Hello, im ray suarez. In the autumn it looked like the opposition strategy was going to work. A minority of states decided to set up their own Affordable Care act marketplaces so the federal government was going to have to pick up much more of the load. The air was thick with allegations frightening fine print that wasnt in the law. Governors worked hard to make it fail. Oh, yeah, and the main purchase point, the healthcare. Gov website didnt work. The Enrollment Period ran until the end of march, and plenty of analysts felt confident the administrations hoped for enrollees simply would not happen. In the department of health and Human Services started to say quietly maybe 6 million would be enough. Its midapril. The president announced 8 million enrollees and it seemed like a legitimate point in the timeline to stop and ask is it all going to work . I know the American People dont want us spending the next two and a half years refighting the settled political battles of the last five years. Reporter the president came to the White House Briefing room and declared victory on the Affordable Care act, and he told his adversaries that its time to move on. They still cant bring themselves to admit that the Affordable Care act is working. They said no one would sign up. They were wrong about that. They said it would be unaffordable for the country, they were wrong about that. The repealed debate is and should be over. The Affordable Care act is working. Reporter congress is in holiday recess and g. O. P. Leaders have not commented on camera. But when asked if republicans were going to move on, House Speaker john boehner spokesperson said im sure he would like that, given how wildly unpopular it is, and how destructive it has been for millions of americans. President obama trumpeted the numbers. 8 million have now signed up for private insurance in the Health Insurance market place. House majority leader eric cantor responded on twitter writing, i have a question, how many boom care enrollees were previously uninsured. The administration has not released those numbers yet or revealed how many people have paid their first premiums, but the president noted 35 of enrollies are under 35 years old. The question now is whether that is enough Young Healthy people to keep down the overall costs to the expanded risk pool. Before this law added new transparency and competition to the individual market, folks who bought insurance on their own regularly saw double digit increases in their premiums. That was the norm. While we would suspect that premiums will keep rising, as they have for decades, we also know that since the law took effect healthcare spending has risen more slowly than at any time in the past 50 years. Reporter under the aca the main cost to the taxpayer come from federal sub syd i didnts to lower Income Insurance buyers, and from the expansion of medicaid. This week the Nonpartisan Congressional Budget Office reported this year the aca will cost 36 billion. Thats 5 billion less than previous estimates. The projected cost for the next ten years is now 104 billion less than previous forecasts. The president wants to crunch those numbers to prove the aca is working, but he also wants to reframe the political debate. I recognize that their party is going through the stages agreed, the angry, denial, all that stuff. Were not at acceptance yet, but at some point my assumption is that there will be an interesting to figure out how to figure out how to make this work in the best way possible. There were trips and stumbl stumbles, but in the first open Enrollment Period the Affordable Care act reached its goals and surpassed them. Joining us on inside story bill snyder, and in new york, yegeni, and cee cee connolly, with Health Research institute. Cee cee, what needs to be known that isnt known yet in order to start making conclusions about whether the imagined mechanics, the relationship between cost and expenditures cost and revenues are going to work out . One of the most important questions, ray, next up is who are these new customers . And what kind of Health Status are they in . And are they going to come and participate in managing their care . Because that really cuts to the heart of how expensive or not they may be, and this idea of managing the risk pool in insurance. Thats going to have an impact on premiums in the future years. Its very important. We know that many, many of the Health Insurance companies at this very moment are trying to reach out to these new members and get them to take a questionnaire, come in for a physical, provide any sort of insight into what kind of Health Conditions they might have that need to be addressed. Youre a guy who watches the numbers very closely. Now that the Enrollment Period is closed, so we basically have the pool that surers are going to be working with for the rest of the year, is this something that cee cee was just talking about . Are they things that could be known relatively quickly . Or is there some time that this has to percolate before we really know how its working . So im going to disagree with you. We still dont know the full pool for 2014. Even after this open Enrollment Period there could be special Enrollment Periods. So if you lose your job you lose your job base coverage. You can qualify for the next open Enrollment Period. And if you give birth to a kid, you can enroll the kid. But broadly we know who is in the pool. Generally speaking we have some idea. What is unknown is the Health Status. And the 2015 premiums are not going to be based on the Health Status of this pool because insurers wont have enough experience to know. On top of that we have another two years of federal back stop programs transitional reinsurance and the Risk Corridor Program that offset some losses. They help insurers deal with highcost patients. My best guess after 2016 and 2017 is really one were going to be able to see what the law is going to look like going forward, what kind of people it will attract. You heard cee cee mention that we have to learn more about who these people are and what their Health Status is. A lot of attention has gone to younger enroll yeses. Part of that is because we use health and youth as proxies for each other. Is that strictly speaking a good idea . So strictly speaking absolutely not. Ideally you would want to know the full Health Status, the full risk score in insurance speak of every individual that youre signing up, but its illegal for insurers to ask these questions at the point of sign up, so right now there is no other way to do it but to base it on peoples ages. We try to account for differences between counties. So there is a little bit more leeway, but the best thing insurers can do is enroll people and then hope that they get a good milk, and then manage any chronic condition that they find. The possibility that a lot people who did decide to enroll are people who did have chronic conditions or underlying Agency Problems while the socalled invincibles stayed out of the market praise . Sure. Thats why theyre trying to do as much as they can to get those folks to participate. Most of those can be well managed. Its a matter of getting them in a care team, if you will, to start doing the right things in terms of diet, exercise, having your proper medications. That sort of thing. This is brand new terrain. I do agree, it will take a few years. Its hard, im a former journalist, and i know we want to know everything right about now, but this is a big dramatic change in our insurance world. We havent mentioned there are a lot of people, probably 5 million, who have purchased off the exchanges. Theyll come into these risk pools as well. At the same time a lot of employers are making changes in their benefits packages. There are so many moving pieces to this right now it will take a few years to kind of settle it down into place. Apart from the policy wonk discussion, bill snyder, is there power of anecdote . This has been a very unpopular law in a lot of circles. But does that start to get chipped away at now that weve sort of ended the battle . Youve got the 8 million enrollments, and people are where they are. Is this a time where people didnt have Health Insurance before might start to soften themselves even in the face of the mandate which has been so unpopular. The anecdote is very important. Cee cee was a journalist. Im a journalist. Well say, put a face on this story. Get the human interest. The government has done a good job of telling the story of people who lost their Health Insurance or those who have to pay more for their insurance, theyre getting more for their insurance but they dont say that. The democrats have to come out with those who say for years i didnt have coverage. I was depressed because i had a condition, i didnt have insurance policy, but now i have it and now i feel better. Those people have to be pro rated out, featured, and democrats have not done as good of a job at that as republicans. Arent there a lot of people with 25yearold kids, people who were locked in jobs because of preexisting conditions and couldnt change employment because they couldnt change insurers. You start to add those people up and its a lot of people. Its a lot of people we got to hear from them we got to have a face. We dont want numbers. We want a face. We want stories. Every news feature there has got to be a story. We need stories of peoples experiences on one side of the people who are welcoming the new healthcare law to match the stories of people who say i lost my Health Insurance, and now its costing more. Were going to take a short break. When we come back well talk about how this thing rolls out in the medium term. Are there hidden time bombs waiting down the road . This is inside story. Every saturday, join us for exclusive, revealing, and surprising talks with the most interesting people of our time. Everywhere i go there they are wanting to tell dr. Jane what their doing. The inspirational dr. Jane goodall talks to john seganthaller i started with a notebook, and a pair of secondhand binoculars. Which was all i could afford. And reveals the remarkable human nature of chimpanzees. They have a dark side, and that made them more like us than i had thought before. Talk to al jazeera only on Al Jazeera America results of analyses were skewed in favor of the prosecution the fbi cant force the states to look at those cases the truth will set you free yeah. Dont kid yourself the system has failed me welcome back to inside story. Im ray suarez. On this edition of the program were talking about the Affordable Care act. The enrollment phase for 2014 is over. Heres what we know. 8 Million People signed up. 35 of them are 35 and younger. Heres what we dont know. How many people have paid their premiums. How many of the 8 million are being insured for the first time. Despite those Unanswered Questions president obama said the aca is working, and politically its time to move on. As part of the problem with the rollout of the Affordable Care act that we were doing something difficult, asking millions of people to buy something that many of them had never actively shopped for before. In the last couple of weeks there was a rand study that came out that showed when people were asked to compare the impacts of Different Levels of deductible they first had to find out what a deductible was. You know, we built this edifice of Health Insurance that people have never had to really understand a lot of elements of their Health Coverage when they get it from their employer. They dont understand what deductibles are. They few Health Insurance as being relatively free. Thats a massive obstacle to selling the Affordable Care act to people who may have never had insurance before. They never needed insurance, they dont think they do. Or people who have been on a sponsored coverage before, they no longer have it, and now theyre out in the wild. Its extremely difficult, and im not sure that we have surpassed that obstacle yet. Is that cycle when you compare this to people buying other goods and services that it gets better over time . Will people be better consumers, better shoppers in 2016 and 2017 than they are today . I hope so. I think part of that is going to have toit will have to do with what kinds of plans are being offered. Right now the plans are difficult to decipher because they use tight network management. They have very limited forme formularies. If they still remain as narrow as they are as tightly managed, then its going to take longer for people to learn how to deal with this new type of product. Two thoughts on that. Yes, i think they will become better shoppers. But much more importantly we believe that the Health Industry will become more consumer friendly and consumer centered. Theyll change the language to become more accessible, but youll be able to go on online places and look at Comparison Shopping looking apples to apples. Just as we had seen in the airline industry, the hotels. Think about going to the bank on friday to have cash on the weekend. Now im paying my bills and moving money around. Those sorts of changes are finally belatedly come together healthcare industry. So this is a remarkable transformation that is only a little bit about the law, and its about many other Market Forces taking place. Peoples anxieties, bill, must only have been fed by the difficulties with doing that sign on. It must have only made the down stream political problems worse. It did. It was very dismaying for the administration when the roll out proved to be such a catastrophe. A lot of americans did not like the plan because of one thing, the mandate. They liked Everything Else in the plan, but they didnt like the mandate. They didnt like the government telling them they have to buy something. They have to buy Health Insurance. President obama was not for the mandate in 2008. Hillary clinton was, but he had to embrace it. Thats what people dont like. Even if its working they are still going to be suspicious. The opposition to the Affordable Care act is ideology among people who think that the act is wrong. Its wrong because its too much big government. Ideologues believe if its wrong it cant work. Even if it does work they wont be convinced by this. I would never imply that youre an ideologue, but you know some. Maybe you can take us a little bit into the mind of people who are predicted they would never get to 6 million now they are at 8 million. There are opponents to the act even though its up, run, and for better or worse, its in operation. I appreciate the compliment, actually. I was one of these people who did who did say that the 6 million figure was going to be difficult to reach. I was wrong. Im big enough to admit that. I think the reason why there is so much opposition there is this platform that many republicans ran on to get elected. They ran against obamacare. And i think after these midterm elections that are coming out in november, after then were going to start seeing republicans start to shift away from repeal to replace strategies that are more focused on fixing the law, deregulating it. Theyre going to critique the law. Thats going to be a big part of the platform, but its going to be more constructive critiques. I think were going to see changes down the pike sometime after the midterm elections. You can only oppose the law for so long. Eventually youll have to accept that it is law whether or not you like it. Remember the surge in iraq, that worked. John mccain argued until he was blue in the face that the surge passfied iraq, and you know what that meant . The critics didnt believe it one bit. They continued to say that it is wrong even know th even though s working. Well talk about the law that is not well understood by the public and what it means about the Affordable Care act and for up coming elections. Aljazeera america presents a break through Television Event borderland. Are you tellin me its ok to just open the border, and let em all run in . The teams live through the hardships that forced mira, omar and claudette into the desert. Running away is not the answer. Is a chance at a better life worth leaving loved ones behind . Did omar get a chance to tell you goodbye before he left . Which side of the fence are you on . Sometimes immigration is the only alternative people have. Borderland only on Al Jazeera America welcome back to inside story. Im ray suarez. Problem said the Affordable Care act is working. He remembered republicans to drop it as a political issue while acknowledging the law cant fix all the problems in our healthcare system. The president talked of his recent trip to the lbj library and said back in the 60 60s pee were skeptical of medicare for years until people realized it helped lift seniors out of poverty. With us bill snyder, in new york,