WASHINGTON (AP) — Now is when Americans start figuring out that President Barack Obama's health care law goes beyond political talk, and really does affect them and people they know.
With a cranky federal website complicating access to new coverage and some consumers being notified their existing plans are going away, the potential for winners and losers is creating anxiety and confusion.
"I've had questions like, 'Are they going to put me in jail if I don't buy insurance? Because nobody will sell it to me,'" said Bonnie Burns, a longtime community-level insurance counselor from California. "We have family members who are violently opposed to 'Obamacare' and they are on Medicaid — they don't understand that they're already covered by taxpayer benefits.
"And then there is a young man with lupus who would have never been insurable," Burns continued. "He is on his parents' plan, and he'll be able to buy his own coverage. They are very relieved."
A poll just out from the nonpartisan Kaiser Family Foundation documents shifts in the country in the month since insurance sign-ups began.
Fifty-five percent now say they have enough information to understand the law's impact on their family, up 8 percentage points in just one month. Part of the reason is that advertising about how to get coverage is beginning to register.
"The law is getting more and more real for people," said Drew Altman, the foundation's president. "A lot of this will turn on whether there's a perception that there have been more winners than losers. ... It's not whether an expert thinks something is a better insurance policy, it's whether people perceive it that way."
The administration is continuing its efforts to influence those perceptions. On Wednesday, Obama will meet with volunteers in Dallas who are helping people enroll in health insurance plans. Cabinet officials are also expected to make stops around the country in the coming weeks to encourage people to sign up for insurance even as the website problems persist.
A look at three groups impacted by the law's rollout:
LOSING CURRENT PLAN
The Obama administration insists nobody will lose coverage as a result of cancellation notices going out to millions of people. At least 3.5 million Americans have been issued cancellations, but the exact number is unclear. Associated Press checks find that data is unavailable in a half the states.
Mainly they are people who buy directly from an insurer, instead of having workplace coverage. Officials say these consumers aren't getting "canceled" but "transitioned" or "migrated" to better plans because their current coverage doesn't meet minimum standards. They won't have to go uninsured, and some could save a lot if they qualify for the law's tax credits.
Speaking in Boston's historic Faneuil Hall this past week, Obama said the problem is limited to fewer than 5 percent of Americans "who've got cut-rate plans that don't offer real financial protection in the event of a serious illness or an accident."
But in a nation of more than 300 million, 5 percent is a big number — about 15 million people. Among them are Ian and Sara Hodge of Lancaster, Pa., in their early 60s and paying $1,041 a month for a policy.
After insurer Highmark Inc., sent the Hodges a cancellation notice, the cheapest rate they say they've been able to find is $1,400 for a comparable plan. Ian is worried they may not qualify for tax credits and doesn't trust that the federal website is secure enough to enter personal financial information in order to find out.
"We feel like we're being punished for doing the right thing," he said.
Their policy may not have met the government's standards, "but it certainly met our minimum standards," Hodge added.
"The main thing that upsets us is the president ... said over and over and over again: If you like your health plan, you will be able to keep your health plan, guaranteed."
There's a chance the number of people getting unwanted terminations may grow. In 2015, the law's requirement that larger companies provide health insurance will take effect. It's expected that a small share of firms will drop coverage, deciding that it's cheaper to pay fines imposed under the law.
Before the law's online health care markets launched Oct. 1, the administration estimated nearly 500,000 people would enroll for subsidized private insurance within the first month. Despite high consumer interest, a computer system beset by gremlins has kept most from doing so.
The administration refuses to release enrollment numbers until mid-November, when a crash program of computer fixes may be showing results. The numbers are expected to be disappointingly low; officials acknowledge as much.
A different prong of Obama's coverage expansion seems to be doing fairly well. It's an expanded version of Medicaid, embraced so far by 25 states and the District of Columbia. An informal survey of 14 of those states by The Associated Press shows that at least 240,000 people had enrolled in or applied for the expanded safety-net program as of the third week of October.
Private coverage is what interests Cecilia Fontenot of Houston, a part-time accountant in her early 60s. She has diabetes, high blood pressure and high cholesterol. Though she manages well, she has been unable to find affordable insurance. Under Obama's law, insurers will not be able to turn away people with medical problems or charge them more.
Fontenot gave up on HealthCare.gov and instead applied through a call center on Oct. 19.
"They said it may take a while because so many people had called in," Fontenot explained. "I'm a very patient person, and I'm looking forward to getting that insurance."
She wants a plan that covers a better diabetes drug than the one she can afford now by paying out of pocket. Her doctor has also recommended a high-tech imaging test for a breast lump.
WONDERING WHETHER COVERAGE WILL CHANGE
Americans are still divided over the Affordable Care Act, with negative views outweighing positives. But they also lean against repealing it. The final judgment may be in the hands of people who now have employer-provided health insurance. They're about half the population, and they've noted Obama's assurances that their coverage won't be disrupted.
Up to now, the changes for employer plans have been incremental. They tend to expand benefits, not take things away.
For example, young adults can stay on a parent's coverage until they turn 26. Employers cover women's birth control as a preventive service, free of charge. Screening tests such as colonoscopies are also free.
But cost control provisions, mainly a tax on expensive insurance plans that starts in 2018, are converging with the long-standing push by employers to tame health costs. Some companies have raised deductibles and copayments for employees, saying they need to scale back to avoid tangling with the coming tax. Others are giving employees a fixed amount of money to shop in private health insurance markets that resemble those created by the law.
Expect cutbacks to be blamed on the law. Sorting out whether that's warranted may be difficult.
"What the Affordable Care Act did was give companies a very convenient excuse to say 'Oh, gosh, we really have to get serious about insurance costs,'" said Paul Keckley, an independent health benefits consultant. "I think there's a bit of a bob and weave. The ACA was a convenient excuse for doing what (corporate) human resources departments have been calculating to do for years."
NEW YORK (AP) — From New York's Liberty Island to Alaska's Denali National Park, the U.S. government closed its doors as a bitter budget fight idled hundreds of thousands of federal workers and halted all but the most critical government services for the first time in nearly two decades.
A midnight deadline to avert a shutdown passed amid Congressional bickering, casting in doubt Americans' ability to get government services ranging from federally-backed home loans to supplemental food assistance for children and pregnant women.
For many employees of the federal government, Tuesday's shutdown meant no more paychecks as they were forced onto unpaid furloughs. For those still working, it meant delays in getting paid.
Park Ranger and father-to-be Darquez Smith said he already lives paycheck-to-paycheck while putting himself through college.
"I've got a lot on my plate right now — tuition, my daughter, bills," said Smith, 23, a ranger at Dayton Aviation Heritage National Historical Park in Ohio. "I'm just confused and waiting just like everyone else."
The impact of the shutdown was mixed — immediate and far-reaching for some, annoying but minimal for others.
In Colorado, where flooding killed eight people earlier this month, emergency funds to help rebuild homes and businesses continued to flow — but federal worker furloughs were expected to slow it down.
National Guard soldiers rebuilding washed-out roads would apparently be paid on time — along with the rest of the country's active-duty personnel — under a bill passed hours before the shutdown. Existing Social Security and Medicare benefits, veterans' services and mail delivery were also unaffected.
Other agencies were harder hit — nearly 3,000 Federal Aviation Administration safety inspectors were furloughed along with most of the National Transportation Safety Board's employees, including accident investigators who respond to air crashes, train collisions, pipeline explosions and other accidents.
Almost all of NASA shut down, except for Mission Control in Houston, and national parks closed along with the Smithsonian museums and the National Zoo. Even the zoo's popular panda cam went dark, shut off for the first time since a cub was born there Aug. 23.
As the shutdown loomed Monday, visitors to popular parks made their frustration with elected officials clear.
"There is no good thing going to come out of it," said Chris Fahl, a tourist from Roanoke, Ind., visiting the Abraham Lincoln Birthplace National Historic Park in Hodgenville, Ky. "Taxpayers are just going to be more overburdened."
Emily Enfinger, visiting the Statue of Liberty, said politicians need to find a way to work together.
"They should be willing to compromise, both sides, and it discourages me that they don't seem to be able to do that," she said. "They're not doing their job as far as I'm concerned."
Joe Wentz, a retired federal employee from Lebanon, Va., visiting San Francisco with his wife, bought tickets to visit Alcatraz on Thursday — if it's open.
Wentz said he's frustrated that some politicians are using the budget to push changes in the Affordable Care Act.
"We've been disgusted a long time that they're not working together," he said.
The shutdown was strangely captivating to Marlena Knight, an Australian native visiting Independence National Historical Park in Philadelphia. She was confounded that the impasse focused on the nation's health care system — an indispensable service in her home country.
"We can't imagine not having a national health system," she said. "I just can't believe that this country can shut down over something like a national health system. Totally bizarre, as an Australian, but fascinating."
It turns out an institution as massive as the federal government takes some time to grind to a total halt: Many federal workers were being permitted to come in Tuesday to change voicemail messages or fill out time cards. But after that, they were under strict orders to do no work, even check their email.
With no telling how long the budget standoff will last, even programs not immediately affected could run out of cash.
Barbara Haxton, executive director of the Ohio Head Start Association, said its preschool learning programs would be in jeopardy if a shutdown lasted more than two weeks. March's automatic budget cuts meant nearly 3,000 children lost access to services and there could be dire consequences if the budget standoff drags on.
"It's not as though this is a throwaway service. These are the poorest of the poor children," Haxton said. "And our Congressman still gets his paycheck. His pay doesn't stop and his health insurance doesn't stop."
Associated Press reporters Kathy Matheson in Philadelphia, Joan Lowy in Washington, D.C., Dylan Lovan in Louisville, Ky., Terence Chea in San Francisco and Amanda Lee Myers in Cincinnati contributed to this report.
WASHINGTON (AP) — A conservative challenge to the president's health care law has the federal government teetering on the brink of a partial shutdown.
The Senate has the next move on must-do legislation required to keep the government open past midnight on Monday, and the Democratic-led chamber is expected to reject the latest effort from House Republicans to use a normally routine measure to attack President Barack Obama's signature health care law.
Congress was closed for the day on Sunday after a post-midnight vote in the GOP-run House to delay by a year key parts of the new health care law and repeal a tax on medical devices as the price for avoiding a shutdown. The Senate is slated to convene Monday afternoon just 10 hours before the shutdown deadline, and Majority Leader Harry Reid, D-Nev., has already promised that majority Democrats will kill the House's latest volley.
A House GOP leader, Rep. Kevin McCarthy of California, said the House would again rebuff the Senate's efforts to advance the short-term funding bill as a simple, "clean" measure shorn of anti-heath care reform provisions.
Since the last government shutdown 17 years ago, temporary funding bills known as continuing resolutions have been noncontroversial, with neither party willing to chance a shutdown to achieve legislative goals it couldn't otherwise win. But with health insurance exchanges set to open Tuesday, tea party Republicans are willing to take the risk in their drive to kill the law, so-called "Obamacare."
"You're going to shut down the government if you can't prevent millions of Americans from getting affordable care," said Rep. Chris Van Hollen, D-Md.
A leader of the tea party Republicans, Sen. Ted Cruz, R-Texas, insisted the blame rests with Senate Democrats.
"The House has twice now voted to keep the government open. And if we have a shutdown, it will only be because when the Senate comes back, Harry Reid says, 'I refuse even to talk,'" said Cruz, who led a 21-hour broadside against allowing the temporary funding bill to advance if stripped clean of a tea party-backed provision to derail Obamacare. The effort failed.
The battle started with a House vote to pass the short-term funding bill with a provision that would have eliminated the federal dollars needed to put Obama's health care overhaul into place. The Senate voted along party lines to strip that out and set the measure back to the House.
The latest House bill, passed early Sunday by a near party-line vote of 231-192, sent back to the Senate two major changes: a one-year delay of key provisions of the health insurance law and repeal of a new tax on medical devices that partially funds it. The steps still go too far for the White House and its Democratic allies.
Senate rules often make it difficult to move quickly, but the chamber can act on the House's latest proposals by simply calling them up and killing them.
Eyes were turning to the House for its next move. A senior leader vowed the House would not simply give in to Democrats' demands to pass the Senate's "clean" funding bill.
"The House will get back together in enough time, send another provision not to shut the government down, but to fund it, and it will have a few other options in there for the Senate to look at again," said McCarthy, the No. 3 House Republican leader.
He suggested that House Republicans would try blocking a mandate that individuals buy health insurance or face a tax penalty, saying there might be some Democratic support in the Senate for that.
On the other hand, Democrats said the GOP's bravado may fade as the deadline to avert a shutdown nears.
Asked whether he could vote for a "clean" temporary funding bill, Rep. Raul Labrador, R-Idaho, said he couldn't. But Labrador added, "I think there's enough people in the Republican Party who are willing to do that. And I think that's what you're going to see."
A leading Senate GOP moderate called on her fellow Republicans to back down.
"I disagree with the strategy of linking Obamacare with the continuing functioning of government — a strategy that cannot possibly work," said Sen. Susan Collins, R-Maine.
McCarthy wouldn't say what changes Republicans might make. He appeared to suggest that a very short-term measure might pass at the last minute, but GOP aides said that was unlikely.
Republicans argued that Reid should have convened the Senate on Sunday.
Yet even some Republicans said privately they feared that Reid held the advantage in a fast-approaching end game.
Republicans argued that they had already made compromises; for instance, their latest measure would leave intact most parts of the health care law that have taken effect, including requiring insurance companies to cover people with pre-existing conditions and to let families' plans cover children up to age 26. They also would allow insurers to deny contraception coverage based on religious or moral objections.
Tea party lawmakers in the House — egged on by Cruz — forced GOP leaders to abandon an earlier plan to deliver a "clean" stopgap spending bill to the Senate and move the fight to another must-do measure looming in mid-October: a bill to increase the government's borrowing cap to avert a market-rattling, first-ever default on U.S. obligations.
In the event lawmakers blow the Monday deadline, about 800,000 workers would be forced off the job without pay. Some critical services such as patrolling the borders, inspecting meat and controlling air traffic would continue. Social Security benefits would be sent, and the Medicare and Medicaid health care programs for the elderly and poor would continue to pay doctors and hospitals.
McCarthy appeared on "Fox News Sunday," while Cruz and Labrador were on NBC's "Meet the Press." Van Hollen appeared on CBS' "Face the Nation."
JEFFERSON CITY, Mo. (AP) - Republican senators have made it clear that there will be no Medicaid expansion in Missouri this session.
The Republican-led Senate voted down a Democratic attempt Monday night to insert $890 million of federal funds into Missouri's budget to expand Medicaid eligibility to an estimated 260,000 lower-income adults.
The vote was just the latest in a series of similar defeats in the Missouri Legislature for the Medicaid expansion backed by Democratic Gov. Jay Nixon and called for under President Barack Obama's health care law.
But this vote carried a bit more weight. That's because it ensured that neither the Senate nor the House version of the budget includes the Medicaid expansion. Under legislative rules, negotiators cannot insert money into the final budget that wasn't in either chamber's plan.