TIME Healthcare

Nonprofit Hospitals Seize Low-Income Patients’ Wages

An investigation reveals the ongoing struggles of people too poor to afford health insurance but no poor enough to qualify for Medicaid

Many hospitals in the U.S. receive tax breaks in exchange for the community service of providing care to those who cannot afford to pay. But hospitals in at least five states employ aggressive debt collectors to garnish the wages of low-income patients with unpaid debts, a ProPublica/NPR investigation revealed Friday.

Hospitals in Kansas, Oklahoma, Nebraska, Alabama and Missouri pass debts along to for-profit collection agencies. People affected tend to be those who earn too much to qualify for assistance in states that rejected the Medicaid expansion in President Barack Obama’s health care law, but not enough to purchase health care on their own. The cost of health care services for the uninsured tend to be significantly higher than for people with health insurance.

Read more at ProPublica

MONEY Health Care

Why Getting Mental-Health Coverage Can Be So Tough

Despite rules mandating better insurance benefits, finding care remains a challenge, a new 50-state report concludes.

Even though more Americans have access to health insurance because of the health law, getting access to mental health services can still be challenging.

A new report concludes that despite the 2008 mental health parity law, some state exchange health plans may still have a way to go to even the playing field between mental and physical benefits. The report, released by the advocacy group Mental Health America, was paid for by Takeda Pharmaceuticals U.S.A. and Lundbeck U.S.A, a pharmaceutical company that specializes in neurology and psychiatric treatments.

The report listed the states with the lowest prevalence of mental illness and the highest rates of access to care as Massachusetts, Vermont, Maine, North Dakota, and Delaware. Those with the highest prevalence of mental illness and most limited access are Arizona, Mississippi, Nevada, Washington, and Louisiana.

Among its other findings:

•42.5 million of adults in America, 18.19%, suffer from a mental health issue.

•19.7 million, or 8.46%, have a substance abuse problem.

•8.8 million, or 3.77% of Americans have reported serious thoughts of suicide.

•The highest rates of emotional, behavioral or developmental issues among young people occur just west of the Appalachian Mountains, where poverty and social inequality are pervasive.

Part of MHA’s examination focused on the exchange market and its essential health benefit requirements that guided 2014 coverage. The group found that, while information provided through plans’ “explanation of benefits” might show that there aren’t limits on mental health coverage, limitations including treatment caps and other barriers still exist.

“Parity is in its infancy. Most plans know the numerical requirements around cost-sharing, but few have taken seriously the requirements around equity—around access through networks and barriers to care through prior authorization,” said Mike Thompson, health care practice leader at PricewaterhouseCoopers. “And, in practice, we have a history of imposing much more stringent medical necessity standards on mental health care than other health care.”

However, Susan Pisano, vice president of communications for America’s Health Insurance Plans, an insurance trade group, said the report doesn’t reflect the fact that many health plans have rolling renewals. That means the plans have until Jan. 1, 2015, to fully comply with the parity law.

“Our members are committed to mental health parity, and we’re supportive of legislation, and what isn’t apparent is that benchmark plans represented a snapshot in time … so that doesn’t give us the full picture,” Pisano said. “Our plans have really been working to get in compliance.”

Chuck Ingoglia, senior vice president of public policy at the National Council for Behavioral Health, a Washington-based trade group for community mental health and substance use treatment organizations, said the report’s findings aren’t surprising — though they are troubling. Implementation of the parity law remains a work in progress, he said.

“The law is based on a sound policy premise — that addiction and mental health treatment decisions and management should be comparable to physical health conditions,” he said. “But this also creates a tremendous barrier to proving violations as it requires a consumer to obtain access to plan documents for both types of care, which is frequently handled by different plans,” Ingoglia said.

In addition, the report found that some plans didn’t set out what and how many services were covered. That means consumers would only find out a treatment wouldn’t be paid for by their insurer after they’d already received care.

Americans with mental disorders have the lowest rates of health insurance coverage, so obtaining insurance is a good first step, according to Al Guida, a Washington, D.C.-based lobbyist who works on mental health issues with Guide Consulting Services. But the only way a denial can be reversed is through an appeal, which can be a long and arduous process.

“The vast majority of insurance plans offered on Affordable Care Act federal and state exchanges have close to no transparency, which could lead to abrupt changes in both mental health providers and psychotropic drug regimens with the potential for serious clinical consequences,” Guida said.

Meanwhile, there is a shortage of mental health care professionals—nationally there is only one provider for every 790 people, according to the report.

All of these factors can cause minor mental illnesses to grow more severe, according to Mental Health America CEO Paul Gionfriddo.

He suggested that mental illness should be screened for and covered in the same way cancer, kidney disease, and other illnesses are.

“Right now we’re trapped in a stage where we wait for a crisis, when they’re in advanced stages and then we treat it, and we wonder why it’s so hard to treat it more cheaply,” Giofriddo said.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

5 Things You Need to Know for Today’s Health Care Coverage Deadline

Today is the deadline to buy individual health insurance if you want to have coverage on Jan. 1.

Since open enrollment began on Nov. 15, almost 1.4 million people have signed up for health coverage through the federal insurance exchange, and another 183,000 through state exchanges. With nearly 7 million people already participating, signups are on pace to meet the government’s projection of 9 million enrollees in 2015, according to the Kaiser Family Foundation.

If you’re one of the many who still need to enroll for 2015 coverage, here are five keys things you need to know before you visit your state’s health exchange website.

1. If you want health insurance on Jan. 1, you must enroll today. You still have until Feb. 15 to buy a 2015 plan, but you will have a gap in coverage if you enroll after today’s deadline. Coverage begins on Feb. 1 for people who enroll between Jan. 1 and Jan. 15. Sign up between Jan. 16 and the end of the month, and coverage won’t begin until March 1.

2. Some states are giving you more time and extending the deadline to get coverage by Jan. 1. For example, New York and Idaho’s exchanges will allow users to sign up until Dec. 20. To find out whether you’re eligible for an extension, visit your state’s marketplace exchange website through healthcare.gov.

3. You’ll be automatically re-enrolled if you bought on an exchange last year and do not renew coverage by today. If the health plan you signed up for is no longer offered, insurers can automatically enroll you in another policy similar to the one you have now. But you can opt out of any plan you’re automatically enrolled in and choose another up until Feb. 15.

4. Skip automatic enrollment and shop again, even if you liked your 2014 policy. The Department of Health and Human Services found that more than 70% of people who currently have insurance through the health law’s federal online marketplace could pay less for comparable coverage if they are willing to switch plans.

5. Costs have changed. Many plans will have out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health. But the tradeoff for those lower maximums may be a higher deductible, so be sure to pay attention to both figures when choosing your plan. You can also expect to see your premium change. Depending on where you live, that may be a good or bad thing. The premium for the second-lowest-cost silver plan in Nashville jumped 8.7%, while it dropped 15.6% in Denver, according to a study by the Kaiser Family Foundation.

TIME politics

How Obama Bungled Obamacare’s Success Stories

The president's health care plan has saved many lives. So why hasn't he told us about them?

By now, there are thousands of people who can make Barack Obama and the Democrats’ case for the Affordable Care Act. Across the nation, there must be countless tales of Americans who would be broke and broken were it not for Obamacare. They have to exist in all walks of life, in every state, of all political persuasions.

And yet this week, as Monday’s deadline approached for signing up for 2015 health plans, none of those people appeared as part of the pitch. The most frequently aired TV ad features a racially diverse cast of young people speaking in generalities about how their Obamacare plans provided “peace of mind” at a surprisingly low, low price. These folks, none of whom seem to have been sick, gush about the heckuva deal they got and how happy it makes them.

But why? Why is America still being asked to take it on faith that the ACA is a social and moral good? Why does the Obama Administration continue, even after these many years of largely unanswered attacks by Republican opponents, with a failed marketing effort that amounts to, “Trust us! You’ll love it!”

Here’s the ACA ad they should make: a grizzled, Duck Dynasty-like Alabaman stands outside a neonatal intensive care unit. “I was against Obamacare,” he tells the camera. “I sure didn’t vote for Obama, either. And, man, I liked my health plan, wanted to keep it. When I found out I couldn’t, boy was I pissed.” The camera pans to a wriggling baby, tubes everywhere, the man’s wife gazing longingly into the incubator holding their child. “Then my daughter was born, and she almost died,” he says, choking up a little. “My old plan wouldn’t have covered this. We would’ve lost the house, probably would’ve had to go bankrupt. It’s all still pretty dang expensive, I can’t lie. But my Obamacare coverage really saved us. Thanks, Obamacare!”

You think that’s some liberal, nanny-state fever dream? It’s not. This is not conjecture; it is a statistical certainty based on all the data used by insurance carriers to set rates. A certain chunk of the 8 million people who signed on to Obamacare plans – or the millions more whose existing plans were bolstered to comply with the ACA – suffered health catastrophes in 2014. Many opposed the law and were angry when Obama’s “like it, keep it” promise was broken. But without the reform that required comprehensive plans and eliminated rejections of coverage based on pre-existing conditions, many would have met the same fate of so many in recent decades.

That is, lest anyone forget, how it was. Obama, strangely, really never told those stories back then, either. In 2009, when he stood before a joint session of Congress to make his case for health insurance reform, the political genius who campaigned in 2008 with such art and eloquence failed to use the moment to introduce skeptics to a parade of average, hard-working Americans who endured the all-too-common financial devastation of a serious illness. Can’t you see those people, their wheelchairs and colostomy bags and adorable kids, festooning the dais as Obama made his case? How could a purported Judeo-Christian nation see those faces and hear those stories and not agree that something had to change? Instead, the president gave a boring, wonky speech that nobody remembers, a teaser for the incompetent public relations effort to come.

And there they go again. The current marketing effort also failed to appeal to anyone’s emotions or sense of justice. Rather, it insisted that having good insurance makes you feel good about yourself the way, say, eating tofu or reading Tolstoy might. Perhaps Obama once had to rely on unproven predictions, but that ended on Jan. 1, 2014. Since then, ACA supporters have had their pick of uplifting stories of tragedy averted by this law.

Rep. Jan Schakowsky, D-Ill., knows this. Last month, in a Chicago Sun-Times essay, she cited several specific cases of ACA success. Cancer-stricken David Price, for instance, saved $4,000 this year on his meds versus 2013. Gary Wood, bankrupted 18 years ago by the cost of care from a heart attack and then shut out of coverage ever since, underwent a life-saving quintuple bypass in 2014 paid for by the Obamacare Medicaid expansion. And so on. It’s not hard to find these people. They’re everywhere, even in the deepest red of states.

The gang behind this year’s campaign offered up just one limp trick: rebranding. The TV ad, for instance, opens with a woman who says, “Healthcare.gov allows me to continue on with my life.” In other words, it’s not Obamacare. It’s not even the ACA. It’s now just “healthcare-dot-gov,” as if that’s a policy or a government program rather than a place on the Internet. Given that the rollout of the website was among the biggest PR disasters of any sort in recent history, it’s an odd and ineffectual choice.

Stop being so cute. This is really, really easy; just tell the story. It goes like this: Obamacare has successes. It has already saved many Americans from financial doom. It has improved the health care of millions. It has given many entrepreneurs the courage to quit jobs they hated and start new businesses. Here, meet some of these folks. They’re just like you. You could be next.

The evidence is now on Obama’s side. It is mystifying that he doesn’t seem to know it.

Steve Friess is an Ann Arbor, Mich.-based freelance writer and former senior writer covering technology for Politico.

MONEY Health Care

The Key Numbers to Look for When You’re Picking a Health Plan

pill bottle with numbered pills around it
Tim Robberts—Getty Images

Monday is the deadline to buy insurance if you want it on January 1. But don't shop solely on the premium. A new study finds that many exchange-sold plans have lower-than-expected out-of-pocket caps, a boon for some health care consumers. But deductibles are up.

Consumers shopping on the health insurance marketplaces will find many plans with out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health.

Seventy-four percent of 2015 silver level plans’ out-of-pocket spending caps are below the $6,600 spending limit allowed for individual plans and $13,200 maximum for family plans, according to Avalere, a consulting firm. The average out-of-pocket maximum for 2015 individual silver plans will be $5,853, says Caroline Pearson, a vice president at Avalere. Silver was the most popular plan type this year, selected by about two-thirds of enrollees.

After a policyholder reaches the out-of-pocket spending limit during the year, the insurer pays all the bills, unless, for example, they involve doctors and hospitals not in the health plan’s network.

The vast majority of other plans also feature lower limits on out-of-pocket spending—which includes deductibles, copayments, and co-insurance, but not premiums. Seventy-one percent of bronze plan spending limits were below the allowed maximum (with an average spending limit for single coverage of $6,381), as were 94% of gold plans (average limit, $4,458) and 98% of platinum plans (average limit, $2,145).

Avalere said the average spending limits for single coverage were in most cases close to those for 2014 plans: bronze ($6,330); silver ($5,877); gold ($4,443) and platinum, $2,795.

Avalere’s analysis included plans sold on the federal marketplace that serves 37 states, as well as data from the California and New York state marketplaces. Consumers have until Feb. 15 to enroll.

The tradeoff for lower out-of-pocket spending maximums may be a higher deductible, says Pearson. The average deductible for silver plans will increase 7% in 2015, to $2,658. Other metal-level average plan deductibles are increasing as well.

Higher deductibles are likely helping keep premiums low, and low premiums are what consumers are looking for, Pearson says.

For people who are generally healthy, a lower premium may be more attractive than a lower deductible. They’re never going to meet their deductible anyway, so they’d prefer to save on monthly premiums.

But for people with chronic conditions, “the lower out-of-pocket maximum helps you because you’re going to exceed your deductible no matter what,” says Pearson.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Innovation

Five Best Ideas of the Day: December 11

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. A rule in the Affordable Care Act could make hospitals safer.

By Mike Corones at Reuters

2. As U.S. influence in the Middle East wanes, the United Arab Emirates is stepping up.

By Steven A. Cook in the Octavian Report

3. How do you extend banking services to an industry that’s illegal under federal law? Colorado’s answer is a credit union for pot growers and sellers.

By David Migoya in the Denver Post

4. A simple step — lighting pathways to latrines and latrines themselves in rural areas — can improve safety for women and girls.

By Dr. Michelle Hynes and Dr. Michelle Dynes at Centers for Disease Control and Prevention

5. The International Olympic Committee vote to protect gay athletes is an important first step, but more work remains.

By Laura Clise in the Advocate

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME politics

Obamacare Turned Our Health Insurance Into a Game of Musical Chairs

medical chart
Getty Images

A year of major illnesses and expenses has our family changing doctors and health plans

At the exact moment President-elect Barack Obama proclaimed that “change has come to America,” I stood at the foot of my husband’s bed in the cardiac ICU of Mission Hospital in Mission Viejo. I was praying. Jim lay, with a ventilator tube down his throat, recovering from open-heart surgery to replace a congenitally defective aortic valve.

I was elated — for his survival, for Obama’s victory. I looked forward to one of Obama’s major campaign promises: to provide national healthcare reform so Americans with a pre-existing condition could get insurance Since his heart diagnosis in 2005, Jim, who probably couldn’t have found a policy as an individual because of his condition, had been covered by small-business group insurance — because his self-storage business in Banning had one other employee. But his work, and his coverage, were always subject to change.

I remained vulnerable as a freelance writer and part-time university professor who had to pay for her own health insurance. I also had had a few recent health hiccups, including a surgery to repair a herniated disk from spinal degeneration, and so I lived with the daily realization that one bit of bad health news could cause my policy to be canceled.

As it happened, the 2008 election was the first time Jim and I were bitterly divided on candidates. Jim foresaw healthcare reform as an addition to the federal deficit more worrisome than any health benefit. When I told my husband about Obama’s victory in the hospital, he grumbled, “I guess I can’t blame Obama for breaking my heart.” But, he worried that he would eventually be able to blame the president “for keeping me from getting better.”

The transition to Obamacare — at least for a 59-year-old man and a 56-year-old woman in south Orange County — wouldn’t be quite that bad. But it would be, in three big ways, far rougher and more frustrating than I’d ever dreamed.

1. Obamacare brought us new health insurance options – but cost us our more affordable plans.

“If you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance — this law will only make it more secure and more affordable,” President Obama promised in 2012.

The fact that this wasn’t true would be our biggest disappointment. In November 2013, Jim learned his small-business policy would be cancelled because it didn’t comply with the new mandate to cover pediatric dentistry and maternity care. So Jim went to Covered California, the state’s health insurance exchange, to look for coverage for his employee and himself.

He found that the cost of his employee’s individual “bronze” plan monthly premiums went up 13 percent , and that his own new individual “silver” plan was also more expensive. In 2014, Jim was individually paying $82 more a month in premiums. The deductible (the amount you have to pay before the insurance company starts footing the bill) did go down — from $5,000 to $2,000 for each individual insured. But if you added together 12 months of premiums, the deductible, and the new policies’ out-of-pocket maximums, we were potentially on the hook for $13,260 — rather than the $11,024 from 2013 — if Jim got very sick. Around this time, Jim was diagnosed with prostate cancer, so the threat of high medical bills was real.

The individual plan I had with Blue Cross was cancelled, too. The bronze plan I got at Covered California raised my monthly premium payment from $301 to $422, with a $5,000 deductible. The maximum I might be responsible for if I got really sick went from $8,612 to $11,314.

2. We learned patience, but we couldn’t keep our doctors.

The only way to decrease the cost of our premiums was to get the subsidy offered by the federal government to lower- and middle-income people. And the only way to get the subsidy was by getting insurance through Covered California. But contacting Covered California, especially by phone, was maddening. The elevator music they played on hold became our winter soundtrack.

We had applied online and sent copies of our passports to California Covered for verification, but we received no bill, no confirmation of our coverage, no insurance cards. Jim spent an hour and a half on hold once before getting disconnected. He tried again the next day, waiting another two hours before getting disconnected.

After a few more calls, Jim drove to a pop-up Covered California shop in the Laguna Hills Mall on Jan. 15, 2014, the deadline for adding coverage. He hoped to avoid website computer glitches and phone hang-ups. All we had were verbal assurances — not enough to see the cardiologist and a urologist at the insurance-negotiated rate. Receptionists at the doctors’ offices said we could pay cash — $150 per visit for the urologist; $203 for the cardiologist, plus lab and treatment expenses.

On Jan. 22, we finally got our enrollment number and made our first payment to Blue Cross so we could start seeing doctors. Jim finally went to his cardiologist on Feb. 10, only to discover the doctor had left Blue Cross.

Thus began a session of musical chairs as we tried to match our insurance to the doctors we wanted to see before the music stopped. This was one time we had the advantage over an employer-sponsored health plan, which has only one open enrollment period in a year. Due to the start-up problems with state insurance exchanges, the deadline for Affordable Care Act insurance kept being pushed back, allowing us to change coverage twice.

We canceled Blue Cross and enrolled in Blue Shield so Jim could see his urologist. Then, when the urologist’s office said they didn’t accept Blue Shield patients enrolled through the state exchange, we canceled California Covered Blue Shield and bought directly from the insurance company, even though that meant foregoing the subsidies.

But the urologist wouldn’t accept our new Blue Shield plan — even though the Blue Shield website said he did. Jim’s regular dermatologist left Blue Shield, too.

In each case, the doctor’s office said the reimbursements for the insurance we had were too low. In each case, the receptionists chirped, “We’re happy to make you a cash patient.”

Eventually, we requested records and sought new doctors. Although we read frequent reports of patients unable to find physicians willing to take new patients, in our case Jim found a new urologist he liked better than the old.

3. The Affordable Care Act saved us money this year, but it didn’t alleviate our concerns about obtaining affordable medical care.

Jim treated his prostate cancer with radiation, and received his recommended echocardiogram and MRI. So in 2014, we paid the maximum out-of-pocket expense and the insurance company covered the rest. Tallying his medical costs, Jim said, “I take back what I said. Obamacare did help me get better.”

I’m well below my annual deductible. I baby my back, neck, knees, and hip degeneration with regular walking, yoga, and acupuncture. I’ve benefited from regular $28 acupuncture treatments, something that wasn’t covered in my old plan. But my licensed acupuncturist hasn’t received any reimbursement yet. It’s also harder for her to make a living — the insurance company cut her pay by 25 percent.

What Obamacare hasn’t eliminated is worry: We’re deeply concerned about our ability to get quality medical care from doctors we trust. The day may soon come when we can’t afford the plans our doctors accept, or we’ll have to wait hours to seen. Will the best doctors flock to a cash-only model? How long can a good doctor be satisfied with the $39.75 the insurance company paid her for my annual check up a few months ago?

We had thought that our work and businesses had paid us enough to live on in these older years — but we’re discovering we didn’t account for such dramatic increases in health care costs. Medical expenses already gobble up 20 percent of our income. In 2015, if we keep the same plans, our premiums will rise $95 a month. We have no choice to opt out of the required pediatric dentistry or maternity coverage we’ll never use, so we’ll eventually have to settle for less generous policies, with higher deductibles and out-of-pocket maximums. My husband isn’t required by law to insure his one employee, though he feels it’s the right thing to do. As costs continue to rise, we may have direct him to buy his own health insurance at his own cost.

We’ve already started the dance of enrollment all over again and are having a hard time finding partners. As I write this, the “Find a Provider” link on the Covered California website offers 2014 health providers, but not 2015, even though we’re shopping for 2015 insurance policies. Ditto Blue Shield. Administrators at our medical group won’t say yet if they’ll remain with Blue Shield. At least this year we think we know the steps to the dance. Let the music begin.

Catherine Keefe is an essayist, poet, editor, and writing instructor at Chapman University in Orange, California. She wrote this for Zocalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

MONEY Health Care

Act Fast to Get Health Insurance for Next Year—But Not Too Fast

pill bottles with money in them
Adrianna Williams—Getty Images

The deadline for buying individual health insurance for 2015 is days away. If you got a policy on an exchange last year, don't just automatically renew. With new insurers in the marketplace, you could save by taking the time to compare plans.

More than 70% of people who currently have insurance through the health law’s federal online marketplace could pay less for comparable coverage if they are willing to switch plans, officials said last week.

With a Dec. 15 deadline looming for coverage that would begin Jan. 1, current policy holders should come back to healthcare.gov to see if they can get a better deal, the officials said. They’ll find more plans available and nearly 8 in 10 current enrollees can find coverage for $100 or less a month, with subsidies covering the rest of the cost.

A Department of Health and Human Services analysis of 2015 individual market premium data for 35 of the states participating in the federal marketplace, or exchange, found that premiums for the lowest-cost silver plans will increase on average by 5%, while prices will increase on average by 2% for the second-lowest-cost silver plans, which is called the benchmark plan because subsidy levels are pegged to its cost. “The plans offering the lowest prices have sometimes changed from 2014 to 2015, so consumers should shop around to find the plan that best meets their needs and budget,” the report advises.

If they stay in their current plan, consumers may discover that their subsidy may not go as far if the price of the benchmark plan declined for 2015. “We strongly, strongly encourage people to come back to the website and shop,” marketplace CEO Kevin Counihan told reporters during a press call. Federal marketplace enrollees who do not switch plans by Dec. 15 will be automatically re-enrolled in their current coverage.

Those who don’t switch plans might see higher prices. “For the vast majority of people, if they stay in the same plan, I think they’ll see rate increases in the single digits to high single digits,” said Andy Slavitt, CMS principal deputy administrator. “That’s not going to be true for every individual. Some will go down, some will go up a little bit higher.”

The number of companies offering policies for next year has increased by 25%. Consumers can choose from an average of 40 plans for 2015, up from 30 in 2014, based on the HHS analysis, which examined plan rates at the county level.

Consumers have until Feb. 15 to enroll for coverage in 2015, the marketplace’s second year.

The HHS analysis, mirroring other reviews of 2015 premiums, shows that what consumers pay for coverage depends on where they live. In Juneau, Alaska, for example, a 27-year-old enrolled in the second-lowest-cost silver plan would pay $449 per month for coverage in 2015 before tax credits, a 34% increase from 2014. In Jackson, Miss., that same level of coverage would cost $253, or 24% less than $332 charged in 2014.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Healthcare

Obamacare Economist Apologizes to Congress for ‘Glib’ Comments

The MIT economist had come under fire for controversial statements on the Affordable Care Act

Jonathan Gruber, the healthcare economist whose controversial comments about Obamacare have drawn fierce criticism in recent weeks, apologized Tuesday while under harsh interrogation by House Republicans.

“I’m a professor of economics at MIT. I’m not a politician or a political adviser,” Gruber said in his opening statement before the House Oversight and Government Reform Committee. He apologized for statements he called “glib, thoughtless and sometimes downright insulting.”

Gruber, and supporters of the Affordable Care Act in general, came under fire last month after video clips surfaced of the economist suggesting the ACA was passed in a way intended to confuse the public. “Lack of transparency is a huge political advantage. Call it the stupidity of the American voter, or whatever,” he said.

“I knew better, I know better, I’m embarrassed and I’m sorry,” Gruber said Tuesday. He insisted his comments were taken out of context and reflect a personal failing that should not reflect on the substance of the healthcare reform measure. “I behaved badly and I’ll have to live with that but my own inexcusable arrogance is not a flaw in the Affordable Care Act,” he said.

Committee Republicans leveled a harsh and sometimes insulting interrogation against Gruber.

“Are you stupid?” Committee Chairman Darrel Issa asked Gruber in his opening remarks. Issa questioned whether Gruber’s comments reflect substantive problems with the ACA and closed with a call for an independent audit of Gruber’s complex simulation model on the effect Obamacare would have on the cost of obtaining insurance, which was widely cited in debate over the ACA.

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