Correction added 9:00 p.m.
Today marks the deadline for Obamacare open enrollment sign-ups. If people don't at least start filling out an application today, they'll have to wait until 2015 to get insurance through the exchanges. It's also the deadline for first impressions of the health-care law to solidify -- although it might be too late for those to change much at this point. So, how do things look on the ground? Here's a quick snapshot of what people are saying about the Affordable Care Act around the country.
California is one of the most-populated states that the Obama administration was targeting for sign-ups this month. The state had more than 1 million enrollees as of last week. However, California officials are still worried about all the uninsured people they didn't manage to sign up -- something many states are thinking about as the enrollment deadline approaches -- especially the people who make too much to qualify for Medicaid but can't afford the private insurance plans. University of California academics predict that 3 or 4 million people in the state will still not be insured five years from now. According to the Los Angeles Times, L.A. County is already making plans for how to help this population.
The county plans to set up a managed-care-like system for some uninsured residents, but advocates question whether the effort to get patients assigned to community clinics — and out of emergency rooms — will be enough. They plan to gather Tuesday before the county Board of Supervisors' weekly meeting and push for additional funding to expand the program.
In rural Colorado, many people are already worried about rising premiums, especially since people in non-urban areas have traditionally had higher health-care costs to begin with. The Aspen area currently has the most expensive exchange options in the country: $483 per month for the silver plan. In Denver, that plan would cost around $280.
According to the New Haven Register, Rep. Rosa DeLauro (D-Conn.) was out canvassing this morning, going door-to-door to encourage last-minute sign-ups. The state has featured one of the least glitchy implementations, and has signed up at least 27 percent of its uninsured population. Its Web site worked so well that Maryland is abandoning its own troubled site and swapping it for Connecticut's technology. Despite the good signs, a local newspaper raised some questions this morning:
To what extent does the exchange’s membership include people who were previously uninsured, as opposed to people who migrated from other health plans to policies sold through the new marketplace?
How much of a dent has the law made in the uninsured rates among groups that have been less likely to have coverage in the past, such as blacks and Hispanics?
How do the ages and health care needs of the people in the new insurance pools compare with what insurers expected when establishing their premiums, and what will that mean for the cost of next year’s plans?
And, perhaps most significantly, how will the newly insured use their coverage? Will they be able to afford their deductibles and other out-of-pocket costs? Will they be able to easily get appointments with health care providers who accept the exchange plans? And will they begin to use more preventive services, rather than waiting to seek care until they get sick?
Last week, two community organizers were arrested in Chicago after someone called 911 on them while they were canvassing door-to-door, hoping to sign up people last minute for insurance. The police think the charges will be dismissed. Otherwise, Illinois has been pretty successful in encouraging sign-ups, getting more than 113,000 enrollees so far. A local CBS affiliate toured the city this morning and saw lines of procrastinators waiting to sign up at a hospital that enrolled more than 400 people this weekend.
Right now, the state is deliberating whether it wants to continue doing a partnership exchange with the federal government or build its own -- and get the federal funds that come with it. The governor supports transitioning to a state-run exchange, but Democrats in the state are still wary about expanding the state's role in administering Obamacare before the election. Illinois has until Nov. 14 to decide.
From the outside, Kentucky's Obamacare rollout has looked successful, and many national outlets have applauded it as a model for how conservative states could implement the policy. Despite the fact that the state has enrolled more than 350,000 people, Kentucky itself doesn't look too impressed. Republicans in the state legislature are planning to dismantle it, the Republicans in the U.S. Senate primary have found little else to talk about and about 49 percent of residents wanted to repeal the law in February.
Gov. Steve Beshear is one of the few Democrats willing to talk about Obamacare at a decibel audible to humans, and he seems pretty pleased about how the big sign-up push he advocated has unfurled. He told Yahoo! News last week, “When the Affordable Care Act came along, it was a gift from heaven in the sense it gave us a tool to change the history of this commonwealth when it came to the health of our people.
The Courier-Journal reported this morning that about 80 percent of sign-ups in the state have been for Medicaid, and 75 percent of sign-ups through both Medicaid and the insurance exchange were for people who were previously uninsured. The newspaper also mentions the big questions people have about the new enrollees in the state: Will Kentucky be able to handle all these new Medicaid patients? How will people with canceled plans react to their new premiums?
MNsure -- Minnesota's state-run exchange -- has been trying to get young people to sign up throughout March. It has run a "March to Enroll" campaign, which featured over 100 events, some of which were at local breweries. Only 21 percent of sign-ups in the state have been with people between the ages of 19 and 34. Exchange officials plan to have an equally big marketing campaign for the 2015 open enrollment period.
A Minnesota-based insurance company has quietly helped fix exchange Web sites in its home state, Massachusetts and Maryland, as well as HealthCare.gov. Despite its rescuer role, the company has been wary of joining the Affordable Care Act marketplaces, according to reporting in Bloomberg.
The Affordable Care Act is not too popular in New Hampshire. In January, 2014, only 34 percent of residents approved of the law. The highest the law ever polled in the state was 43 percent in October, 2012. Regardless, more people have signed up in the insurance exchange than the federal government originally projected.
According to NPR, the state has its presidential campaign pedigree to thank for signing up so many. The person in charge of the main Obamacare nonprofit in the state is Karen Hicks, who advised Hillary Clinton during her 2008 campaign. The state is also small, which makes outreach far easier than in a state like California or Texas. "
One question many observers have had about New Hampshire's insurance exchange is how having one plan in the marketplace would affect their premium prices. Two other carriers are planning to join the exchange in 2015, but for this year New Hampshire enrollees only have Anthem to choose. As of last week, the state is also planning to adopt the Medicaid expansion
North Carolina has signed up more than 200,000 people so far. Ninety-one percent of enrollees in the state will receive subsidies, the second highest in the nation behind Florida. Despite the higher than anticipated sign-ups, North Carolina, like most states, has underperformed in getting young people to enroll -- only 25 percent of enrollees as of the end of February. Local insurance providers have desperately tried getting young people to sign up with their "Live Fearless" campaign.
Organizers and navigators have told local reporters that sign-up events have been drawing big crowds and lines. One told WNCN News, "This is the sixth event we've put on in Wake County this week, and at each and every site we have this kind of demand."
Today, Politico called Oregon "Obamacare’s biggest technological disaster." It managed to sign up a lot of people via phone or in person, but its Web site makes HealthCare.gov look like a shining beacon of tech savvy.
CoverOregon.com, the state’s equivalent of HealthCare.gov, is the only insurance exchange in the country on which people still cannot buy coverage entirely online. The flaws are so deep that Gov. John Kitzhaber concedes the state may give up on its own exchange and move to the federal HealthCare.gov next year. The challenges were so persistent that the state received federal permission to add a full month to its open enrollment season. The deadline for most of the country to become covered is 11:59 p.m. Eastern time Monday; here, enrollment will run through April.
The finger-pointing and political posturing have escalated as the exchange story has unfolded. Now, as states like Washington to the north and California to the south celebrate their progress, Oregon’s controversy is in full eruption. Kitzhaber, who is running for reelection this fall, faces mounting questions over whether he could have stopped the disaster. And the exchange board is hunting for its third leader since December.
The state is currently deciding whether it can fix the site. Politico contrasted Oregon's rollout with its next-door neighbor, which it said "has run fairly smoothly almost from the start." Marketplace interviewed a health-care professor who noted that all the anecdotal coverage and sign-up number crunching misses the things that we should actually be thinking about now. "'It's almost like looking at the stock market day to day. You're missing the bigger picture.' [He] says that's whether Obamacare improves health-care quality and lowers costs -- something we won't know by today's deadline.'"
There's no arguing that Obamacare has not been a success in South Dakota. However, there's also no question that its elected officials didn't want it to be one. The state was one of 26 that sued to have the law repealed, and it chose not to expand Medicaid. The state has many low-income residents who qualify for subsidies, although few have taken them. The Argus Leader reported,
Only a fraction of state residents eligible for subsidies that the law creates have stepped up so far to buy. A federal report two weeks ago showed South Dakota had 6,765 enrollments at the end of February, about one-sixth out of 40,000 uninsured and eligible for subsidies at the exchange.
The Kaiser Family Foundation estimates South Dakota’s problem to be even worse. The foundation said 6,000 South Dakotans enrolling at the marketplace have qualified for subsidies totaling $19 million, or $3,180 a piece. That rate is ahead of the national average of $2,850. But only 9 percent of South Dakota residents eligible for the credits have enrolled, ahead of only Hawaii at 6 percent. The national rate is 21 percent. Vermont leads with 50 percent.
Wyoming has had an equally low number of sign-ups.
Correction: A previous version of this story had a quote from Gov. Steve Beshear in the New Hampshire section. He is from Kentucky.