STEVE INSKEEP, HOST:
Millions of Americans have found the Affordable Care Act to be unaffordable. We have numbers this morning on people who have checked out of the law called Obamacare. The law was meant to hold down health care costs and encourage almost everybody to get health insurance. And to be clear, people have been signing up. The rate of people uninsured in this country has been improving. But millions of people still lack insurance, even though they're eligible to buy it. And NPR's Alison Kodjak reports that millions more who did sign up last year have quit carrying insurance.
ALISON KODJAK, BYLINE: Two million people, that's how many signed up for health insurance through Obamacare last year and then dropped it. There are lots of reasons. Some got insurance through a job. Others turned 65 and qualified for Medicare. Others like Dave Egbert, a bus driver in Huron, S.D., just didn't think it was worth it.
DAVE EGBERT: The point of having insurance is that you should be able to go to the doctor when you need to and not be worried about the bills.
KODJAK: Egbert let his insurance lapse when he moved to South Dakota last year because the premiums for the few plans offered in his area were too high. His partner, Rich Davis, works at a bowling alley. He only bought insurance after going to the hospital with chest pains earlier this year. Egbert remembers that day.
EGBERT: Well, by the time he got home, he was feeling dizzy, and they said, oh, we think you're having a heart attack, and they basically rushed him to the hospital. At first, they thought he was just going to die.
KODJAK: Hospital officials helped Davis sign up for insurance through Obamacare. But six months later, he dropped that policy, too. Egbert says the copays for doctor visits and the additional fees for tests were more than the couple could handle.
EGBERT: You know, if you don't know how much you're going to end up paying at the end of the month, it's really, really scary. You know, it's still way too expensive.
KODJAK: Egbert and Davis are among those who bought policies through the exchanges and then dropped out before the year ended. Now government officials want to convince them that insurance is worth the cost. Larry Levitt studies health reform and insurance markets for the Kaiser Family Foundation.
LARRY LEVITT: Some of the hardest groups to reach now are lower middle income people who, you know, still struggle with the cost of insurance but aren't getting subsidies that are quite as large.
KODJAK: Levitt says most of those who leave the exchanges find insurance elsewhere. About 15 percent quit altogether because it's too expensive or because their insurance doesn't pay for enough of their medical costs.
LEVITT: If that number starts to grow, I think it would start to be a cause for concern that maybe the subsidies are inadequate, and insurance just isn't affordable enough for people.
KODJAK: The Department of Health and Human Services says it doesn't expect enrollment to grow this year as much as it did in the past. The agency plans to use email, text messages and web ads to convince holdouts to get insurance. And for the first time, they'll talk about penalties. People who don't buy a policy face a $695 charge at tax time next year. And the government will get lots of help from private groups.
ANNE FILIPIC: We have staff on the ground in 14 states across the country and work with partners in all 50 states.
KODJAK: Anne Filipic is president of Enroll America, a nonprofit group that helps people enroll in health care plans.
FILIPIC: We do a lot of work with faith leaders across the country, with community colleges and small business owners. We work with restaurant associations and taxi cab associations. Perhaps we'll go to church on Sunday, and we'll actually stand up in front of the congregation and share with them the information about what's available.
KODJAK: And Enroll America will have a new web app to compare health plans. The federal government is launching one, too. Filipic says the apps will allow people to enter their doctor's names and their medications and estimate cost based on how many visits and drugs they need.
FILIPIC: And that is a level of transparency that has not existed in the past.
KODJAK: The hope is this extra clarity will reduce unexpected costs and help keep people like Dave Egbert and Rich Davis insured through next year. Alison Kodjak, NPR News, Washington.
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