DAVID GREENE, HOST:
In 2014, millions of people got insurance under the Afford Care Act through exchanges set up by the law. But the year ends with some uncertainty. Republicans who have serious objections to the Affordable Care Act won both houses of congresses and the U.S. Supreme Court said it would hear a case that could derail the exchanges altogether. Jeff Cohen from member station WNPR in Connecticut spoke with two people with wildly different takes on the exchanges. One's trying to gut them, other's sole jobs is to make them work.
JEFF COHEN, BYLINE: Kevin Counihan began 2014 running a state exchange that didn't stumble, and he ended it running the federal exchange that did. He was tapped in August to leave Connecticut and run the federal insurance marketplace. And he says serving consumers is a big priority. The good news for him is that the bar for that is relatively low. Last year, healthcare.gov began by failing. This year, things are looking up.
KEVIN COUNIHAN: A year ago, when somebody would come on healthcare.gov, they would have to walk through 76 screens in order to complete their application. That's been reduced now to 16.
COHEN: He points to other successes, too - there are more insurers in the marketplace, people renewing could have a fairly easy time of it since their applications have 90 percent of the information already filled out, and this - millions of people got in touch before December 15, the deadline for those who wanted coverage beginning January 1.
COUNIHAN: We had an extraordinary weekend. And the call center, for example, took 1.6 million calls over the weekend. They took 1 million calls - over 1 million calls on the last day. And the next day, that Tuesday the 16, you know, the first thing we asked - what are the service issues? - no consumers had called in with service issues.
COHEN: Counihan says he hasn't had time to stress about the broader existential threats to the Affordable Care Act, he's just focused on making it run.
COUNIHAN: The basic premise is that having more people insured then fewer is better for both people and the country because it provides the best way to improve people's lives and also to better control health care costs. So I think it could be described really as probably the most significant social program in 50 years since the creation of Medicare and Medicaid.
COHEN: But one way of looking at it. Here's another...
MICHAEL CANNON: It's amazing what you can accomplish when you're willing to break the law.
COHEN: That's Michael Cannon. He's the director of health policy studies of the libertarian Cato Institute and has long opposed the Affordable Care Act. Here's how he sees it - the Obamacare train may be running on time, but it never should have left the station to begin with. Why? Because he says the subsidies the government's paying to consumers who buy their insurance through the federal exchange aren't in the law, and by paying them, he says, Obama is breaking it. So sure, there are millions of people with health insurance now who didn't have it before, there are exchanges, there are more insurers in the market, there's even more competition, but...
CANNON: None of this would have happened if not for those illegal subsidies the president is offering in the 36 states with federal exchanges. There would be no exchanges. There would be no competition. There would be no insurers participating. None of this would have happened if the president had been following the law. There would be no successes if the president had followed the law.
COHEN: Cannon has spent the past few years arguing that the subsidies were a problem. Soon the Supreme Court will hear the case.
CANNON: By mid-2015, the Supreme Court could rule that the administration has been breaking the law, and at that point, some 5 million people whom the administration has enrolled in health insurance through healthcare.gov, will see their premiums quadruple, they'll see their tax liabilities increased. They could see their plans disappear.
COHEN: And while that may be disruptive, Cannon says it wouldn't be nearly as bad as letting the subsidies continue and giving Obama and all future presidents permission to govern beyond the limits of the law. But Cannon also says this - don't get too caught up on how the court will rule because even if Obama wins the legal argument, with Republicans in charge of Congress, the political fights will continue. For NPR News, I'm Jeff Cohen.
GREENE: Jeff's story is part of our reporting partnership with NPR, WNPR and Kaiser Health News.
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