Their own exchange they didnt know any more than the average consumer would, a lot of people running that website didnt know what is was going on. Welcome to inside story, im they couldnt offer advice and ray suarez. Help because they didnt know what was going on either. When the first Enrollment Period of course they knew what was going on. For the rg Affordable Care act this is a classic example of biting off your nose to spite your face. Began, the websites didnt work some of these republican and tens of thousands of americans didnt understanding governors went out of their way how the law worked. To sabotage act. For example in texas, the state those that werent teacted by it with the biggest percentage of all, the websites worked, some uninsured in the country. Of the most post officed state the state that would benefit the governments have cooperated, a most from expanding medicaid. Little, many havent. The governor there said were as the insurance not going to expand medicaid. Marketplace hes getting texas taxpayers to expand medicaid in other states prepares to open again, well but in his own state hes find out who the Affordable Care keeping people uninsured. Isnt that a fair comment that some of the states with the act is working for, in a few highest concentration of weeks ads like these will be back. Uninsured the governors were encouraging millions of adamantly opposed to because the governors did a unassured americans to buy survey and they said expanding uninsured americans to buy insurance under the affordable medicaid is going to cost us care act. We dont want people to even with 100 match in the settle with the penalty. First couple of years is going we want people to realize that this is an opportunity for them to cost our state you 118 to be covered. Billion that we did not have. As the campaign gets over what period of time . Underway, the program is facing over years, thats going to another challenge, keeping the take money from roads and enrollees it already has. Education and public safety. In february of this year about so theyre saying we dont want to expand medicaid. 11. 7 Million People were enrolled in federal and two able bodied working adults staterun marketplaces but by who thirds of them with the the end of june that number option, where should we expand dropped by 15 , town to medicaid with those options 9. 9 whether there are other options down to 9. 9 million. For them . I got say, theres waiting for a job, others something didnt realize how expiive it i find pretty cynical, it woulexpensive itwould be. Doesnt come from a magic atm in the sky. Others were ineligible to buy were going to tax him, give it insurance on the exchange. To you and if you dont take it varies a lot. It the cost of insurance, some but the money doesnt get spent. Exactly. Of the most difficult places to the money comes from somewhere afford health care are in these and these governors in a lot of 20 states. Those are the states that these states say we dont want a part of this and havent expanded medicaid. But what about jays point . But the Obama Administration insists despite the challenges a taxpayer in fort worth was the new system is working. Paying for medicaid in five years in and millions have new coverage. Massachusetts and not in dallas. Precisely the same when you and the annual uninsured rate go to a restaurant with a bunch has been reduced to the lowest of levels on record. Friends, saying im not the rate of uninsured people getting the 50 is down to 11. 6 . Desert, why Health Officials estimate about 10. 5 million your honor insured people are still eligible for coverage. Disertd, and why not . This new Enrollment Period will be the toughest yet. Everybody else is paying for it. Most of the low hanging fruit when there were navigators in states paid for by private so to speak has already been picked. Dollars to tell you taxpayer dollars. Those who benefit the most from the state person who answered the phone couldnt tell you go subsidies have already enrolled. To a navigator instead. They think they can live without it, convincing them they i used to be the insurance commissioner in missouri. Actually do need insurance, thats going to be the challenge. And at that time we had a while our goals are harder to Cooperation Agreement with the federal reach were working harder to government. Reach them. We know americans are what missouri did was pass a law depending which prohibited any state on it, and were doing official from even cooperating everything we can to find the with the implementation of obamacare. Coverage they need. The Obama Administration will so my friend who is the insurance commissioner now, is he prohibited by Missouri State market to areas dallas,ing law by cooperating, and if he miami, northern new does cooperate then under this jersey. Law 2016 will be the true test of the Affordable Care act and this any missourian can sue him time the ads will need to be a personally because he is violating the law. Lot more convincing. That gives you an example how much opposition there has been. Because the citizens of minnesota, land of 10,000 missouri passed a law that they reasons for getting Health Insurance. The Affordable Care act two did not want Obamacare Obamacare implemented in their state. He is responding what the voters years after the deeply troubled said. Rollout. Grace maria this law in 200 different marie turner. Surveys only one law has shown the law more popular than robert unpopular. People dont like this law. Grayboy, Senior Research fellow at they dont want to be told they have to pinches health George Washington insurance. Center. Im going to have to leave it there. Whether we return, has the and jay Affordable Care act as suggested angoff, jay, in the earlier in the program, already picked the low hang fruit . Original design, was it already understood that there was going boosting the ranks of the insured under the ones in line to be a certain amount of churn, to receive the largest subsidies . People signing up, dropping out, are the young so at risk to make signing up, dropping out, there would Obama Obamacare work, enough carrot and stick to push them to be a constantly changing population . Sign up . Sure. When the churn is windows open in a few giving companies a weeks, will there be enough to chance to sign up . Shopping for care, its the inside story. Ing the price low. People can compare, come close to doing apples to apples comparisons. Thats be 97 for companies to pry low. Whether you call it churn or Something Else it benefits consumers because for the first time, Insurance Companies really do have an incentive to compete on price rather than on differentiating the benefit package and things aconfuse consumers. We dont have a big idea, but over two years, does that give incentive to keep prices low . People on both sides acknowledge its working. Its here to stay, there can be changes made. I think there ought to be changes made. For example, i think the benefits should be more standardized so people can more easily compromise. Competitive bidding, Insurance Companies know if they offer too high a price they cant sell on the exchanges. But the structures in place, and as i said, its here to stay. And you know, 10 Million People have gotten coverage on exchanges. 7 million off the exchanges. 14 million new people in medicaid. Again im not a defender of every aspect of the Affordable Care act. But this really made a tremendous difference and it is here to stay. Grace marie turner, when you look at things how they are going now and how they have gone over the arc of the last two years, what do you make of it . Working . First of all, we needed big changes. When you talk about churn and you talk about price you have to think about what has been the consumers experience. At least 6 Million People lost the coverage that they had before obamacare because it didnt comply with this avalanche of rules and regulations. They lost the coverage they liked, they were forced into coverage the cookie cutter coverage, essentially, and many say it provides too many benefits, more coverage than they want or need and mostly at welcome back to inside story. A much higher price. Im ray suarez. We have seen the price increases obamacare was drafted to push that are coming this year, 20 , the uninsured to buying their 30 in many of the plans. Own health care. Yes there should be competition. It tried to create incentives but consumers are saying i dont like the churn. For Getting Health Care and i dont like the price. Costs without it. And particularly, they dont inducements and punishments like these radically increase the extraordinarily high deducts pool of insured. Expensive years of care and too deductibles. Roberts grayboy, i wonder and few healthy lowneed premium ive looked at a lot of the payers to keep the whole thing solvent. Research talking to consumers so what happens now . Since then. There are some that are used to are there fixes, the actual getting insurance for their daytoday obamacare needs, employers didnt know how to impossible under the current shop for Health Insurance in the conditions. First place. Is the current marketplace i dont think consumers got seeing enough young enrollees what they expected, i still the keep the Health Insurance dont think theyre getting what they expect. Participating . With me are my decembers, im in this fo as a business. From the demographic front . Theres encouraging news that its no huge surprise that has nothing to do with all this stuff. Consumers are crank their heads, for 70 years weve talked about insurance insurance insurance, coverage coverage, how many saying i didnt know this was in there. People have a plastic card. Im critic of both parties, there are 320 million americans and since obamacare we have the growth ideologies or health same number of doctors, same care. Both ideologies on Health Number of nurses, probably fewer shoourn. Some have hospitals, fewer other resources, nothing has changed more, higher deduct in the supply of what treats us. Inls, some lower, there isnt a criterion that said, what does until we change that, until we fundamentally alter care and how it mean that obamacare is working . Efficiently we dlir it none of its never been stated. This again its going to be revisited. Let me refine the question a were egoing to give some of little bit more. As people lived through this your care away, give it to him experience longer can we expect and give some of his to you. That they will become better there, by the way, i promised i shoppers, better able to think twice that i can get in on navigate the shop windows in the more conservative states. Their states, and better able to they tend to be compare plans in 2017 than they highly were in 2014 . I think its going to be a destructive on things like permanent state of instability. Telemedicine. None of these things are part of i think there are just too many the conversations on Health Care Reform and they are all way more cogs, too many wheels, many of which dont mesh. Important how you tweak the insurance system. Go ahead. And again ill state, i try repeatedly state, i dont think young people are not signing up in the numbers that they need the opponents have any to in order to make these pools stable. Particularly good ideas how to deal with it. We have seen, for example, five but yo no, i dont think its of the citizen berun going to stabilize. Cooperatives go under. Part of it was because they were 017 will be just a very bad getting older and sicker people so that they didnt have the numbers that they needed to make year, thats when the risk partly ends and some programs this work. Will go away. Stand by. Doesnt the nip turn into a ful years since the passage of the Affordable Care act. Real bite to force Young Persons in . What difference the low level of the penalty becomes higher cooperation with state every year but young people look governments make in the at a deductible of 6,000 a year. Programs early successes and which is the average deductible failures. In the exchange policies. Had states opened their cases theyre saying id rather take my chances, pay the fine or, would the number of uninsured be there are 31 different ways you significantly lower today, or can get out of paying the fine and get excused from it. Would the problem of the aca theyll figure out some way to have problems all its own . Get around it and theyll say its just not worth the money. With the high premiums and high deductibles for a Young Healthy person you have to provide real incentives for them to get in. Killing of journalists is a everyone says you have to have question that is directed the same benefits package but to society. They are impartial. If you wanted to be a good journalist in iraq, the young person says, give me a you had to risk your life. Catastrophic policy only. Youre right. They observe and report. In the first year the penalty kidnapping is a very real and maybe you said this too, problem. Maybe youre right too. Journalists on the front lines. In the first year the penalty sometimes that means risking death. Getting the story, no matter what it takes. Was next to nothing, it was a thats what the Fourth Estate is all about. Hundred thats why im risking my life. Bucks. All groups acknowledge the people who come in in the first year are going to be disproportion addly unhealthy. The worst risks come in in the first year. Thats good news for 2016. The worst risks are already disproportionately in the system. The risks coming in in 2016 have to be better risks. If they come in. Right, the incentive for them to come in, the minimum penalty is seven times what it was in 2014, so Young Healthy people have a great incentive to come in. A lot of them if they do the arithmetic, paying 7 and getting nothing or paying a little more with all the subsidies and getting quite a bit. Let me say a word about the subsidies, something we havent touched on. The people who are insured today who didnt have insurance before they benefit under obamacare. But i think a very underreported story is, the Insurance Companies benefit too. The government is telling people, they must buy the insurance companys product. Youre watching inside and they were delivered story, im ray suarez. Customers. The obama years have seen a if you strong move to republican were governors and state penalized 650, do the math, if you make emotional maybe 40,000 a year as an individual, you are not going to get any subsidy at all. So theres not going to be a subsidy. And most data shows that the only people who are really buying in big numbers are those getting the maximal subsidy. Slightly higher, theyre still saying no thanks. And we can argue where the exact line is. But let me agree with one point that she made. Ill put a lilt different twist on it. Theres no question but that high deductibles are being institutionalized. I dont blame obamacare for that. But its not just a question of coverage. Its the type of coverage you get. So one of the reason Insurance Companies are doing so well, the stocks of the big Insurance Companies have more than tripled since obamacare has been enacted, there are a lot of people who dont blow through their deductible. Thats pure profit for the companies. Theres a good argument to be played that the government should be a little more proactive and standardize, in such a way that these deductibles are not as high as they are today. I want to thank robert grayboy. Grace marie turner. And jay angoff. Ill be back in a moment with a final thought on politics, health care, and what if anything, we owe each other. Send us your thoughts on twitter, ajinsidestoryam, or follow me and get in touch at raysuareznews. What do you think works and doesnt work with the Affordable Care act. Wed love to read it. Good morning and welcome to al jazeera america. Is this the first chance theyre getting to asses the damage. We begin with breaking news coming out of the west bank. I just had a horrible nightmare. My companys entire network went down, and i was home in bed, unaware. But that would never happen. Comcast business monitors my Companys Network 24 hours a day and calls and emails me if something, like this scary storm, takes it offline. So i can rest easy. What. You dont have a desk bed . Dont be left in the dark. Get proactive alerts 24 7. Comcast business. Built for business. Tand thats what were doings to chat xfinity. Rself, we are challenging ourselves to improve every aspect of your experience. And this includes our commitment to being on time. Every time. Thats why if were ever late for an appointment, well credit your account 20. Its our promise to you. Were doing everything we can to give you the best experience possible. Because we should fit into your life. Not the other way around. The introduction, the debates debates over, the mud wrestle. The implementation of the Affordable Care act has been full of surprises. For years people were telling me how much they hated their Insurance Companies. The prospect of regulating them, so they couldnt drop you when you were sick, suddenly jack up rates or deny you a procedure or drug recommended by your doctor i figured would be welcomed by anyone who heard or experienced Horror Stories about away Insurance Companies had treat their customers. I had totally missed the stampede, changes in an insurance system that people hated, were perceived as risky, heavyhanded, socialist or whatever. Suddenly complaining about what you had was replaced by nervously sticking by what you had. But a big part of the blame goes to the Obama Administration. The tens of millions who got coverage from their jobs whose lives were barely going to be changed 50 laws, were listed as warriors of the Affordable Care act, are charging into a vacuum left by a president who had fought the political but not the informational battle. The story of the implementation of obamacare is not over. This is a titanic business political and social story with the final chapters yet to be written. So stay tuned. Thanks for joining us for inside story. Ill see you next time. Im ray suarez. Youre not the person to tell me who i am. I kept trying to make him not be a boy. We tried to force her to wear more masculine clothes. When they people come to see us, they are desperate. Who will love my child . Who will protect my child . I asked for something and now im a happy little boy. Being a woman its more than a physical body. Its all about your essence. I get to blossom into the beautiful flower i am