Skip to main content

What else could go wrong with Obamacare?

By Leigh Ann Caldwell, CNN
updated 5:46 PM EDT, Wed October 30, 2013
  • Other issues of concern are plaguing the health care program
  • Website problems are blocking the young and healthy from signing up
  • People are losing their current insurance policies
  • An estimated 4.8 million people are unlikely to be able to purchase insurance

Washington (CNN) -- It's clear, is problematic.

Health and Human Services Secretary Kathleen Sebelius apologized for its rocky rollout on Wednesday. But the website is not the only issue with the Affordable Care Act.

Other issues are plaguing the health program. The issues range from the serious that could cause the foundation of the entire program to crumble to the annoying that could frustrate consumers.

Too few 'young invincibles'

"Young invincibles" are key. They are the young and the healthy. If they don't purchase health insurance, the program is at risk.

Sebelius: 'Hold me accountable'
Obamacare: Can you keep your plan?
Murphy: I want Sebelius to do her job

If too many exchange consumers are older or unhealthy, then monthly premiums will likely skyrocket in 2015 and this could cause the exchanges to topple. If that occurs, one of the highest-profile parts of the law will be viewed as a failure.

This group is so key that President Barack Obama spoke in Boston on Wednesday, hoping to convince this constituency to be patient with the website's problems and keep trying sign up for coverage.

In fact, he is targeting most of his sales pitch to them.

In an interview with Fusion TV on Monday, Obama made a tough sell to younger Americans. He highlighted a new report released by the Health and Human Services Department that found 46% of people up to age 34 are eligible for a subsidy that could provide them with insurance for $50 a month.

"Less than your cellphone bill, less than your cable bill," Obama said. "And about 70% can get if for less than $100 a month."

"The law would not be judged a success if the exchanges fail," said Drew Altman, president and chief executive of the Kaiser Family Foundation, a private, non-profit health care research organization.

To pass this test, the administration figures roughly 40% of exchange consumers -- 2.7 million if the Congressional Budget Office's estimates are correct -- need to be between the ages of 18 and 35.

Younger and healthier premium pools will keep overall costs lower and ease the financial hit to the program when it does pay benefits.

Insurance changes

While the President has said that "You can keep your health care plan" if you like it, that's not necessarily true.

Cancellations, modifications coming for many Americans in individual health consumer market

Well, it might be true if you purchased your plan before 2010 and have a plan that has been "grandfathered" into the Affordable Care Act.

But the reality is that many Americans will see drastic changes.

3 states tell insurers to scrap plans that don't comply with Obamacare

That's because the law now mandates that insurance plans cover certain services. So regardless of which plan you choose, whether it's the low-cost, high-deductible bronze plan or the most expensive, low-deductible platinum plan, they all have to provide basic services. Those services include immunizations, ambulatory care, prenatal care, newborn care, mental health and substance abuse services.

A full list is here.

While Sebelius insisted that some people will keep their insurance, she said those who are seeing their plans canceled "will have consumer protections for the first time."

"For some people, the coverage they have today is going to be changed to cover the new requirements," Robert Zirkelbach, a spokesman for America's Health Insurance Plans, said.

While policies now offer greater coverage, it comes at a financial cost.

High cost

It depends on the state but costs could go up for consumers. The Kaiser Family Foundation wrote in February that unsubsidized premiums for individuals and families "will be somewhat higher under reform than they are today."

Kaiser said many reasons are to blame for higher monthly out-of-pocket costs, including higher quality coverage due to minimum coverage requirements, prohibition on preexisting conditions and caps on out-of-pocket costs.

In addition to higher premiums, plans, especially the lower cost bronze and silver plans, include high deductibles. For instance, in Washington, D.C., deductibles for a family of three run up to $12,000.

While high premiums might prohibit people from being able to afford the monthly cost, high deductibles mean some may not be able to afford getting sick.

Coverage gap

An estimated 4.8 million low-income people are likely to fall into what is called the insurance "gap." They are the people who make too much to qualify for Medicaid in their state but too little to qualify for federal subsidies for the insurance marketplace.

Obamacare's coverage gap: The poor caught in between

That's because subsidies for health insurance are available for people who make 138% of the poverty level, or about $31,300 for a family of four.

To accommodate the individuals and families who don't make that much, the federal government is paying for states money to expand Medicaid, but 25 states opted to not take the federal government's money and not expand Medicaid.

So many wage-earners, including most workers who earn a minimum wage, make too much to qualify for Medicaid but are too poor to receive federal subsidies. Purchasing insurance without subsidies is likely to be cost prohibitive for most in this category.

CNN's Adam Aigner-Treworgy, Sanjay Gupta and Jim Acosta contributed to this report

Part of complete coverage on
updated 1:35 PM EST, Fri November 21, 2014
House Speaker John Boehner said he has sued the Obama Administration in federal court over its decisions to make changes to the President's health care law.
updated 3:00 PM EST, Tue November 11, 2014
Two potential 2016 Republican presidential candidates -- Rep. Paul Ryan and Sen. Marco Rubio -- are teaming up on a proposal to replace Obamacare.
updated 9:24 PM EDT, Sun October 12, 2014
Tthe Department of Health and Human Services has released a report highlighting the impact of the law on hospital costs.
updated 11:05 AM EDT, Wed July 23, 2014
Two U.S. appeals courts issued conflicting rulings on a subject that's important to millions of people: the availability of subsidies to help purchase coverage.
updated 10:06 AM EDT, Wed July 23, 2014
It was a tale of two rulings -- the best of times and the worst of times for Obamacare in the federal appeals courts.
updated 6:00 AM EDT, Wed July 23, 2014
More than half the public says Obamacare has helped, but less than one in five say they've personally benefited from the health care law.
updated 8:01 AM EDT, Fri July 11, 2014
House Republicans are going forward with plans to sue President Barack Obama and will base their legal case on the sweeping health care law he championed and they despise.
updated 6:41 PM EDT, Tue October 29, 2013
Nationally, consumers are learning a number of well-known hospitals won't accept insurance under Obamacare.
updated 1:16 PM EST, Mon December 23, 2013
Open enrollment started October 1. Here's a step-by-step guide to navigating the insurance marketplaces, also known as exchanges.
updated 4:37 AM EDT, Sat October 19, 2013
Obamacare has survived a Supreme Court appeal, a government shutdown and ongoing challenges by opposing politicians.
updated 10:44 AM EDT, Thu September 26, 2013
If you don't know what all those health insurance buzz-words like "co-pay" and "premium" mean, you're not alone.
It's a popular assertion, but is it true? The CNN Politics team hunts down the facts.
Some may offer help navigating the new health insurance marketplace for a fee. Others will warn that you will need a new Medicare card.
updated 12:57 PM EDT, Mon September 30, 2013
Who's in, who's out... and what about the costs? CNN Chief Medical Correspondent Dr. Sanjay Gupta breaks down Obamacare.
Consumers can avoid the exchanges by buying plans directly from insurers or through brokers. But should they?
Here's the first look at insurance premiums on 36 exchanges run by the federal government.
Check out our page with all things you need to know about Obamacare and how it will affect you.