The federal government is on the verge of a partial shutdown –- the first in nearly two decades. The Affordable Care Act is at the center of the political fight. Early yesterday, the House of Representatives approved a measure to delay President Barack Obama’s signature health law for one year and repeal a tax on medical devices. Senate Majority Leader Harry Reid says the Senate will reject that proposal today. Beginning tomorrow, despite the threatened shutdown and a predication of technical glitches, millions of Americans are expected to visit the online markets to shop for health plans and see if they qualify for federal subsidies. Diane and her guests discuss the rollout of Obamacare.


  • Julie Rovner Health policy correspondent, NPR; author of "Health Care Policy and Politics A-Z."
  • Mary Agnes Carey Senior correspondent, Kaiser Health News.
  • Susan Davis Congressional correspondent, USA Today.


  • 10:06:54

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Health insurance exchanges are scheduled to launch tomorrow despite technical glitches and political sparring over their funding. Joining me in the studio to talk about the rollout of Obamacare: Julie Rovner of NPR, Mary Agnes Carey of Kaiser Health News, and Susan Davis of USA Today.

  • 10:07:20

    MS. DIANE REHMThroughout the hour, I want to take as many of your calls as we can. We'll open the phones early to provide you with the time you need to ask your questions about the new healthcare law. Give us a call at 800-433-8850. Send us your email to, follow us on Facebook, or send a tweet. And welcome to all of you.

  • 10:07:51

    MS. JULIE ROVNERHi, Diane.

  • 10:07:51


  • 10:07:51

    MS. SUSAN DAVISThank you.

  • 10:07:52

    REHMAnd what a joy for me to be in WAMU's new media center for the first time, and I'm happy to have you all here. Susan Davis, talk about what's happening with the politics on Capitol Hill, what happened over the weekend, and what we're likely to see today.

  • 10:08:19

    DAVISThe most interesting dynamic playing out in all this right now is within the Republican Party. We have House Speaker John Boehner who didn't want this fight. This is not the fight that he originally intended. In August, he tried to prepare his members to say, let's not do this fight over the shutdown. Let's have a bigger fight later this year on the debt ceiling. It didn't really for him that way. I think, in part, Sen. Ted Cruz is a name you've heard a lot of who has worked a lot of grassroots and outside groups to really rally the conservative base to say, now's the time to fight.

  • 10:08:51

    DAVISWe will never have as much leverage as we have right now on these two must-pass bills we have coming up, and we want to have this fight. So House leadership is really be driven more by their rank and file than leadership telling the rank and file what they're going to do. Over the weekend, they passed the second attempt to sort of dismantle the Affordable Care Act.

  • 10:09:11

    DAVISTheir first attempt to defund it was easily dispatched by the Senate. And the second attempt is to delay the implementation for one year, full delay. Harry Reid, today, using easy Senate procedure, can just dismiss it. They don't have to take it up. They don't even have to vote on it. They can motion to table it and move on, which is essentially what Harry Reid has said he's going to do.

  • 10:09:30

    REHMSo, no matter what happens today, the healthcare law and the ability to apply for it goes into effect tomorrow, is that right, Mary Agnes?

  • 10:09:46

    CAREYThat's right because the part of the implementation for the exchanges is mandatory spending. Even if the government were to close, that's discretionary funding. So the exchanges will open as planned on Oct. 1. Some states are running their own exchanges. The federal government is doing it in the vast majority of states, and so people should be able to get online tomorrow. You go to, log on, and see what's available to you and see if this is something that works for you.

  • 10:10:14

    REHMAll right. Now, Julie, talk slowly about how people enroll.

  • 10:10:22

    ROVNERWell, the first thing to remember is that this isn't for everybody. For most people, if you have insurance through your job, if you have Medicare or Medicaid or insurance through the VA, you don't need to do anything. This is only for people who buy their own insurance or who are uninsured. So this is about 15 percent of the population that we're talking about.

  • 10:10:42

    ROVNERSo let's start there. Everybody else, tomorrow's really a non-event for you.

  • 10:10:46

    REHMForget it.

  • 10:10:46

    ROVNERForget it. Forget it. If you don't have insurance, if you buy your own insurance, tomorrow is a day you should start paying attention. And maybe you want to wait a couple of weeks because it's probably going to be a little glitchy at first. But if you're interested, if you want to get online right away, you can start at That's the federal web portal. It will take you to your state insurance exchange page. There you can start looking at the plans that might be available. And there are a wide variety of plans at different levels.

  • 10:11:15

    REHMAnd if your state has decided not to offer Obamacare, then what?

  • 10:11:23

    ROVNERIt doesn't matter. If your state is offering it itself, there'll be a website. If the federal government is doing it, there'll be a website. It will be invisible to the consumer whether the state is doing it itself of the federal government is running it. Every state will have a website. Some of them will have sort of cute names. I'm trying to remember now some of the cute names.

  • 10:11:45

    ROVNERBut every state will have its own website that you will go to and where you can look at plans that are available not just in your state, but in your local area -- will differ by local area. Obviously in California, enormous state, many different parts of the state, many different plans. You'll have to plug in, in some cases, your zip code to find out what plans are available.

  • 10:12:06

    REHMAnd, Mary Agnes, talk about the variety of plans.

  • 10:12:12

    CAREYWell, the federal government last week released some data saying, in the federal exchanges, consumers would have an average of 53 plans to choose from. They are based on four different names of metals: bronze, gold, silver and platinum. Generally, the platinum plans are more expensive, but they cover more. The bronze are sort of your bare bones plans, and so there will be subsidies to help people purchase coverage.

  • 10:12:35

    CAREYThese plans all cover something called the essential health benefits, a set of mandated benefits, include things like doctor's visits, emergency room care and so on. But the difference will be in the co-pays and deductibles. And an important thing for people to remember, it's not just your premium cost because, as we know with our health insurance, we have our premiums, we have our co-payments, we have our deductibles. So as you evaluate these, you need to look and see what your total out-of-pocket cost would be on a particular plan.

  • 10:13:02

    REHMAll right. Then let's take a person among those 15 percent who are eligible because they don't have insurance, they want insurance. Say they don't want insurance for a moment. They don't want any part of Obamacare. What happens, Julie?

  • 10:13:26

    ROVNERWell, you don't have to buy insurance. It's not a requirement. I mean, people talk about this individual mandate, but there is a choice. In fact, this is how it was upheld by the Supreme Court. You cannot buy insurance, and then you'll be subject to a tax penalty. The first year, it's pretty low. It's $95 or 1 percent of your taxable income.

  • 10:13:42

    REHMRight. But it goes up.

  • 10:13:43

    ROVNERIt does go up. It eventually becomes $695 or 2.5 percent of your taxable income. That is still probably, in most cases, less than you would pay for insurance, but, of course, you won't then have insurance. There are going to be a lot of fairly low-cost plans. As Mary Agnes said, if you buy a bronze plan, and if you think you're going to be healthy, you might want to get a plan with pretty low premiums and pretty high out-of-pocket spending because, remember, if you're not sick, if you're not going to use the healthcare system, you won't be subject to that out-of-pocket spending.

  • 10:14:14

    ROVNERThe administration, in releasing the premiums last week, pointed out that six out of 10 people will have access to plans that cost less than $100 a month. And there was a report last week from Credit Suisse who went and looked and really dug into some of these numbers, found out that 6.5 million people will actually be eligible for a plan that costs zero premium because of these tax credits that will be available, meaning they could take the subsidies and buy down to a bronze plan. They could actually get health insurance for zero premium.

  • 10:14:44

    REHMAll right. I promised to open the phones early. Let's go first to Chip in Weatherford, Texas. Hi there, Chip. You're on the air.

  • 10:14:56

    CHIPGood morning, Diane. I would just like to say you are an oasis of stability in chaotic times.

  • 10:15:03

    REHMThank you.

  • 10:15:03

    CHIPI enjoy your show.

  • 10:15:03

    REHMThank you.

  • 10:15:03

    CHIPI keep on hearing the Republicans trying a variety of different ways, 30-plus now ways to take this thing apart or to bust it up. It's a law. They need to quit calling it a bill, and I think, at this point, they just need to put on their big boy pants and deal with it. I'm self-employed. And I tried to buy insurance on the open market a few years ago, and it was $350 to $450 a month for bare bones coverage.

  • 10:15:40

    CHIPAnd my question from the start of all this has been the definition of affordable. If you're hanging out with millionaires and multi-millionaires, $350, 400, $500 a month is affordable. If you're a single mother of three working at Walmart for 36 hours a week for $9.50 an hour, that same money is a car note or it's the rent or a utility bill.

  • 10:16:07

    REHMYou bet. What about Walmart? Have they decided to go along with the president's Affordable Care Plan or not?

  • 10:16:19

    ROVNERI'm trying to remember what they did because it varies between part-time and full-time workers. Now, a lot of these companies, this was a big issue that were offering some of what were called mini meds, these very bare bones plans. Those plans are not going to be allowed anymore. In fact, this was controversial. Some of those companies got waivers to allow them to continue those bare bones plans until 2014, until this law took effect.

  • 10:16:42

    ROVNERAnd some of those companies are now dropping those plans, and some of those consumers will end up having to go to the exchanges and buy basically better plans. And this has been a big issue for people who say, well, we're now going to have to pay more. And they are, but they're going to be getting, you know, much more comprehensive coverage.

  • 10:16:59

    REHMBut, Susan, he makes a good point. Republicans continue to call it a bill when, in fact, it is the law.

  • 10:17:08

    DAVISAnd House Republicans, prior to the fight we have now, have voted over 40 times to repeal or delay or defund the law. The legislative reality is you cannot dictate what the government can do when you control one-half of one-third of the process that enacts the laws. That is the legislative reality of the situation.

  • 10:17:27

    DAVISThe chances that they are going to have any major concessions on the healthcare law in this fight are almost zero. But I think it does show you the tremendous amount of political pressure Republicans are under to try and do something, and it also does show you how divisive this law has been on Capitol Hill. There is not a single Republican that I'm aware of who is on record saying they support the Affordable Care Act.

  • 10:17:48

    REHMAnd will that continue, do you believe?

  • 10:17:52

    DAVISI think it will continue at least through the 2014 midterm elections.

  • 10:17:56


  • 10:17:57

    DAVISBecause I think that, in some ways -- Sen. Lamar Alexander, one of his lines is, I'm not part of the shut-down-the-government crowd, I'm part of the take-over-the-government crowd, that there's Republicans that say, if you really don't like this law and you want to change it, then you need to win elections, and that they should have this fight in 2014 where the Senate, depending on how the landscape plays out, could be up for grabs. And if Republicans control both chambers of Congress, they're more likely to be able to extract some concessions on the law.

  • 10:18:24

    REHMSusan Davis, congressional correspondent for USA Today. Short break, and, after that, more of your calls. We'll be right back.

  • 10:20:02

    REHMAnd as we talk about the new Affordable Health Care Act, which you will be able to enroll in tomorrow, here's an email from Lynn which is so important. She says, "So much media coverage implies that people enrolling in insurance on the new marketplaces must go online. But many of your listeners will know people who don't have internet access or are not comfortable enrolling online. So be sure to mention a number." Have a pencil ready because I'll repeat this later on, 800-318-2596. And there are other ways to get to health care enrollment.

  • 10:20:57

    CAREYThe health law has created people called navigators and assistors that are sort of the boots on the ground all over the country. They've been trained. They'll be ready to go. If you don't know how to find one in your area, you can -- again, I don't mention everything online, but online, if you go to, you can type in your zip code, and it will tell you where the navigators are in your community.

  • 10:21:17

    CAREYAnd I think once the -- tomorrow, when these rates go up for the federal exchanges, when the federal government can actually say in your state, in your community, here's what insurance will cost you, you will hear a lot more about how to access these people, how they will help you. This is really the beginning of a six-month rollout period and a strong campaign from the administration to get people to understand how to enroll.

  • 10:21:40


  • 10:21:40

    ROVNERAlso there's going to be an enormous outreach effort. A lot of community organizations are going to be coming to people. I've been talking to a lot of the groups, a lot of civic groups, faith groups, local public health groups, hospitals, pharmacies. You're going to be able to go to your local pharmacy and find out ways to help sign up. And in fact, at the beginning, it looks like some of the online enrollment may not be up and ready perhaps for several weeks. You may have to use paper applications at the beginning.

  • 10:22:06

    REHMOh, I see.

  • 10:22:08

    ROVNERPlus, insurance brokers and people who traditionally sign people up for insurance coverage have been training to help with the enrollment in the Affordable Care Act. So the old ways people have signed up for insurance coverage will -- you'll be able to use to sign up for this insurance coverage, too.

  • 10:22:23

    REHMSusan, back to the politics, what about the polls That Republicans continue to cite saying that people don't want the Affordable Care Act, they don't want this insurance, it's going to ruin the economy? What are the bases on what they're making such allegations?

  • 10:22:45

    DAVISWell, they're -- it depends on what polls you look at is always part of it, where the data's coming from. I do think that there has been some skepticism and some wariness within the public about what's going to happen with the law.

  • 10:22:57

    REHMSure, sure.

  • 10:22:57

    DAVISAnd that's understandable, especially for people that do not have health insurance.

  • 10:23:01

    REHMIt's brand new.

  • 10:23:02

    DAVISAnd it could take a lot out of the family budget, and people have concerns about that. More people than not do not support complete repeal of the law. I would say that there is opposition to the law in the country, but I think that they overstate the majority support that they claim. They do -- one of the points that they have made is that there have been delays in implementation for businesses for small employers.

  • 10:23:28

    DAVISAnd they make an argument, shouldn't regular individual people be treated the same way? That is more of a political argument than a legislative argument. But I think at this point they just would like to be able to extract some kind of a concession to prove that this was not all for naught.

  • 10:23:42

    REHMAll right. Julie, quick comment.

  • 10:23:44

    ROVNERThere was a fascinating poll last week that, when they polled people on did they like or not like Obamacare, it was much higher than did they like or not like the Affordable Care Act.

  • 10:23:54

    REHMIsn't that interesting? So it depends on what you call it. Let's go to Susan in Sarasota, Fla. Hi, you're on the air.

  • 10:24:07

    SUSANHi, Diane. Thank you. I couldn't get through the morning without you.

  • 10:24:10

    REHMOh, you're kind. Thank you.

  • 10:24:13

    SUSANI'm just calling about what they call the family glitch where the affordable term is defined as the premiums of an employee being less than 9.5 percent of their income and -- but if they do offer family coverage, either spouse or kids, that that can be any amount. And so their whole family is then deemed affordable, so we do not have access to the exchanges, we get no subsidies. But they remove the penalty if we don't buy insurance because they know that this is a wrong ruling.

  • 10:24:53

    SUSANBut we -- in my case, through my husband's work -- because I don't get insurance, I'm self-employed -- to cover our whole family would be 20 to 28 percent of our entire family income, not just his. If it were his, it'd be over 35 percent of his income to cover us. But we do not have -- we cannot go to the exchanges now, and we will not get a subsidy. So thanks to our good health, I can buy private insurance, and I've been doing that. It's about $300 a month for three of us.

  • 10:25:23

    REHMOK. Mary Agnes.

  • 10:25:26

    CAREYHere's the family glitch. There's a provision in the law that says if you have an offer of coverage from your employer, you could not qualify for a subsidy unless one of two things happen. Number one, which she's talking about, whether or not the coverage is more than 9.5 percent of your family income or it doesn't cover -- doesn't pay for 60 percent of covered expenses, but that 9.5 percent is geared to the cost of self-only coverage.

  • 10:25:51

    CAREYSo it's cheaper to cover one person than to cover a family. And that's what she's talking about that if you looked at the cost for individual coverage, perhaps on her husband's employer plan, that may fall into the 9.5 percent affordability. I'm not quite sure if it would or would not. But she should still -- I think they should still look at the exchanges to find out, what is the cost that they would have to incur?

  • 10:26:15

    CAREYDoes it make -- does it cost more than 9.5 percent of their family income for the employer? It sounds like it would. It sounds like a fairly pricey plan. And then they could look at the exchanges, which are fairly generous for subsidies. Up to a family of four, it's up to about $94,000 for a subsidy. They might be able to get a subsidy on the exchange to help.

  • 10:26:32

    REHMYeah, but it sounds pretty expensive, Julie.

  • 10:26:35

    ROVNERIt is, but, I mean, you know, when they passed the law, they knew they were doing this. The problem was, if they let these families go onto the exchanges and get subsidies, it would be increasing the cost of the law because it would make that many more people eligible for subsidies. That is what the family glitch is. It wasn't something that was accidental.

  • 10:26:55

    ROVNERIt was something they knew that they were doing. But it does put a lot of families in this particular situation where they -- if they go -- they can go to the exchange, but they're probably not going to be eligible for subsidies there. And it is a problem. It was something that Bill Clinton spoke about in the speech that he made about the Affordable Care Act a couple of weeks ago.

  • 10:27:12

    ROVNERAnd it's something that, you know -- one of the issues with this law is that there's a lot of things like this that a lot of people would like to fix, but they'd be expensive. You know, when the Republicans talk about repealing the medical device tax, a lot of people would like to repeal the medical device tax. That would take money away from supporting what the law is going to cost. So there's issues with, you know, how do you pay for this? But this is something that, yes, a lot of people would like to fix, but it would cost money to fix.

  • 10:27:35

    REHMSure, sure. All right. To Antrim, N.H. Hi there, Ken, you're on the air.

  • 10:27:43

    KENHi. Well, I'm disabled, and I have received Medicare. And last year my Medicare Advantage plan went up from $100 a month basically to $297. That's, like, one-third of my check, so I couldn't afford it. So now I've been paying that extra money that they would pay putting it in bills, and I've had a tough year. I've yet to see or hear anybody talk about any plans for people who have Medicare for these add-on plans because they've gone up so much in the past couple years.

  • 10:28:12


  • 10:28:12

    ROVNERMedicare Advantage plans will not be sold on the exchange, but -- and if you're over 65, you can't buy plans on the exchange. But I have talked to people who talk about people with disabilities...

  • 10:28:24

    KENThat's what I have.

  • 10:28:24

    ROVNER...exactly -- who are under 65 who might in fact want to go to the exchange and look and see if they might be able to purchase coverage on the exchange.

  • 10:28:32

    REHMAnd that would be instead of Medicare?

  • 10:28:35

    ROVNERNo, no, no, not instead of Medicare. This would be a supplement to Medicare.

  • 10:28:38

    REHMI see.

  • 10:28:39

    ROVNERPeople who are under 65 and disabled and have Medicare might in fact be able to find a plan that would help them with their Medicare coverage. This is one of those sort of interesting little quirks in the law. It's possible. I don't -- you might want to speak with an expert on this. But if you're over...

  • 10:28:56

    REHMTake a look at that, Ken.

  • 10:28:58

    ROVNERRight -- if you're over age 65 and on Medicare, you can't shop on the exchange.

  • 10:29:01

    REHMI'm glad you called.

  • 10:29:02

    ROVNERIf you're under age 65 and on Medicare, you might.

  • 10:29:04

    REHMAll right. To Anthony in Lansing, Mich., hi. What's your question?

  • 10:29:12

    ANTHONYHi there. Thanks for taking my call.

  • 10:29:13


  • 10:29:14

    ANTHONYI'm a freelance musician, and I don't make a lot of money. And I'm fairly certain that I qualify for Medicaid. Now, I know that Michigan recently just decided to expand its Medicaid rules but is delaying the expansion until later in 2014. So I'm curious as to what's going to happen in the intervening months. If I can't be enrolled in Medicaid right on Jan. 1, do I pay a penalty? And how do I get coverage within the intervening months (unintelligible) three or four months?

  • 10:29:49

    REHMMary Agnes.

  • 10:29:51

    CAREYOK. I'm going to take a guess at this. I think you have, like, about a three-month grace period before the penalty is assessed, so that might help him. That may or may not coincide with the enrollment period for Medicaid in Michigan. Another question I have is -- I don't know the age of this person. If he's under 30, he could perhaps try to get -- there are these plans -- high-deductible plans for people who are younger. They're kind of bare-bones policies, high deductibles, about $6400. Whether or not he could purchase that as a stop gap plan, I'm not sure, for a few months.

  • 10:30:22

    REHMWell, Julie.

  • 10:30:23

    ROVNERIt's also important to remember that the individual requirement does not apply to people who don't earn enough money to file federal taxes, so that if you earn under about, I think it's -- like, next year, it'll be about $11,000, you wouldn't have to file federal taxes, and it wouldn't apply to you anyway.

  • 10:30:36

    REHMAnthony -- do you fall into that, Anthony?

  • 10:30:41

    ANTHONYTo be honest, I'm not sure. This is a question that I would probably have to ask somebody who has greater knowledge of actual what's going on in Michigan. But I really don't make a lot of money. I'm fairly certain that I fall within the range of Medicaid qualifications.

  • 10:31:03

    REHMOK, Mary Agnes.

  • 10:31:05

    CAREYWell, he's -- if Medicaid -- the expansion is up to about $16,000, but, to Julie's point, if he's earning under about $11,500 right now, he's not even subject to the individual mandates. So he doesn't have to worry about the penalty.

  • 10:31:17

    REHMOK. Here's an email from Paul in Newport News, Va. who says, "It seems that everyone who's trashing this act as dangerous or harmful are people who have good insurance. I've had insurance for the last year, but before that, I spent five years with no insurance for me, my wife, two kids. It really changed my opinion of this discussion. It's a good place to start. We have to do something, so let it go, Republicans." And here's an email from Daniel who says, "I've heard no one explain what the Republicans oppose in this law and why. Can you?" Susan Davis.

  • 10:32:10

    DAVISThey -- I -- they oppose it almost in its entirety. And none of the Republicans that are in Congress today voted for it. I'm not aware of any Republican that supports it. I think that they oppose it in a -- it would be more easily explained on a philosophical level of an expansion of big government that they just find unconstitutional and un-American.

  • 10:32:28

    REHMSusan Davis, she's congressional correspondent for USA Today. And you're listening to "The Diane Rehm Show." Let's take another caller. This one, Ernesto in Boca Raton, Fla. Hi there.

  • 10:32:49

    ERNESTOHello. Thanks for taking my call.

  • 10:32:51


  • 10:32:52

    ROVNERMy question is the following: Is there any significant evidence that large and, you know, non-small business employers are dropping benefits for their employees and choosing instead to pay the tax fine, therefore leaving employees to go into the exchanges and lose existing coverage which may have been very -- you know, very comfortable or very good otherwise from their employer?

  • 10:33:17


  • 10:33:18

    ROVNERYou know, we've seen some anecdotal information. We've seen -- although I did a story -- I think it was just last week -- about companies dropping coverage for spouses. This gets very confusing. They're not allowed to drop coverage for dependents, or at least they won't be allowed. But they can drop coverage for spouses, particularly -- a lot of companies are dropping not spouses, period, but spouses who have access to coverage at their own workplace. So if company -- if the spouse works somewhere else and has access to their own coverage, that's mostly what's going on.

  • 10:33:49

    ROVNERThat's what UPS did. That's what a number of other companies did. I talked to someone at the University of Virginia. That actually predated -- that trend predated passage of this law. That was already starting. What's happening to a lot of these companies is that it's sort of accelerating a trend that was already going on.

  • 10:34:06

    REHMSo what options do those people who are dropped off have?

  • 10:34:11

    ROVNERWell, in this case their option is to take their own insurance at their own job.

  • 10:34:14


  • 10:34:15

    ROVNERIn some cases we are also seeing companies, as I mentioned earlier, who are dropping part-time workers because now the part-time workers have access to the exchanges. Trader Joe's is doing something interesting. They're dropping their part-time workers, giving them $500 in cash saying, go to the exchange. You're probably going to get a better deal there. So they're not abdicating responsibility. They're saying now there is an outlet.

  • 10:34:38

    ROVNERThe bigger concern is companies, as we've seen, cutting sort of full-time workers back to part-time. But remember the requirement for large employers to cover their workers has been delayed for a year. So there's nothing to stop them. There really hasn't been a lot of evidence that -- the evidence that we've seen of people having hours cut, most economists think is more due to the sequester and to other things going on in the economy than to the health care law, at least for right now.

  • 10:35:03

    REHMAll right. And to Phoenix, Ariz. Hi there, Renee.

  • 10:35:10

    RENEEHello, Diane. Thanks for having me on today.

  • 10:35:11


  • 10:35:13

    RENEEI'm 25, and I will be covered under my parents insurance past the -- I believe March is the deadline for the closing of the exchanges. I'm wondering what happens to people like me who are going to be in that situation after the exchanges are closed.

  • 10:35:30

    CAREYYou could be covered up to age 26. So once you turn 26, if you're outside of the enrollment period, that would be one of these qualifying events that would allow you to go to the exchange, look at the subsidies and enroll if that works for you. So there are these exclusions like this. He turns 26 outside of the enrollment window that would -- he could still go ahead and look at the exchanges.

  • 10:35:54

    ROVNERThat's right. There are several sort of life qualifying events -- if you lose your job and your insurance, if you get married, if you turn 26. There are certain things that happen. Mostly you have to enroll only during the open enrollment period.

  • 10:36:05


  • 10:36:05

    ROVNERBut like job-based insurance, if something happens and your life circumstances change, you can enroll at a time other than the open enrollment period.

  • 10:36:11

    REHMAll right. And to Summerset, Ind., a quick call from Carol Joy. You're on the air.

  • 10:36:21

    CAROL JOYThank you very much for your program and for having me. I have one question and one quick statement. The statement is that people without insurance get -- rack up their bills and then go broke, and so then we're paying for them. But the question is, what is the Social -- people on Social Security over 65 -- I've had a lot of friends say that they're going to lose benefits. It's going to -- Social Security -- Medicare is going to cost a lot more for them.

  • 10:37:03

    REHMYou know, we've heard a lot about that. Mary Agnes.

  • 10:37:07

    CAREYThere is -- actually you get more benefits as a Medicare beneficiary under the Affordable Care Act. There's more screenings and no co-pays and deductibles, more help with your Medicare prescription drug coverage, and there is no indication that your Medicare's going to increase.

  • 10:37:21

    REHMMary Agnes Carey, Susan Davis, Julie Rovner all here to answer your questions. More of them after a short break.

  • 10:39:59

    REHMAnd welcome back as we try to answer as many of your questions about the Affordable Care Act as we can. And here's a major one. It's from Stewart in Durham, N.C., who says, "Isn't the ACA really just a tax on the uninsured poor to lower premiums for the people who are already insured? Lots of people can't afford food, clothing or shelter. This law puts healthcare as priority number one before those essentials in order to force everyone to pay into the system. Lots of people will opt out to pay the fine, get nothing in return." Susan Davis.

  • 10:40:52

    DAVISThat is not accurate. I think that, as we have already discussed in here, if you are at that level of working poor, it'd be the amount of subsidies and qualifications you would have. You would be either exempted or given a break in how you would pay for it.

  • 10:41:05

    DAVISI don't underestimate that there are some people on the cusp of certain poverty lines and things that even though most plans will be $100, I do acknowledge that there's probably a lot of families that that's still a hit on, and that's going to be tough. And that shouldn't be underestimated. But in terms of this idea that to put the working poor on insurance to lower my premiums, that is not an accurate assessment.

  • 10:41:25

    REHMJulie, where does this kind of thinking come from?

  • 10:41:29

    ROVNERIt comes from the continual, you know, political attacks on the law and the idea that, you know, everybody's required to have health insurance or pay this fine. But it's really important to remember that, you know, as we said before, if you don't -- if you don't pay taxes, there's no requirement. If you're under 133 or 138 percent of poverty, in most states you're going to be eligible for Medicaid. There's no cost for that.

  • 10:41:52

    ROVNERAnd that, within the exchanges, if you are required -- if you are required to have health insurance, that there are going to be a lot of very low cost plans. So really you have to make a fairly substantial income to be required to buy health insurance. And even in that case, there will be very substantial subsidies available.

  • 10:42:10

    REHMAll right.

  • 10:42:10

    ROVNERSo the idea that really poor people will be required to have insurance ahead of buying food or paying their rent is really just not true.

  • 10:42:18

    REHMTo Alan in Licking, Mo, you're on the air.

  • 10:42:22

    ALANThank you, Diane. I've got a question about why the Republicans continue to bring up the same thing over and over again, and this has been a past law. It was President Obama was reelected, and they made it a big thing there. But yet he was elected. And I'm just wondering if there's any precedence in history where a law that has been passed has been totally brought back time and time again.

  • 10:42:49

    REHMIt's a good question. Susan.

  • 10:42:53

    DAVISNot at least in modern history. I do know from in terms of studying the debate over the ACA that obviously when Medicare was enacted, that was a debate that was carried on...

  • 10:43:02

    REHMSame thing.

  • 10:43:03

    DAVIS...for years after enactment of the law.

  • 10:43:05


  • 10:43:05

    DAVISAnd now it seems almost ludicrous to think that people hated Medicare at a certain point, which is the argument that Barack Obama has been making as he's gone out and done these campaign events, is that he makes a joke where he says, you know, once people know what Obamacare is and they learn to like it, Republicans are going to stop calling it Obamacare, 'cause they're not going to want him to get the credit for having this new -- this new system that people actually may like.

  • 10:43:26

    REHMMary Agnes.

  • 10:43:26

    CAREYYou also have to think about, you have to look at, we talked about the popular, the health law before, the repeated votes on the House floor have confused people. And I think they've attributed it to things like the Kaiser Family Foundation just did a poll released this weekend, talked about 64 percent of the public have no idea that these exchanges are opening up on October the 1st. And for the uninsured, only 12 percent know that they're opening.

  • 10:43:50

    CAREYNow, part of that could be Obama administration's, the weakness they've had in marketing the campaign, getting out there. But also when the House of Representatives votes 40 times to defund all their part of the law, even though those -- they passed the House, they fail in the Senate, in some ways the Republicans almost win by losing because they get out there, and I think they confuse people. And people don't understand the law still exists. They think maybe it's been repealed.

  • 10:44:13

    REHMSo is most of this negativity that you see political, primarily political, or is it really based on, you know, you hear some members say, it's going to ruin the economy, it's going to trash our worldwide standing. I don't get it. Where is this coming from, Julie?

  • 10:44:39

    ROVNEROh, I think it's both. I mean, the people who really oppose this, really oppose it. They have a deep seeded philosophical believe that this is really the wrong way to go about fixing the healthcare system. They say they have other plans for how you could cover people with preexisting conditions and get healthcare costs down. Although the plans that they put forward are awfully vague.

  • 10:45:00

    ROVNERBut, you know, they really deeply, deeply do not want this law to take full effect. And I think that's what you've seen really in the last month as it's come closer to going into full effect. They don't want particularly the subsidies, which are really the new entitlement portion of this law, to go into place, because they feel that once that takes root, you'll never be able to make it go away.

  • 10:45:22

    REHMHere's an email: "What happens to the money collected in fines for those who do not buy insurance? What happens to that money?" Do we know?

  • 10:45:34

    ROVNERIt goes into the general Treasury.

  • 10:45:35

    REHMOK. Let's go to how about Brandon in Baltimore, Md. Are you there?

  • 10:45:43

    BRANDON(unintelligible) ladies. You all have a great day.

  • 10:45:46

    REHMBrandon, you're on the air.

  • 10:45:50


  • 10:45:51

    REHMHey, Brandon, you're on the air. Go right ahead. Well, Brandon, I'm going to take you off. Unfortunately, you are not there with us. Let's go to Andrew in Houston, Texas. Are you there?

  • 10:46:08

    ANDREWYes, I'm here. Thank you for taking my call, Diane.

  • 10:46:11

    REHMOf course.

  • 10:46:12

    ANDREWYes. I agree wholeheartedly that the Affordable Care Act is the law, and that point has been made by some callers and certainly by the panel. That being the case, I'm a former government professor, and I'm a little confused as to where President Obama derives the authority to unilaterally suspend the employer mandate. If it's a law and it's supposed to go into effect, if we're going to suspend that, should that not be done through the normal legislative process? And I'm just curious to know what your panel thinks about that.

  • 10:46:43

    REHMMary Agnes.

  • 10:46:45

    CAREYThe administration vetted this with their lawyers. They say they have the legal authority. They also put out at the time, they delayed the employer mandate for a year, a list of several other times that both Republican and Democratic administrations have made this decision to delay a portion of the law. So they think they're on good legal standing.

  • 10:47:04

    CAREYSome Republicans disagree with that. Theoretically, the administration could face lawsuits over this. But they say they have the authority. And, again, I apologize, I can't cite you another time it's been done by another administration. But I remember when this was delayed, they did cite numerous instances Republican and Democratic administrations had done a similar thing.

  • 10:47:23

    REHMYou know, it's interesting how many callers and emailers are referring to the politics as opposed to asking specific questions about their own eligibility. Here's an email from Jerry in Kalamazoo, Mich., who says, "People are not against Obamacare. They're just sick hearing about it without hearing about it. Number one, people don't like what they don't understand.

  • 10:47:57

    REHM"Number two, people don't like hearing about the same thing over and over, but not really hearing anything about it. Obama made a mistake by letting this drag out. It took two years for it to pass, four years without feeling like anything happened. The media have made matters worse by reporting on 42 attempts to repeal a law nobody understands instead of explaining it." Susan Davis.

  • 10:48:31

    DAVISI would say that parts of the law people have started -- have started to feel, and a lot of it has been largely positive. As Mack mentioned, being able to -- the kids staying on insurance until they're 26...

  • 10:48:40

    REHMRight, right.

  • 10:48:40

    DAVIS...preexisting conditions, those are the ones that have often been cited. It takes a long time to implement a law of this size and of this breadth. I would also add to the caller's list of things that people do not like is Congress.

  • 10:48:51

    DAVISAnd I think that part of what has fueled maybe negative attitudes towards the law or confusion is that, when you hear a significant bloc of legislators publicly and repeatedly saying that this law is going to ruin your life, these tend to be people that you -- not that people necessarily trust Congress. But when your senator is saying, this could ruin your life, you listen, and you're worried. And I do think it has spread confusion, and people are concerned about it.

  • 10:49:15

    REHMOn what grounds can they say, this could ruin your life, Mary Agnes?

  • 10:49:21

    CAREYWell, I think it gets back to the point Julie made about this deep, philosophical difference with the Obama administration and Democrats over how to cover the uninsured. The parties have always been split. The Democrats tend to favor these kind of solutions where you have the federal government more involved. It is a plan that's based on the employer-based system. But nonetheless, a lot of the Republicans don't like this idea of the federal government having subsidies up to the level that they have to expand Medicaid coverage and so on.

  • 10:49:49

    REHMOK. I don't want to keep talking about why people from some sectors don't like it and others do. Julie, tell me how confusing it's going to be for people who either get online or call that number tomorrow.

  • 10:50:12

    ROVNERI think at the beginning everybody expects it's going to be a little bit glitchy. I mean, one of the reasons it's taken this long is that it takes a long time. They're building an entire new infrastructure from scratch. There are a lot of moving parts. People are going to have to -- you're going to have to confirm your income to see, you know, what kind -- what level subsidies people are eligible for, what types of plans are available in which areas.

  • 10:50:33

    ROVNERAs we've mentioned, this is still, you know, a state based system, and to some extent a regional based system. You had to have insurers draw up new plans to figure out what they wanted to offer. It really was extremely complex. And it's still extremely complex. So to make this all sort of work, you know, like the president's been saying, you know, like Travelocity or, you know, buying something on Amazon, getting the backend of this up and running has been really an enormous process.

  • 10:50:58

    ROVNERAnd they're expecting tomorrow to be what they call sort of a soft launch. So you can expect it not to all work exactly as you want. Good thing to keep in mind, this is a six-month long open enrollment, so if everything isn't working exactly tomorrow, they're hoping that people will spend the first couple of weeks window shopping, you know, look around, see what's available. Coverage doesn't begin until Jan. 1. That's really important to keep in mind.

  • 10:51:23

    ROVNERIf you sign up, if you get enrolled by Dec. 15, your coverage can start Jan. 1. So you don't have to panic if everything doesn't work right, you know, starting tomorrow. It's a good time to start looking. If you have coverage by March 31, you will not be subject to the fines for not being covered. There is that three-month grace period. So even though it would be for people who want insurance, you can have it starting Jan. 1, you don't have to have it until the end of March.

  • 10:51:46

    REHMAll right. Let's go to Chesapeake, Va. and to David. You're on the air.

  • 10:51:53

    DAVIDHi, Diane. Thanks for taking my call.

  • 10:51:55


  • 10:51:56

    DAVIDI wanted to, I guess, get the panels', you know, take on this, too. I've always been a proponent of the Healthcare Act and everything. And, you know, I've also owned a small business, and then I had to go back into the full-time workforce just because of the economy. I just got a letter today from the Department of Labor.

  • 10:52:18

    DAVIDI worked for the government as well, local government. And, you know, in the beginning when this whole thing got approved, it stated that, you know, people would have options, and, you know, even if you had healthcare through your existing employer, you could still opt to do certain things and have other options made available to you with all of this, you know, healthcare situation going on.

  • 10:52:38


  • 10:52:40

    DAVIDWell, the letter states that if I have insurance, if I'm covered by my employer, I cannot be eligible for doing anything in the marketplace, unless I meet two conditions -- and I have to meet both of them in order to be able to get any tax credits or do anything else. But I still can't choose another plan. Which is I have to -- it has to cost me more than 9 percent -- 9.5 percent of my household income.

  • 10:53:07

    DAVIDAnd I have to -- I can only make within one to four times of the federal poverty level. Well, I don't meet either one of those conditions, so therefore I can't do anything. But I went out and looked at some of the healthcare plans that they offer. I can get better coverage, and it might cost me a little bit more on my premium. But I can get better coverage than my existing plan, and I think that's a really big bait and switch.

  • 10:53:27

    REHMAll right. Mary Agnes.

  • 10:53:30

    CAREYIf you don't need a subsidy, anyone can buy from the exchange. The question is whether or not you qualify for the subsidy. Even if you have employer sponsored insurance that is not in the criteria that he mentioned -- I mean, that's the thing that intrigues me here. If he wants to look on the exchanges and purchase, he can, but he's not...

  • 10:53:45

    REHMEven though he just got this letter?

  • 10:53:46

    DAVIDNo, you can't.

  • 10:53:47

    CAREYNo, no, no, no. The deal is whether or not you can get a subsidy. OK. There's two criteria for the subsidy. Number one is the 9.5 percent of income, household income. And the second is it doesn't cover 60 percent of the covered cost. I've been told -- and we've reported and others as well -- that the exchange is everyone can look at them. The question is whether or not -- you won't be able to qualify for a subsidy if one of those two criteria aren't met.

  • 10:54:07

    REHMAnd you're listening to "The Diane Rehm show." Julie.

  • 10:54:12

    ROVNERYeah, I mean, that's -- remember, the whole point of this is what they -- is that they wanted to basically keep the employer-provided system mostly intact. And these notices, by the way, most people will be getting these notices because they're required to go out to people who have insurance to help explain what the law is about. So employers will be sending out these notices mostly this month to people who have health insurance, just explaining, you know, what the exchanges are and who's eligible for them.

  • 10:54:37

    REHMBut are you saying he's misunderstanding the primary points that this letter is making?

  • 10:54:44

    CAREYMy guess is the letter is -- I don't have it in front of me. And he said he works for -- I believe he said he works for the local government.

  • 10:54:50

    REHMLocal government.

  • 10:54:51

    CAREYRight. But it's my understanding that his -- whether or not he could quality for a subsidy is where those criteria come into play. But if -- and chances are that, you know, he would be -- I mean, he would have to go on the exchanges and look. He'd have to pay the full freight. That's the big qualifier here.

  • 10:55:07

    CAREYIf he can get a better deal than what he's got from his employer, and the subsidies are out of the equation unless certain criteria are met, he can go on the exchange and buy it. That may be a tougher hurdle to meet than he envisions because most of the time he's got employer-based coverage. They may be negotiating for a variety of people that may be contributing to the premium and so on.

  • 10:55:26

    REHMAll right. And finally, an email from Tom in Ann Arbor, Mich. "Why is Ted Cruz saying millions of people are being harmed by the Affordable Care Act? What is the basis for that remark?" Susan Davis.

  • 10:55:48

    DAVISI think Ted Cruz has made his opposition to the Affordable Care Act very clear in his 21-hour, filibuster style remarks last week. Cruz -- I think this is also part of the sort of political frame you have to look at this. Ted Cruz is someone who, I think, is possibly eyeing a run for president in 2016. I think he is someone who was elected directly out of the Tea Party fervor that has driven a lot of Republican primary elections.

  • 10:56:13

    DAVISI think he has accepted that mantle, and very few things have excited and inflamed sort of the Tea Party grassroots than the opposition to Obamacare, I think, in part often fed by misinformation about the law and what it's going to do, but he has sort of championed himself as the singular fighter against the law in Congress.

  • 10:56:35

    REHMAll right. Let's, before we close, give once again the websites and the telephone numbers.

  • 10:56:44 is the website that you can go to. And if you have a state run exchange, they'll direct you there. If not, that's the federal government website for the exchanges.

  • 10:56:52

    REHMAnd the phone number.

  • 10:56:52

    CAREYI think you had the phone number.

  • 10:56:53

    REHMOK. I can't find the phone number right this second, but we'll get it up on our website. Thank you all so much, Julie Rovner, health policy correspondent for NPR and author of "Health Care Policy and Politics A-Z," Mary Agnes Carey, senior correspondent with Kaiser Health News, Susan Davis, congressional correspondent for USA Today. Thanks for listening, all. I'm Diane Rehm.

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