How Obama Changed His Health Care Law

There's been a lot of maneuvering this week between the Obama administration and Congress over the Affordable Care Act. NPR's Julie Rovner joins guest host Don Gonyea with the play-by-play, and discusses what's next in the ongoing Obamacare saga.

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DON GONYEA, HOST:

Not all the action surrounding the health law took place on Capitol Hill this week. Yesterday's vote was just the last of several significant events in the ever-evolving saga that is the Affordable Care Act. NPR's Julie Rovner covers health policy, which these days means pretty much covering the federal health law full time. She joins us in the studio now. Hi, Julie.

JULIE ROVNER, BYLINE: Hey, Don.

GONYEA: So yesterday's vote in Congress may not result in any real changes for people who are getting their health plans cancelled, but what President Obama proposed on Thursday just might. Tell us how that will work.

ROVNER: Yes, what the President did is actually a policy change, although it's not clear how many people will be able to keep their cancelled plans because of it. What the rules say right now are that starting January 1st, 2014, no insurance company can sell or renew a policy in the individual or small group market that doesn't meet all the new requirements of the Affordable Care Act.

That's what led to most, although not all, of the cancellations. The changes it plans in existence as of this past October 1st can be renewed - not sold new - but renewed, for people who already have them, for one more year anytime through 2014. So they could extend it to 2015.

But there's a couple of big ifs here. First, it's up to the insurance company to decide if it wants to continue to offer the policy, not to the individual or small business. And second, it depends on the state. Some states have already passed laws to make their state insurance laws conform to the federal rules, so it would be difficult, if not impossible, for these policies to be extended in those dozen or so states.

GONYEA: So it's going to depend where you live?

ROVNER: Absolutely. And even in states where there's no law blocking it, state insurance commissioners are going to have to decide if they want to allow this to happen. So far only a few have said one way or another. California and Florida, two of the biggest states have said yes. Washington State, which is running its own exchange and where people with cancelled policies are having a pretty easy time finding alternative plans, has said no.

GONYEA: Got it. Now, cancelled policies weren't the only news this week. We also got the first set of enrollment numbers from the health care exchanges. What did those tell us?

ROVNER: Well, not a whole lot, according to most experts. Mostly it told us that the federal website pretty much wasn't working for the first month. That's something we already knew. And the first month wasn't expected to see a lot of people sign up and write premium checks for coverage that doesn't start until January, in any case.

Officially, according to the federal government's report, 106,000 managed to get far enough along in the process to choose a health plan between October 1st and November 2nd on the federal exchange, HealthCare.gov, and on 11 of 14 exchanges run by the states. Of that total, only about a quarter managed to complete the process on the federal exchange. We also learned that nearly 400,000 people were determined to be eligible for either Medicaid or the Children's Health Insurance Program.

GONYEA: Speaking of that federal website that wasn't working very well in October, it's supposed to be working by the end of this month. What do we know about the progress being made to fix it?

ROVNER: Well, we're told it's coming along, that errors are down and its ability to serve more people at a time is up. One big sign that things must be going better is that this week the federal government sent e-mails to a quarter of a million people who got stuck in the early part of the process in October, inviting them to come back and try again. But there's a big flashing warning sign if the government doesn't meet that end of the month deadline. Those couple of million people who got those cancellation notices need insurance to start January 1st.

That means they have to sign up by December 15th, and if everyone who's waiting until the website is supposedly fixed at the end of November to get on, tries to get on all at the same time, it could be overwhelming no matter how much capacity they add.

GONYEA: Something to watch for. That's NPR's Julie Rovner. Thanks, Julie.

ROVNER: Thank you.

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