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Q&A: Status update as health law marks a milestone

Friday - 4/4/2014, 6:14pm  ET

SEIU-UHW worker Kathy Santana, left , assists Ruben Torres, 27, during a health care enrollment event at SEIU-UHW office, Monday, March 31, 2014, in Commerce, Calif. Monday is the deadline to sign up for private health insurance in the new online markets created by President Barack Obama's health care law. (AP Photo/Ringo H.W. Chiu)

NANCY BENAC
Associated Press

WASHINGTON (AP) -- Like so much about the government's health care overhaul, Monday's deadline to sign up for coverage in 2014 didn't turn out quite as planned: Many people still are eligible for extensions that will let them enroll.

The change of plans shouldn't come as much of a surprise, given the disastrous HealthCare.gov rollout last fall, the mass policy cancellation notices that shocked even the president, and other set-in-law deadlines that turned out not to be not so firm.

Still, step by step, the law is taking effect. People are signing up. Insurance is kicking in or changing for millions of Americans.

It's time for a status report as the law marks a milestone, although no one's quite sure how to define success:

Q: How many people have gotten coverage?

A: That's the big question, and the answer is a moving target. About 6 million people have signed up for private insurance through the new state and federal marketplaces, and several million more have gotten insurance through expanded Medicaid coverage under the health care law. But a lot of those people switched over from other plans, so the net increase isn't known. Also, under changes that kicked in during 2010, 3 million young adults up to age 26 have gotten coverage under their parents' plans.

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Q: Do those numbers meet government expectations?

A: It depends on which expectations. Initially, the government had hoped to sign up 7 million through the marketplace exchanges by March 31. It ditched that number after HealthCare.gov experienced near-paralysis when it launched last fall. The new target became 6 million signed up through the exchanges. The administration is giving many people extra time to finish signing up, hoping for a robust number at the end. Monday night, government officials told The Associated Press the original 7 million target was in sight.

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Q: What happened to the March 31 deadline?

A: It's still there. It's just that a lot of people don't have to meet it. The government last week announced "special enrollment periods" for two big groups of people: those who have started an application but didn't manage to finish the complicated enrollment process by Monday, and people dealing with "special circumstances" such as natural disasters, technical difficulties, family problems, complications related to immigration status and more.

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Q: In general, who's already signed up?

A: Mostly people who didn't have insurance through their jobs, many of them with modest incomes. More than half are women.

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Q: How many of the people who have signed up are getting help paying their premiums?

A: Four out of five of those selecting plans through the insurance exchanges have been qualifying for federal subsidies. In general, a single person earning between $11,670 and $46,680 or a four-person family bringing in $23,850-$95,400 can get premium breaks, according to the Kaiser Family Foundation. Provided on a sliding scale that's keyed to income, the most generous subsidies are available to people on the lower rungs of the middle class.

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Q: Does signing up for coverage seal the deal?

A: No. People still have to pay their premiums. There's no definitive word yet on how many people are following through. Caroline Pearson of the market research firm Avalere Health estimates that between 10 percent and 20 percent have not paid, which could drop total enrollment down to between 5 million and 6 million people.

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Q: How many people are still uninsured?

A: That's the flip side of the big enrollment question. There were about 47 million uninsured people in 2012. The number has surely gone down since then, but it's still sizable. A Gallup-Healthways survey, based on interviews in January and February, found that 15.9 percent of U.S. adults were uninsured, down from 17.1 percent for the last three months of 2013. That translates roughly to about 3 million people gaining coverage since the start of the year. The Congressional Budget Office predicts there will still be 30 million people without insurance once the law is fully implemented.

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Q: Who's still uninsured?

A: Millions of low-income people, in part because nearly half the states haven't acted to expand Medicaid coverage. Also, the estimated 11 million-plus immigrants who live in the U.S. illegally aren't eligible to get insurance through the health exchanges.

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Q: What's happening with the "young invincibles" who have gotten so much attention?

A: During the first five months of enrollment, 26 percent of those who selected plans were between the ages of 18 and 34, although this group makes up about 40 percent of potential enrollees.

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