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Despite Criticism, Affordable Care Act Soldiers On


Open enrollment begins today for health insurance under the Affordable Care Act. For the next three months, Americans can sign up for insurance through state and federal exchanges. Millions of Americans are still uninsured, so the big challenge for those trying to get people enrolled is just getting the word out.

PETER LEE: Good morning, Los Angeles. What a beautiful day. Good morning.

RATH: Here in LA, the people who run California's health care exchange have been traveling from city to city by bus holding outdoor events with a Taiko drumming group and a mariachi band.


RATH: Peter Lee is the executive director of Covered California.

LEE: Many of the people that are uninsured today have adjusted to a culture of coping, making do barely without having health insurance coverage. We need to reach out to them that we have a new day, a culture of coverage where affordable coverage is available to all Californians.

RATH: Despite efforts like this, the Affordable Care Act remains unpopular. According to the Kaiser Family Foundation, only 36 percent of Americans have a favorable view of the law. To run through some of the numbers on healthcare, I talked to Julie Rovner. She's a senior correspondent for Kaiser Health News. I asked first whether the number of uninsured Americans has dropped.

JULIE ROVNER: Well, as far as we can tell it has. We won'tg et the official numbers until next year. But most of the surveys out this year suggest that the percentage of the population that's uninsured fell by about five percentage points. So now we're down between 13 and 15 percent of the under 65 population uninsured. That's probably about 10 million people who have coverage who didn't.

RATH: And do we know if healthcare spending nationwide has been affected?

ROVNER: Well, that's a source of really great debate.

RATH: Yeah.

ROVNER: Healthcare spending is definitely going up more slowly than it has. The question is why? The administration says at least some of it is due to things in the health law, like penalizing hospitals if patients who are discharged come back too soon. Other economists say it's left over from the recession, which slowed down health spending in general. And still others look at the changing health insurance landscape where everybody who has insurance is pretty much being asked to pay more for their healthcare coverage.

RATH: So looking at year two of Obamacare, what kind of enrollment is expected this time around?

ROVNER: Well, that depends who you talk to. The Congressional Budget Office has estimated that 13 million people would sign up. The administration has sort of lowered those expectations saying it could be between nine and 10 million people. Now, the administration says that's for a good reason because fewer employers are actually dropping coverage and sending their employees off to the health exchanges to buy their own coverage. Other people say that the administration is kind of low-balling the estimate, so that if they exceed it, it'll look good.

RATH: And who are the people we're talking about? Who's going to be enrolling?

ROVNER: Well, there's still, I think, about 20 million people who are eligible for coverage in these health exchanges who haven't signed up yet. Now, the people who really wanted it have already signed up. That's kind of the low hanging fruit.

So everybody thinks that these people will be harder to reach. They tend to be less educated. One thing that might push in favor of more people signing up is that the penalties are getting bigger. This year, the penalty is 95 dollars or as much as 1 percent of your income. Next year that goes up to 325 dollars or as much as 2 percent of your income.

The problem with that, though, is that by the time people figure out that they're going to pay a penalty for this year, this current open enrollment will be closed. So it will be too late to sign up for 2015. There's a lot of people worried about the politics of that.

RATH: And any signs of trouble with the website this time around?

ROVNER: Well, not that we know of. But, of course, we didn't know last year that it was going to crash either. President Obama said at a recent news conference that they are, (quote) "really making sure the website works super well." So there you have it.

RATH: Julie Rovner with Kaiser Health News. Julie, thanks so much.

ROVNER: Thank you.

RATH: One group with an especially high number of people without insurance - Latinos. According to the Census, about 1 in 4 Latinos in the U.S. is uninsured.

JOSE PLAZA: They are the most uninsured and they are the most to gain from the Affordable Care Act.

RATH: That's Jose Plaza. He's the director of Latino Outreach at Enroll America, a nonprofit that works to get people signed up for health insurance.

PLAZA: There are several reasons why Latinos are the most uninsured group. There are issues of access. There are issues of language. There's also fear of immigration. And so all these put together tend to impact the reasons why Latinos aren't coming out to enroll.

RATH: Only legal residents and citizens can get coverage in the exchanges. But Plaza says many Latinos worry that signing up for healthcare could expose a family member who is in the U.S. without the proper documents. California, for one, has tried to fight that perception.


UNIDENTIFIED MAN: (Speaking Spanish).

RATH: The state has been running TV ads saying that information about immigration will stay confidential and private.


UNIDENTIFIED MAN: (Speaking Spanish).

RATH: Still, Jose Plaza says it remains a common fear among Latinos.

PLAZA: Latinos, about 1 in 6, tend to be in a mixed-status family, meaning that there's one family member that tends to be undocumented. So what tends to happen is that there is this fear that if your parent or your spouse is undocumented, that if you apply for benefits, you will then be impacted when it comes to immigration proceedings. That isn't the case. There actually exists a memo between ICE and HHS that says that you will not be impacted if you apply.

RATH: ICE is the Immigration and Customs Enforcement.

PLAZA: Correct.

RATH: Now, the initial problems with the website got a ton of attention. But there were less publicized delays and problems with the Spanish-language version of the site. What kind of an impact did that have?

PLAZA: Well, it really didn't to be realistic. Latinos prefer in person assistance. There is a greater mistrust of just going on the phone or on the website and giving your personal information, and so it did impact.

But really what it was, word-of-mouth is critical with Latinos. And so they heard that there was all these issues and so they were a little bit more reticent to go and sign up. But our response at Enroll America was to actually get out there and provide that in-person help.

RATH: Where would you like to see the numbers when it comes to enrollment of Latinos a year from now. What would you consider a success?

PLAZA: For Enroll America last year, we reached close to 5 million Americans. And so it would be great to surpass that number for this upcoming enrollment period. It would be great that we would be at par with all of the other ethnic groups, and we're hopeful that we will reach parity when it comes to getting Latinos enrolled.

RATH: Jose Plaza is director of Latino Outreach for Enroll America. Jose, thanks very much.

PLAZA: Thank you very much for your time. Transcript provided by NPR, Copyright NPR.