, compared to the national low of 4 percent in greater Boston.

Here's a breakdown of the biggest metropolitan areas' uninsured rates before the Obamacare coverage expansion began, courtesy of figures released by the U.S. Census Bureau this week.

uninsured cities

The Affordable Care Act called for Medicaid benefits to be available to anyone earning up to 133 percent of the federal poverty level, which is about $11,500 for a single person this year. Twenty-six percent of people with incomes in this range were uninsured last year, the Census reported.

To date, 23 states, mostly Southern, haven't adopted the expansion, despite generous federal funding. When the Supreme Court upheld the Affordable Care Act in 2012, justices also ruled the Medicaid expansion was optional for states.

What makes matters worse for the people left out of the Medicaid expansion is that another part of the Obamacare law permits only people who earn at least poverty wages to get financial help paying for private health insurance -- so those who earn less get nothing.

According to the Henry J. Kaiser Family Foundation, those decisions not to expand the program will leave 4.8 million people uninsured. More than 1 million of them live in Texas, 764,000 are in Florida, 409,000 are Georgia residents and 319,000 live in North Carolina.

Four other large metro areas that the Census Bureau reported had higher-than-average uninsured rates are in states that expanded Medicaid this year: Los Angeles, San Diego and Riverside, California, and Phoenix, Arizona.

In a survey published in July, the Commonwealth Fund found that the states that expanded Medicaid saw a combined drop in the uninsured rate for people with incomes below poverty from 28 percent to 17 percent after the first round of Obamacare enrollment. In the states that didn't, the share without health coverage was 36 percent -- barely changed from before.

A Gallup-Healthways survey from August also revealed wide variation between Obamacare's effect on the uninsured rate between states that cooperated with the law's implementation, such as by expanding Medicaid, and those that didn't.

Almost All Obamacare Enrollees Are Paying For Coverage

Jeffrey Young   |   September 18, 2014    1:23 PM ET

The Obama administration on Thursday finally revealed how many people paid for Obamacare on the national and state health insurance exchanges: 7.3 million.

Since President Barack Obama announced in April that sign-ups on the Obamacare exchange marketplaces had surpassed 8 million, skeptics have demanded to know what portion of health insurance enrollees had actually paid for their coverage. At a hearing of the House Oversight and Government Reform Committee, Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner offered a partial answer at last.

"As of Aug. 15 this year, we have 7.3 million Americans enrolled in health insurance marketplace coverage and these are individuals who paid their premiums. We are encouraged by the number of consumers who paid their premiums and continue to enroll in the marketplace coverage every day through special enrollment periods," Tavenner said.

But the 7.3 million enrollment figure doesn't tell the whole story. The Department of Health and Human Services can't provide the total enrollment tally, including paid and unpaid, since April because the computer system that would process those records isn't fully operational, a department official said. A manual evaluation would be required to find that number, the official said.

Compared to the enrollment total of 8 million detailed in a May report about the sign-up period that began last October, the retention rate for private Obamacare coverage would be more than 90 percent.

However, because people have been allowed to buy health insurance on the exchanges since then under special circumstances, such as marriage or the birth of a child, the count of people who were enrolled at any given time this year likely rose higher than 8 million.

Nevertheless, the confirmed 7.3 million paid sign-ups appears to repudiate the predictions of doomsayers that huge numbers of Obamacare enrollees would dump their plans or fail to pay their premiums. This tally also exceeds last year's Congressional Budget Office projection that 7 million people would enroll and its revised projection from earlier this year of 6 million enrollees.

Tavenner didn't provide details about the paid enrollments number or the individuals who gave up their Obamacare coverage, or never paid for it. But there are a variety of common reasons people abandon insurance plans, or switch to a different benefit.

Some enrollees may have determined they couldn't afford the insurance or that it wasn't a good value. Others may have experienced drops in income that qualified them for Medicaid, while some may have secured jobs that provided health benefits.

"Historically, there has been enormous churn in the individual insurance market," Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, wrote in an email.

"Of the people buying individual at any given time, almost half of them will no longer be in the market a year later," Levitt wrote. "People get jobs with health benefits or turn 65 and become eligible for Medicare. On the other side of the ledger, people also lose jobs and enter the individual market."

Over time, Levitt wrote, about the same number of people enter the individual insurance market as leave it.

Obamacare Is Doing At Least One Big Thing Right

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

360,000 Obamacare Enrollees At Risk Of Losing Subsidies

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

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

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

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

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

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

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

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

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