TIME Health Care

Obama on the Affordable Care Act’s Fifth Anniversary: ‘It’s Working’

White House Student Film Festival
Martin H. Simon—Pool/Corbis President Barack Obama hosts the second-annual White House Student Film Festival in the East Room of the White House, in Washington on March 20, 2015.

He challenged Republican critics who are campaigning on repealing the law.

President Obama had a simple message on the fifth anniversary of the Affordable Care Act: It’s working.

Speaking in the Executive Office Building next to the White House, Obama argued that his signature health care law was “working better than many of us — including me — anticipated” at increasing health insurance rates and improving the quality of care.

“The bottom line is this for the American people: this law is saving money for families and for businesses,” he said. “This law is also saving lives, lives that touch all of us. It’s working despite countless attempts to repeal, undermine, defund and defame this law.”

In particular, Obama highlighted a government report that showed that fewer mistakes in hospitals saved the lives of 50,000 people between 2011 and 2013, which the White House partly attributed to initiatives to reduce accidental overdoses, bedsores and patient falls.

The remarks came just two days after Texas Sen. Ted Cruz promised to repeal “every word of Obamacare” in a speech launching his presidential campaign, the first Republican to join the 2016 race.

Obama took the opportunity to take a few shots at Republican critics of the law, joking that “death panels, doom, [and] a serious alternative from Republicans in Congress” have all failed to materialize and challenging candidates campaigning for repeal to explain how “kicking millions of families off their insurance” will strengthen the country.

“Making sure that the Affordable Care Act works as intended to not only deliver access to care but to improve the quality of care and the cost of care, thats something that requires us all to work together,” he said.

TIME politics

‘We Need to Get This Right': Obamacare Turns Five

Health Reform Cover
Cover Credit: PHOTO-ILLUSTRATION BY ANN ELLIOTT CUTTING FOR TIME. INSET: BRYCE DUFFY FOR TIME. The April 5, 2010, cover of TIME

The Affordable Care Act was signed on March 23, 2010

When President Obama signed the Affordable Care Act on March 23, 2010, it was obvious that making “Obamacare” official was still only the beginning of the law’s story. “Now for the really hard part,” TIME proclaimed in a cover story about the new law.

Looking back at that story by Karen Tumulty and Kate Pickert that announced the law’s arrival, it’s noteworthy just how tempered expectations were.

As TIME explained:

Economists and health care experts have long agreed on the problems that ail the health insurance system in America. It leaves too many people out. Even those who have coverage may be one diagnosis away from financial catastrophe. On the other side of that same equation lie the waste and excess created by paying doctors and hospitals for the quantity of treatment they provide rather than what works best. By some estimates, as much as 30% of the more than $2 trillion Americans spend on health care each year goes toward treatments that are unnecessary and even harmful. And what does the U.S. get for that staggering investment? Shining hospitals packed with cutting-edge technology but also a population whose health and life expectancy lag behind those of most other industrialized democracies.

Will these reforms turn all that around? We won’t know for years, probably not for decades. The most ambitious element of the new health care law–the expansion of coverage to an additional 32 million Americans–won’t even take effect until 2014. “It’ll take four years to implement fully many of these reforms because we need to implement them responsibly,” Obama said as he prepared to sign the legislation. “We need to get this right.”

The charts that accompanied the 2010 story included predictions for 2019. There number of uninsured Americans was predicted to drop by 28 million — from 50 million at the time of publication, to 22 million — during that time. If those changes happened steadily over the intervening nine years, about 15 and a half million Americans would have gained insurance in the first five years.

Just last week, the Department of Health and Human Services announced that about 16.4 million previously uninsured people have already gained insurance since the law was passed.

Read TIME’s 2010 cover story about the new health-care law, here in the TIME Vault: What Health Care Means for You

TIME Health Care

11 Numbers to Explain Obamacare on its Fifth Anniversary

Marketplace guide Jim Prim works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act at an enrollment event in Milford, Delaware on March 27, 2014.
Andrew Harrer—Bloomberg/Getty Images Marketplace guide Jim Prim works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act at an enrollment event in Milford, Del. on March 27, 2014.

The Affordable Care Act turned five years old Saturday, but that’s not the most important number you need to know about President Obama’s controversial health care law.

To mark the law’s anniversary, here are 11 numbers you need to know to understand the law:

$142 billion: What the Congressional Budget Office projects the law will cost over the next decade

16.4 million: Number of previously uninsured Americans who have gotten coverage under the law

2.3 million: Number of previously uninsured young adults, ages 19-25, who have gained health insurance through the under 26 provision, which allows them to stay on their parents’ plan

29: Current number of states that accepted the law’s Medicaid expansion (including Washington, D.C.)

24,000: High-end estimate of how many lives the law could save per year by increasing the number of insured Americans

50+ : Number of times the GOP-controlled House has voted to repeal the law, in whole or in part

30: Number of Democratic senators who voted for the law who are no longer in office

25: Number of states that signed on to a Supreme Court challenge to the law in 2012

7: Number of states that signed on to a Supreme Court challenge to the law in 2015

2% of annual household income or $325 per person: The fine for not having coverage in 2015

43%: Percentage of Americans who don’t support the law (41% support it)

MONEY Health Care

Good News. Obamacare Hasn’t Led to Less Health Coverage at Work

"Benefits Meeting" announcement on bulletin board
Getty Images—(c) KLH49

A new survey finds that so far employers don't seem to be cutting worker hours to get out of offering health insurance benefits.

There has been much hand wringing over the health law requirement that large employers this year offer insurance to workers who put in 30 or more hours a week or face penalties for not doing so. The new rules would cost employers a bundle, some fretted, as part-timers clamored for company coverage previously unavailable to them. Others worried that employers would cut workers’ hours to get under the cap.

A new study found that so far there’s little cause for concern: Average enrollment in company plans was essentially unchanged between 2014 and 2015 at 74% of all workers.

The survey of nearly 600 employers by benefits consultant Mercer found that in 2015 the average percentage of employees who were eligible for coverage increased one point to 88%, but it was offset by a drop in the enrollment of eligible workers of one point on average, to 83%.

Part of the explanation for the stable results stems from the fact that most employers were already in compliance, says Beth Umland, Mercer’s director of research for health and benefits.

In 2014, employees had to work 25 hours a week on average to be offered health insurance, according to Mercer. That figure has edged up since 2011, when it was 23 hours weekly, but is still well below the law’s 30-hour threshold.

Still, while the expansion in eligibility wasn’t a big change for many employers, “if you were impacted you were really impacted,” says Tracy Watts, Mercer’s national leader for health care reform.

Food and lodging companies were most affected by the new rules, with the average percentage of workers who were eligible for coverage increasing from 57% to 60%. Other industry sectors that felt the change included health care, where per diem nurses and other professionals take on short-term assignments, and higher education, which employs many part-time adjunct professors, says Watts.

But most employers aren’t changing their practices to discourage health plan enrollment, the survey found. Seventy-three percent said they had no plans to change, while 16% said they ensured that newly hired part-timers work fewer than 30 hours weekly, and 19% said they reduced the hours of employees who consistently or occasionally worked more than 30 hours a week.

Even though the health law aims to encourage employers to offer coverage by imposing fines on those who don’t do so, not all take advantage of the offer. Workers might not sign up because they have other options under the health law. Low-income workers may be eligible for Medicaid in states that have expanded coverage to adults with incomes up to 138% of the federal poverty level. Young people can stay on their parents’ plan until they turn 26 under the health law, and many people continue to get coverage through their spouses.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

TIME Health Care

Support for Obamacare Highest in Years, Poll Says

The country is almost evenly divided.

The gap between Americans who support and oppose President Obama’s controversial health care law shrank to its narrowest margin in more than two years, according to a new poll.

A Kaiser Health Tracking Poll conducted in March found that 41% of respondents had a favorable view of the Affordable Care Act—up from 1% in January—and 43% had an unfavorable view. The numbers are a marked increase from July 2014, when the same poll found 53% of respondents viewed the law unfavorably, and they come just ahead of the five-year anniversary of the law’s enactment this weekend. Kaiser has tracked opinion on the health care law regularly.

Support largely fell along party lines, with 74% of Republicans expressing an unfavorable opinion and 65% of Democrats expressing a favorable view. While most people said the law had no direct impact on them, Republicans were far more likely to say it had hurt them than Democrats.

In total, 30% of respondents said that Congress should repeal the law, including 11% of Democrats and 61% of Republicans, while 46% of respondents said the law should remain as is or be expanded, including 72% of Democrats and 16% of Republicans.

Most respondents—53%—also said they were not aware of the Supreme Court case underway that threatens to roll back a key feature of the law.

The poll of 1,503 adults, conducted March 6-12, has a margin of error of three percentage points.

MONEY Obamacare

Everything You Need to Know About the Latest Challenge to Obamacare

140603_FF_QA_Obamacare_illo_1
Robert A. Di Ieso, Jr.

Next week the Supreme Court will hear arguments in a case that could have a huge impact on millions of consumers. Here's what it's all about.

The Affordable Care Act is once again before the Supreme Court.

On March 4, the justices will hear oral arguments in King v. Burwell, a case challenging the validity of tax subsidies helping millions of Americans buy health insurance if they don’t get it through an employer or the government. If the court rules against the Obama administration, those subsidies could be cut off for everyone in the three dozen states using healthcare.gov, the federal exchange website. A decision is expected by the end of June.

Here are five things you should know about the case and its potential consequences:

1. This case does NOT challenge the constitutionality of the health law.

The Supreme Court has already found the Affordable Care Act is constitutional. That was settled in 2012’s NFIB v. Sebelius.

At issue in this case is a line in the law stipulating that subsidies are available to those who sign up for coverage “through an exchange established by the state.” In issuing regulations to implement the subsidies in 2012, however, the IRS said that subsidies would also be available to those enrolling through the federal health insurance exchange. The agency noted Congress had never discussed limiting the subsidies to state-run exchanges and that making subsidies available to all “is consistent with the language, purpose and structure” of the law as a whole.

Last summer, the U.S. Court of Appeals for the Fourth Circuit in Richmond ruled that the regulations were a permissible interpretation of the law. While the three-judge panel agreed that the language in the law is “ambiguous,” they relied on so-called “Chevron deference,” a legal principle that takes its name from a 1984 Supreme Court ruling that held that courts must defer to a federal agency’s interpretation as long as that interpretation is not unreasonable.

Those challenging the law, however, insist that Congress intended to limit the subsidies to state exchanges. “As an inducement to state officials, the Act authorizes tax credits and subsidies for certain households that purchase health insurance through an Exchange, but restricts those entitlements to Exchanges created by states,” wrote Michael Cannon and Jonathan Adler, two of the fiercest critics of the IRS interpretation, in an article in the Health Matrix: Journal of Law-Medicine.

In any case, a ruling in favor of the challengers would affect only the subsidies available in the states using the federal exchange. Those in the 13 states operating their own exchanges would be unaffected. The rest of the health law, including its expansion of Medicaid and requirements for coverage of those with pre-existing conditions, would remain in effect.

2. If the court rules against the Obama administration, millions of people could be forced to give up their insurance.

A study by the Urban Institute found that if subsidies in the federal health exchange are disallowed, 9.3 million people could lose $28.8 billion of federal help paying for their insurance in just the first year. Since many of those people would not be able to afford insurance without government help, the number of uninsured could rise by 8.2 million people.

A separate study from the Urban Institute looked at those in danger of losing their coverage and found that most are low and moderate-income white, working adults who live in the South.

3. A ruling against the Obama administration could have other effects, too.

Experts say disallowing the subsidies in the federal exchange states could destabilize the entire individual insurance market, not just the exchanges in those states. Anticipating that only those most likely to need medical services will hold onto their plans, insurers would likely increase premiums for everyone in the state who buys their own insurance, no matter where they buy it from.

“If subsidies [in the federal exchange] are eliminated, premiums would increase by about 47%,” said Christine Eibner of the RAND Corporation, who co-authored a study projecting a 70% drop in enrollment.

Eliminating tax subsidies for individuals would also impact the law’s requirement that most larger employers provide health insurance. That’s because the penalty for not providing coverage only kicks in if a worker goes to the state health exchange and receives a subsidy. If there are no subsidies, there are also no employer penalties.

4. Consumers could lose subsidies almost immediately.

Supreme Court decisions generally take effect 25 days after they are issued. That could mean that subsidies would stop flowing as soon as July or August, assuming a decision in late June. Insurers can’t drop people for non-payment of their premiums for 90 days, although they have to continue to pay claims only for the first 30.

Although the law’s requirement that individuals have health insurance would remain in effect, no one is required to purchase coverage if the lowest-priced plan in their area costs more than 8% of their income. So without the subsidies, and with projected premium increases, many if not most people would become exempt.

5. Congress could make the entire issue go away by passing a one-page bill. But it won’t.

All Congress would have to do to restore the subsidies is pass a bill striking the line about subsidies being available through exchanges “established by the state.” But given how many Republicans oppose the law, leaders have already said they will not act to fix it. Republicans are still working to come up with a contingency plan should the ruling go against the subsidies. Even that will be difficult given their continuing ideological divides over health care.

States could solve the problem by setting up their own exchanges, but that is a lengthy and complicated process and in most cases requires the consent of state legislatures. And the Obama administration has no power to step in and fix things either, Health and Human Services Secretary Sylvia Burwell said in a letter to members of Congress.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Taxes

Why Some Taxpayers Are In for a Big Shock This Year

Many middle-class families who got subsidized health coverage through Obamacare in 2014 are facing an unexpected tax bill now.

Roberta and Curtis Campbell typically look forward to tax time. Most years, they receive a refund–a little extra cash to pay off credit card bills.

But this year the California couple got a shock: According to their tax preparer, they owe the IRS more than $6,000.

That’s the money the Campbells received from the federal government last year to make their Obamacare health coverage more affordable. Roberta, unemployed when she signed up for the plan, got a job halfway through the year and Curtis found full-time work. The couple’s total yearly income became too high to qualify for federal subsidies. Now they have to pay all the money all back.

“Oh my goodness, this is just not right,” said Roberta Campbell, who lives in the Sacramento suburb of Roseville. “This is supposed to be a safety net health care and I am getting burned left and right by having used it.”

As tax day approaches, hundreds of thousands of families who enrolled in plans through the insurance marketplaces could be stuck with unexpected tax bills, according to researchers. Those payments could be as high as $11,000, although most would be several hundred dollars, one study found.

The result is frustration and confusion among some working and middle-class taxpayers, whom the Affordable Care Act was specifically intended to help. The repayment obligations could dissuade people from re-enrolling and provide more fuel to Republicans’ continuing push for a repeal of the law.

The problem is that many consumers didn’t realize that the subsidies were based on their total year-end income and couldn’t reliably project what would happen over the course of the year, said Alyene Senger, research associate at The Heritage Foundation, a conservative think tank.

“How do you know if you are going to get that promotion?” she said. “How do you know what your Christmas bonus is going to be?”

In addition, Senger said the government didn’t go out of its way to publicize the tax consequences of receiving too much in federal subsidies. “It isn’t really something the administration focused on heavily,” she said. “It’s not exactly popular.”

The system was intended to ensure that people received the right amount in subsidies, no more or less than needed. But the means the government chose to reconcile the numbers was the tax system — notorious for its complexity well before the Affordable Care Act passed.

Enrollees who enrolled in Obamacare now are realizing that certain positive life changes–a pay raise, a marriage, a spouse’s new job–can turn out to be a liability at tax time. “We are definitely seeing some pain,” said Jackie Perlman, a principal tax research analyst at H&R Block.

H&R Block released a report Tuesday saying that 52% of customers who received health coverage through the insurance marketplaces last year underestimated their income and now owe the government. They estimate that the average subsidy repayment amount is $530.

At the same time, about a third of those enrolled in marketplace coverage overestimated their income and are receiving money back–about $365 on average, the report said.

Under the Affordable Care Act, the federal government made subsidies available to people who earned up to 400% of the federal poverty level—about $47,000 for an individual and $63,000 for a couple. For families who ended up making less than that, the federal government limits any repayments that might be due: The poorest consumers will have to repay no more than $300 and most others no more than $2,500. But the Campbells’ income last year exceeded the limit to receive federal help, so they have pay back the whole amount.

Roberta Campbell said she was only trying to do the right thing. Campbell, now 59, lost her job as a program director for the Arthritis Foundation in late 2012. She and her husband, who was working part-time as a merchandiser, downsized and moved into a smaller house.

They were left uninsured but were mindful of the federal mandate to be covered as of January 2014. So they signed up for a plan through California’s insurance marketplace, Covered California. The plan cost about $1,400 a month, but they were able to qualify for a monthly subsidy of about $1,000.

“We are rule followers,” she said. “We decided to get insurance because we were supposed to get insurance.”

They barely used the coverage. Roberta and Curtis each went to the doctor once for a check-up. Then, about halfway through the year, Roberta got a job at UC Davis and became insured through the university. Curtis, who had been working part-time, got a full-time job for a magazine distribution company.

They notified Covered California, which Campbell said cancelled the insurance after 30 days. But with the new salaries, his pension from a previous career and a brief period of unemployment compensation, the couple’s year-end income totaled about $85,000, making them ineligible for any subsidies.

Their tax preparer told them they would have been better off not getting insurance at all and just paying the fine for being uninsured. In that case, the Campbells say their financial obligation would have been much smaller–about $850.

“The ironic thing is that we tried to pull ourselves up by our bootstraps,” Curtis Campbell said. “Now they are going to penalize us. It’s frustrating.”

It’s not surprising that the projections people made about their income in 2014 in many cases were incorrect, said Gerald Kominski, director of the UCLA Center for Health Policy Research. The first open enrollment period started in October 2013, meaning that some enrollees based their estimates on what they earned in 2012.

Kominski said that policy experts knew there would be significant “churn” of people whose incomes change throughout the year and who would gain or lose their eligibility for subsidized coverage. But he and others said there was less understanding among consumers about how that could affect their taxes.

With tax season still underway, it not entirely clear how many people will have to repay the government for excess subsidies. But along with the recent H & R block estimates based on the firm’s customers, a UC Berkeley Labor Center study published in Health Affairs in 2013 suggested the numbers would not be not small.

Nationwide, 6.7 million people enrolled in marketplace exchanges through Obamacare in the first year. About 85% of people got federal help paying their insurance premiums.

Using California as a model, labor center chair Ken Jacobs estimated that even if everyone reported income changes to the insurance marketplace during the year, nearly 23 percent of consumers who were eligible for subsidies would have to pay the government back at least some of the amount received. About 9 percent of those receiving subsidies would have to pay the full amount. If no one reported changes, 38 percent would owe money.

The median repayment–if people reported income changes along the way—would be about $243 but some couples could owe more than $11,000, according to the research. The median amount due if people didn’t report the changes during the year would be $750.

“The most important thing for people to do along the way is to report [income] changes so the subsidy amount is adjusted,” Jacobs said.

For those who must repay money, the IRS will allow payment in installments, even after the April 15 tax deadline. Interest will continue accruing, however, until the balance is paid.

Covered California spokesman Dana Howard said he understands paying back excess subsidies puts some in a difficult spot. But he said consumers who think their circumstances might change can decline the money or just take part of it.

Howard also said the subsidies were designed to give the working class and middle class folks a leg up in affording health coverage. So when people get good jobs, he said, they don’t necessarily need the federal help to get insurance.

“When you get that really good fortune, that has to be shared back,” Howard said. “That is just how the ACA law was written.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Health Care

Why You’re Still Paying for Birth Control Even Though It’s “Free” Now

150211_FF_BirthControl
Laura Johansen—Getty Images

Most women with private health insurance can get contraception for free, but a lack of information means some are still paying out of pocket—even when they shouldn't be.

A record scratch sounded in my head one weeknight this January, when a pharmacist at my local drugstore told me my birth control pills would—for the first time—cost more than $50 a month.

Strange, I thought, since I could have sworn I heard contraception was one of the preventive health services that are free under the Affordable Care Act, and that the law was rapidly expanding access for most women, with at least 67% of insured women on the pill paying $0 (up from only 15% in 2012), according to a recent study by the Guttmacher Institute. Perplexing.

After all, I don’t work for an exempted religious organization or a company such as Hobby Lobby, which in a Supreme Court case last year won the right to deny contraceptive coverage because of conflicting beliefs. And the same pills—Ortho Tri-cyclen Lo—cost me nothing under my old health plan. Sure, I had switched insurance companies in the new year (to Aetna, the third largest in the country), but I’d opted for a high-premium Gold plan. A monthly copay on par with the cost of an iPod shuffle seemed hefty and unfair.

So I left the pharmacy empty handed and went home to call Aetna.

My happiness was brief when a customer service agent informed me that—while most brand-name pills had a copay—I could simply switch to a free generic version of the same compound. The problem? Turns out there is no generic version of Ortho Tri-cyclen Lo yet. So I was trapped, much like women whose insurance companies have denied them coverage for the NuvaRing, reasoning that they can take generic pills with the same hormones—even though the Department of Health and Human Services has been clear that the ring is a distinct form of contraception (and should therefore be free).

I hesitated to simply choose a different generic for a reason that should not surprise the many other women who have tried multiple birth control methods: Switching from pill to pill in the past caused me side effects, which thankfully subsided once I finally found one that worked for me.

“People respond differently to different pills and a change can cause side effects like irregular bleeding and headaches,” says Jill Rabin, an ob-gyn and professor at Hofstra North Shore-LIJ School of Medicine. “There’s no predicting how someone will do unless they try it.”

The pressure I felt to switch seemed especially unjust given this aspect of the law: While women can be charged a copay for brand name drugs when an equivalent generic is available, this Department of Labor FAQ explains, “if, however, a generic version is not available, or would not be medically appropriate for the patient” as determined by her doctor, “then a plan or issuer must provide coverage for the brand name drug … without cost-sharing.”

When I brought my dilemma (and the fact that I was a journalist planning to write about it) to Aetna’s director of communications, Susan Millerick, she took swift action. Within a week, I had my Ortho Tri-cyclen Lo, free of copay.

“It is always Aetna’s intent to abide by the laws that govern our health benefits coverage, and to fairly interpret and apply all laws and regulatory guidance on behalf of our customers and members,” Millerick wrote in an email.

Millerick’s explanation for what had happened suggests any woman would be wise to question any insurer denial for contraceptive; she said Aetna’s “service reps erred” in not telling me about the option to appeal the copay. I should have been told that I could just ask my doctor to call and verify that I really needed my pill and that a different generic would not suffice.

The good news for many women is that simply being informed of your options—and getting your doctor on your side—may be enough to go from paying a wallet-draining copay to nothing at all, says Rabin.

“Figuring out the best contraception that minimizes cost and maximizes efficacy is a conversation that should be between doctor and patient,” Rabin says. “Most doctors don’t want that decision taken out of their hands and would be happy to help make that call for their patients.”

For those women who encounter more resistance than I did—or find, as Kaiser Health News reported, that certain insurers are even trying to wriggle out of covering generics—there are other resources to turn to, like the National Women’s Law Center. Their website has clear instructions on how to fight back if you think your insurer is unfairly denying you free birth control, with templates for appeal letters and a free hotline (866-745-5487) for additional assistance.

Even with all the progress, thousands of women have been contacting the NWLC’s hotline in recent months after running into problems getting free contraceptives, says Mara Gandal-Powers, a lawyer at the NWLC.

Generally, the biggest obstacle to free birth control access right now is ignorance, she says. Many women—and their insurance representatives, doctors, and pharmacists—aren’t on the same page about whether their particular contraception should have a copay or not. Instead of doing a double take at the cost of their contraceptives, Gandal-Powers says, some women never question the charge.

That’s a compelling reason to double check your insurer, pharmacist, and even doctor’s assumptions.

“There is definitely a lot of education that still needs to happen,” says Gandal-Powers, “not just among women themselves but also among health care providers and pharmacists.”

Beyond a lack of education, a few more obstacles to universally free birth control remain. Besides the religious exemption, there’s also a subset of insurance plans that are “grandfathered” in such a way that they don’t have to cover contraception right away—though they will in coming years. Enrollment in grandfathered plans is dropping, with only 26% of covered workers enrolled in a grandfathered health plan in 2014, down from 56% in 2011, according to the Kaiser Family Foundation. Another exception is self-funded student plans.

The takeaway? If you’re paying more than $0 for birth control, it can’t hurt to do a little digging. If you are lucky (and persistent), you could end up pushing your insurer to better comply with the law—and save hundreds of dollars a year, to boot.

TIME White House

White House Says Obamacare Signups in 2015 Enrollment Top 11 Million

People Rush To Enroll Before Deadline For Affordable Care Act
Joe Raedle—Getty Images Jose Ramirez, left, and Mariana Silva speak with Yosmay Valdivia, an agent from Sunshine Life and Health Advisors, as they discuss plans available from the Affordable Care Act in the Mall of the Americas on Dec. 15, 2014 in Miami.

"The Affordable Care Act is working," Obama says

The White House announced Tuesday that 11.4 million people across the United States signed up for health insurance or renewed their plans during the 2015 enrollment period for the Affordable Care Act.

More than 1 million people enrolled for private health care coverage under President Barack Obama’s law during the last nine days until the Feb. 15 deadline, the White House said in a statement and video posted to Facebook. Health and Human Services Secretary Sylvia Burwell added that the final day was the biggest open enrollment day for new consumers, this year or last.

“The Affordable Care Act is working,” Obama says in the video. “It’s working a little better than we anticipated.”

The administration’s preliminary estimate could change, the Associated Press reports, as the White House has offered those who started but didn’t finish applications before the deadline until Feb. 22 to do so. Conversely, the number could fall if any enrollees don’t pay their part of the premiums.

Watch the video here.

MONEY Health Care

What to Know About Obamacare Open Enrollment This Year

150209_FF_ObamacareDeadline
Jeffrey Coolidge—Getty Images

The Obamacare deadline to sign up for a policy is February 15. Here's what you need to do to make sure you're covered.

Update: The Obama administration has announced a special open enrollment period for people who did not realize they would need to pay a tax this year. So you have one more shot to get insurance for 2015, from March 15 to April 30. Here are our tips from February.

Time is running out. The open enrollment period for buying individual health insurance for 2015 ends February 15. Miss this important deadline, and you could remain uninsured all year—and face a steep tax penalty.

As of early February, about 9.9 million Americans had purchased or re-enrolled in private health insurance through the federal and state insurance exchanges created by Obamacare. But an estimated 29 million Americans remained uninsured as of the end 2014, according to the Commonwealth Fund.

Anne Filipic, president of Enroll America, a non-profit that educates Americans about health insurance, says too many people still don’t know that they can get financial assistance if they are struggling to pay for coverage.

“There has been a lot of confusion and misinformation,” Filipic says. “For a lot of people, they’ve heard of the ACA or Obamacare, but they don’t know what it means for them.”

Here’s what next week’s deadline means and what you need to know about getting covered in time.

1. February 15 is a hard deadline.

The window to buy individual health insurance for 2015 runs from November 15, 2014 to February 15, 2015. After that, you won’t be able to buy a policy this year unless you have extenuating circumstances. You may have to remain uninsured until 2016 (open enrollment for 2016 coverage doesn’t begin until next October).

There are exceptions. If you marry, divorce, have a baby, move to another state, lose your employer health insurance, or experience another “qualifying life event,” you can sign up for health insurance any time. You have 60 days after the event to enroll in a new health plan.

2. You have choices where to shop.

Under the Affordable Care Act, aka Obamacare, you can buy private insurance through government-run shopping websites, also called exchanges or the marketplace. Some states run their own sites; others use the federal government’s site. You can find the option for your state at Healthcare.gov, where you’ll also be able to see if you qualify for financial help with your premiums.

You don’t have to shop on a government-run exchange. You can also get insurance from web brokers, such as getinsured.com, gohealth.com, or ehealthinsurance.com. But if you qualify for a premium subsidy, make sure you get a plan that is sold on the government marketplace.

3. If you can’t afford insurance, you may qualify for help.

Almost half of uninsured Americans say they didn’t sign up for Obamacare because they thought they couldn’t afford it, according to a Kaiser Family Foundation poll. Generally, that shouldn’t be the case. The government will pay for part of your health insurance if you earn between 100% and 400% of the poverty level.

The poverty level varies based on your family size. A single person earning between $11,670 and $46,680 this year is eligible for a tax credit. So is a family of four earning between $23,850 and $95,400. With a tax credit, your health insurance will cost between 2.01% and 9.56% of your total income.

The Department of Health and Human Services found that 87% of the people who bought a health plan on the exchanges got financial help, and those people paid an average of just $82 a month. “This is a little known fact for many people,” Filipic says.

And if you earn less than the poverty line? The plan was for households making less than 138% of the poverty line to enroll in Medicaid, a state-administered health care program for low-income Americans. Here’s the catch: The Supreme Court ruled that the federal government could not force states to expand their Medicaid programs.

As a result, some people in the 21 states that did not expand Medicaid may earn too much to qualify for Medicaid but earn too little to qualify for an Obamacare tax credit. The Kaiser Family Foundation estimates that 18% of uninsured Americans fall in this so-called “coverage gap.” Fortunately, about 30% of uninsured Americans are eligible for tax credits to buy private insurance. Another 18% are eligible for Medicaid.

4. If you’re not covered, the penalty is going up.

Another reason not to miss this deadline: Under Obamacare, most Americans are required to have a qualified health insurance plan, or pay a fine.

If you went without health insurance for more than three months in 2014, you could owe the IRS up to $95 per person in your household (capped at $285 for large families), or 1% of your income, whichever is higher. And if you go without health insurance this year, the penalty increases to $325 per person (capped at $975) or 2% of your income. The penalty increases again in 2016.

However, you can qualify for an exemption, including for financial hardship. “Most people who are uninsured will qualify for an exemption because there’s a lot of exemptions,” says Karen Pollitz, senior fellow at the Kaiser Family Foundation. You can apply for most exemptions right on the tax return; you can apply for other hardship exemptions using this form.

5. You can ask an expert to help you enroll.

Still confused? Get help. All across the country, there are thousands of experts, sometimes called “navigators,” who can assist you in-person, for free.

Getting help is especially valuable if you aren’t sure if you are eligible for financial help, Pollitz says. Oftentimes, assisters work year-round for free clinics or other public agencies, so if you’re in the Medicaid “coverage gap,” an assister might be able to connect you with other resources, such as nutrition assistance or free community health services. Plus an ACA navigator or another adviser could help you tally up your income and see if you can claim a tax credit.

You can find an assister near you on the government’s site, localhelp.healthcare.gov. Or sign up for an appointment online using Enroll America’s connector tool at getcoveredamerica.org/connector. There are about 65,000 appointments available before February 15 at some 4,000 locations, and Enroll America offers contact information for another 11,000 locations. “There’s help out there waiting for you,” Filipic says.

6. Even if you bought health insurance last year, you should shop again.

If you bought health insurance on the exchanges last year and then did nothing, you’ve been auto-enrolled in that plan or a similar plan from the same insurer. But you can still switch plans until February 15.

Take a minute to see if that’s still the best deal, especially if you chose the least expensive plan in the first go-round. Last year’s cheapest plans have gotten 9.5% more expensive, on average, according to an analysis by the New York Times. You may be able to lower your monthly premiums by switching.

And your benefits can change too, including your deductible and out-of-pocket maximums.

Another reason to re-enroll is to see if you qualify for a bigger tax credit. “Your tax credit from last year was also automatically renewed, but it may or may not be the right amount,” Pollitz says. “Even if your income didn’t change at all, you probably qualify for a little more tax credit just because you got older. It’s based on a benchmark plan for someone your age.”

And while you’re at it, think about how you liked your health coverage in 2014. “Are you satisfied with the network? Were you able to get in to seeing the doctors you wanted to see? Were there a lot of hassles getting your claims paid?” Pollitz says. “Now is a good time to see what your options are.”

This article was updated to clarify that you can claim most tax penalty exemptions on your tax return, and premium subsidies are only available for plans sold on the government marketplace.

Your browser is out of date. Please update your browser at http://update.microsoft.com