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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 11.2 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.

CORRECTION: A previous version of this story misstated the high end of the estimate for enrollment at the February deadline as 11.7 million.

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    Obamacare Shoppers Get Sneak Peek At New Prices

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

    Tweet Read More: health care, health care reform, obamacare, Obamacare prices, obamacare premiums, obamacare costs, health insurance premiums, health insurance prices, health insurance costs, jeffrey young, obamacare website

    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.

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      Obama Pledges To Protect Health Care Law From Republican Assaults

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

      Tweet Read More: health care, health care reform, obamacare, uninsured, Mitch McConnell, mcconnell obamacare, obamacare repeal, jeffrey young, elections 2014, Health Insurance, obamacare mandate, obamacare taxes, Barack Obama, video

      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.

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        5 New GOP Governors Could Undercut Medicaid Expansion

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

        Tweet Read More: health care, health care reform, jeffrey young, obamacare, medicaid, medicaid expansion, obamacare medicaid, obamacare medicaid expansion, elections 2014, Asa Hutchinson, bruce rauner, Charlie baker, Doug ducey, Larry Hogan, 2014 election, midterm elections, 2014 midterm elections, arizona medicaid, Illinois medicaid, maryland medicaid, arkansas medicaid, massachusetts medicaid, health-care-reform, health-care

        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.

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

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

          Tweet Read More: health care, health care reform, obamacare, obamacare repeal, repeal obamacare, jeffrey young, Health Insurance, employer mandate, obamacare mandate, individual mandate, obamacare taxes, obamacare tax, Mitch McConnell, elections 2014, republican congress obamacare, video

          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.

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            This Election IS About Obamacare For These Uninsured People

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

            Tweet Read More: health care, health care reform, medicaid, medicaid expansion, medicaid expansion governors, Election Day, jeffrey young, uninsured, obamacare, obamacare medicaid, obamacare medicaid expansion, paul lepage, Michael Michaud, Rick Scott, Charlie Crist, Sam Brownback, elections 2014, video, midterm election

            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."

            Comments (231)

              These 5 Scary Obamacare Predictions Were Dead Wrong

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

              Tweet Read More: health care, health care reform, obamacare, obamacare facts, obamacare fact check, Obamacare factcheck, Obamacare lies, obamacare predictions, obamacare trainwreck, jeffrey young, Health Insurance, uninsured, obamacare premiums, health insurance premiums, obamacare costs

              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

              Comments (301)

                Conservatives Proven Utterly Wrong On Key Aspect Of Obamacare

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

                Tweet Read More: health care, health care reform, obamacare, obamacare young adults, Health Insurance, uninsured, jeffrey young, millennials, centers for disease control and prevention, White house council of economic advisers, Obama millenials, obama young adults

                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."

                Comments (565)

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

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

                  Tweet Read More: flu season 2014, flu, influenza, flu vaccine, flu shot, influenza vaccine, influenza shot, ebola, ebola united states, jeffrey young, U.S. Centers for Disease Control and Prevention, swine flu, h1n1, vaccines, Flu Epidemic, Influenza Epidemic, flu pandemic, pandemic flu, influenza pandemic, video

                  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.

                  Comments (126)

                    Obamacare Officials Swear Website Will Work This Time Around

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

                    Tweet Read More: obamacare enrollment 2015, obamacare, health care, health care reform, Health Insurance, uninsured, healthcare.gov, obamacare website, obamacare glitches, Kevin Counihan, Centers for Medicare and Medicaid Services, jeffrey young, medicaid, Andy Slavitt

                    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

                    Comments (24)

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

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

                      Tweet Read More: ebola, ebola outbreak, ebola cure, ebola drugs, ebola vaccine, ebola treatment, Prescription Drugs, pharmaceutical industry, vaccines, Anthony Fauci, National Institutes of Health, jeffrey young

                      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

                      Comments (102)

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

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

                        Tweet Read More: health care, health care reform, physicians, drug company payments to doctors, doctors, drug companies, pharmaceutical industry, big pharma, big pharma doctors, medical devices, hospitals, jeffrey young, obamacare

                        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:

                        Gotta say, Open Payments website is NOT AT ALL consumer-friendly. Not sure it's journalist friendly. We have 3 people working now.

                        — Charles Ornstein (@charlesornstein) September 30, 2014

                        Comments (48)

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

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

                          Tweet Read More: health insurance costs, jeffrey young, Health Care Costs, Health Insurance, Health Care Cost Institute, medical benefits, employer health insurance, employee health benefits, health insurance deductible, employer health benefits, health insurance premiums, health care, health benefits

                          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."

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

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

                            Tweet Read More: birth control cost, jeffrey young, best of huffpost, birth control copay, Health Insurance, obamacare birth control, birth control mandate, contraceptives, obamacare, health care reform, contraception, Birth Control, health care

                            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.

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