WASHINGTON -- Like so much about the government's health care overhaul, Monday's deadline to sign up for coverage in 2014 didn't turn out quite as planned: Many people still are eligible for extensions that will let them enroll.
The change of plans shouldn't come as much of a surprise, given the disastrous HealthCare.gov rollout last fall, the mass policy cancellation notices that shocked even the president, and other set-in-law deadlines that turned out not to be not so firm.
Still, step by step, the law is taking effect. People are signing up. Insurance is kicking in or changing for millions of Americans.
It's time for a status report as the law marks a milestone, although no one's quite sure how to define success:
Q: How many people have gotten coverage?
A: That's the big question, and the answer is a moving target. About 6 million people have signed up for private insurance through the new state and federal marketplaces, and several million more have gotten insurance through expanded Medicaid coverage under the health care law. But a lot of those people switched over from other plans, so the net increase isn't known. Also, under changes that kicked in during 2010, 3 million young adults up to age 26 have gotten coverage under their parents' plans.
Q: Do those numbers meet government expectations?
A: It depends on which expectations. Initially, the government had hoped to sign up 7 million through the marketplace exchanges by March 31. It ditched that number after HealthCare.gov experienced near-paralysis when it launched last fall. The new target became 6 million signed up through the exchanges. The administration is giving many people extra time to finish signing up, hoping for a robust number at the end.
Q: What happened to the March 31 deadline?
A: It's still there. It's just that a lot of people don't have to meet it. The government last week announced "special enrollment periods" for two big groups of people: those who have started an application but didn't manage to finish the complicated enrollment process by Monday, and people dealing with "special circumstances" such as natural disasters, technical difficulties, family problems, complications related to immigration status and more.
Q: In general, who's already signed up?
A: Mostly people who didn't have insurance through their jobs, many of them with modest incomes. More than half are women.
Q: How many of the people who have signed up are getting help paying their premiums?
A: Four out of five of those selecting plans through the insurance exchanges have been qualifying for federal subsidies. In general, a single person earning between $11,670 and $46,680 or a four-person family bringing in $23,850-$95,400 can get premium breaks, according to the Kaiser Family Foundation. Provided on a sliding scale that's keyed to income, the most generous subsidies are available to people on the lower rungs of the middle class.
Q: Does signing up for coverage seal the deal?
A: No. People still have to pay their premiums. There's no definitive word yet on how many people are following through. Caroline Pearson of the market research firm Avalere Health estimates that between 10 percent and 20 percent have not paid, which could drop total enrollment down to between 5 million and 6 million people.
Q: How many people are still uninsured?
A: That's the flip side of the big enrollment question. There were about 47 million uninsured people in 2012. The number has surely gone down since then, but it's still sizeable. A Gallup-Healthways survey, based on interviews in January and February, found that 15.9 percent of U.S. adults were uninsured, down from 17.1 percent for the last three months of 2013. That translates roughly to about 3 million people gaining coverage since the start of the year. The Congressional Budget Office predicts there will still be 30 million people without insurance once the law is fully implemented.
Q: Who's still uninsured?
A: Millions of low-income people, in part because nearly half the states haven't acted to expand Medicaid coverage. Also, the estimated 11 million-plus immigrants who live in the U.S. illegally aren't eligible to get insurance through the health exchanges.
Q: What's happening with the "young invincibles" who have gotten so much attention?
A: During the first five months of enrollment, 26 percent of those who selected plans were between the ages of 18 and 34, although this group makes up about 40 percent of potential enrollees.
Q: Why are young adults so important?
A: Because they tend to be healthier than older people. And having plenty of healthy people paying into the risk pool helps ensure that there's enough money to cover the medical bills of those who are more likely to get sick. Otherwise, insurers may have to increase premiums. Kaiser Family Foundation President and CEO Drew Altman thinks people are making too big a deal of young adult enrollment. He says many insurers anticipated this issue and have already accounted for it in their premiums.
Q: How come more people aren't signing up?
A: For some, it's just a matter of procrastination. But polls show that many of the uninsured are uninformed or confused about the new law or don't think they can afford coverage. In addition, a third say they have tried to get coverage, according to the Kaiser Family Foundation. A very small slice say they don't want or need coverage.
Q: Is health insurance through the Affordable Care Act really affordable?
A: That depends on the particular plan and level of coverage that's selected. Overall, premiums for plans offered through the exchanges have been lower than initially projected. But health insurance isn't cheap. Even when premiums are affordable, people have to watch out for high out-of-pocket costs and deductibles. Under the law, insurers can't charge an individual more than $6,350 in out-of pocket costs a year and no more than $12,700 for a family policy. Patient advocates say that under some plans, people with serious illnesses could end up paying their entire out-of-pocket cap before insurance kicks in any money.
Q: What about the quality of the coverage?
A: Exchange plans have to take all applicants, cover broad benefits and provide strong financial protection in case of catastrophic illness. In return, though, doctor and hospital choices are limited, and there are those out-of-pocket costs mentioned above. In general, plans offered through the health exchanges appear to offer less choice in hospitals and doctors than what people can get through employer-based or Medicare coverage.
Q: What will happen to uninsured people who miss that now-squishy Monday deadline to sign up?
A: If they're not in one of the groups eligible for an enrollment extension, they will have to wait until next year for coverage. The next enrollment period starts Nov. 15, for coverage starting in 2015. In the meantime, they risk getting fined for not having coverage.
Q: How big are the penalties?
A: The penalty for 2014 is $95 per person ($47.50 per child under 18) or 1 percent of annual income above the tax-filing threshold of $10,150, whichever is higher. The fines are due when people file their 2014 taxes. If someone is due a tax refund, the IRS can deduct the penalty from the refund. Otherwise, the IRS will let people know what's owed.
Q: Who's exempt from the penalties?
A: If people don't make enough money to have to file a federal tax form, they don't have to buy coverage.
Q: Did the government fix that clunky website?
A: Well, HealthCare.gov is doing far better than at its disastrous launch last fall, but the system's still not perfect. Some people still experience delays and technical glitches, as it did on Monday. Independent testing by Compuware has found that HealthCare.gov runs slowly when compared to other health insurance industry websites.
Q: What ever happened to all those people who got insurance cancellation notices last fall?
A: Many have gotten a reprieve. Others found new coverage. More than 4.7 million people got cancellation notices because their policies weren't good enough to meet the higher standards set in the health care law. After a public uproar, the government agreed to let states give those affected two years to switch to better coverage. That extension is good for policies issued up to Oct. 1, 2016.
Q: What's next for the Affordable Care Act?
A: There's lots more to come. And there are probably more surprises in store, too.
Here are some dates to watch:
--Nov. 15: Open enrollment begins for 2015. Americans can sign up for coverage or switch to a new plan. And they'll see what rate increases are in store for the coming year.
--Jan. 1, 2015: Deadline for large employers -- those with 100 or more employees -- to offer coverage or face tax penalties.
--Jan. 15, 2015: Open enrollment for 2015 ends.
--April 15, 2015: Tax day. Fines are due for people who weren't insured in 2014.
--2018: So-called "Cadillac" health plans offered by some employers come under a new tax. Some companies will pass the tax on to workers and others may trim employee benefits to avoid it.