>> this is al jazeera america, tony harris. there is no end in site to the government shutdown. president obama went to washington to speak with furloughed workers. he said there are enough votes to end the shutdown. the stalemate of washington is making an impact on wall street. stocks are lower again today. the dow closed 136 points, investors are getting more nervous about the bore ring limit before congress runs out of money before the middle of next month. not long ago secretary of

state john kerry and syrian president bashar al-assad were at odds, and now with a different tone praising president al-assad for it cooperating with the destruction of chemical weapons. prime minister benjamin benn netanyahu called rabbi ovadiayosef dice at 93, who die. >> the fight over obamacare shuts down the federal government, but the fate of millions of uninsured americans really rests in the state. that's tonight's inside story.

>> hello, the affordable care act remains the sticking point as the second week of the second part of the government shutdown begins. senate democrats and the republican say no, open enrollment of the healthcare exchanges continues. the government spent much of the weekend trying to iron out widespread problems. we'll tackle another key feature of obamacare, the expansion of medicaid to insure poor americans. this battle is not in washington but in the states. [applause] >> reporter: when president obama signed the affordable care

act, a key element expansion to the state. the federal poverty line is more than $11,000 for individuals and over 23,000 for a family of four. the law seeks to expand medicaid eligible fo ability for those wh income with 138% of the poverty line. not to exten8 million americanso much t to be eligible for medicd but make too little to buy

insurance. the administration contends, the affordable healthcare has been in de . >> and there are going to be glitches in the sign up. i don't recall anybody threatening apple because of ipad. that's not how we do things in america. we make things work, we make them better, and we keep going. >> the website shut down so technicians could make r improvements to the site. >> joining us now to discuss the affordable care act is reporter jeffrey young, the healthcare reporter for huffington post. the government shutdown over obamacare in the next crisis is

the debt ceiling deadline next week with everyone focusing on the politics of shutdown. do you think ironically the administration got something of a break to kind of fix the glitches while everyone else is focused some place else? >> in a way if you look at the headlines, the shutdown and possibility to fall are the first things to come up. it's not that people aren't talking about the glitches with the affordable care act websites and what the causes may be, but it's not the lead story. it's the second or third one. >> are these problems generalized throughout the system, or are there different problems in different places. >> it varies. the federal government is operating the exchange in more than 30 states. the so in places like colorado, new york, california, they have their own websites, their own exchange systems set up. they're experiencing problems to varying degrees you but they all

seem to be working to the most part, at least a little better than the federal system. >> what is wrong with the federal system? where is the glitch there is? >> the shortest way to put it is that the website doesn't work. it's not that it doesn't work for anyone. they're picking up enrollments in small numbers, but i attempted to create an attack and log in multiple times over the last six days and i've succeeded once. i think that's similar to what other people are experiencing. i heard that from readers who have e-mailed in to talk about how the system wasn't working for them. if you can't get past the first hurdle it's hard to get into the system and find out whether the insurance being sold is something that you could afford. >> the administration suggested part of the problems is due to the high volume of traffic. we see that when there is a surge on the website and the website just can't cope.

>> it's hard to believe that it's just massive demand. it's true that they're getting a lot of web traffic and more than anybody expected to get at the beginning, because this enrollment period lasts for six months. if you go on there today and get through the system and pick out a plan you can't even use it until january. so there is no real incentive to rush unless you're eager. at the same time first it's not entirely credible to say that we just can't run a website with a lot of people using it because that's what websites are for. also the very fact that friday morning through this morning from what 1:00 a.m. to 5:00 each day they took a big part of the site to fix it to write new code to try to fix the bugs underneath the hood. they're ad doing more than addig more servers. i myself had difficulty this

morning, but i think we'll find out in the coming days or weeks. >> if you find the whole internet experience so frustrating or you don't have access to the internet and lots of people don't, is there a lot of ways to do this? >> there are multiel ways, they're not as easy, that's what we were told the experience would be like. but there are paper applications you can fill out. there is a hotline you can call, and they'll walk you through that, and there are people in every state whose job it is to sit down and fill out applications like at health centers, community centers, and you can find those resources on the parts of healthcare.gov . you can put in your zip code and it will tell you who is near you and where you can sign up, you can do it that way. >> there are. places where the websites are working well, is it possible to extrapolate from that experience what the level of enthusiasm is for this? >> you could, but it's hard to

do that with any definitive analysis because every state is so different. small states like rhode island and a big state like california, texas, as the population populae different, the needs are different. the number of people who need health insurance are different. but it's interesting to note kentucky seems to be doing pretty well. the website is working smoothly. they're enrolling thousands of people. the numbers keep getting bigger and bigger. they've had tech problems of their own. they've been able to address them more quickly than the federal government in states like new york where it's been more bothersome. if what is happening in kentucky with rapid takeup. we're only talking about thousands. >> not tens of hundreds of thousands. >> if that's reflective of what may happen in other states if the application process gets fixed, then it's not farfetched to imagine that the millions of people that the administration

says is an achievable goal. >> okay, kentucky is a red state and home to mitch mcconnell and rand paul, two who have been the most soysive rouse about affordable caraffordable care a. >> that's right. the general election date will be right in the middle of the second year of obamacare enrollment. it's not hard to imagine if kentuckians are mostly okay with this, but they'll look back to see if they know what they're talking about. likewise with what senator mcconnell said about this not being workable, that could weigh on the democratic challenger in kentucky as well. >> stay with us, jeffrey. we'll take a break. when we continue we'll switch gears and talk about medicaid

expansion and the affordable care act. it's running problem with the states. this is the 900-page document we call obamacare. it could change costs, coverage, and pretty much all of healthcare in america. my show sorts this all out. in fact, my staff has read the entire thing. which is probably more than what most members of congress can claim. we'll separate politics from policy, and just prescribe the facts.

>> welcome back to inside story. we're continuing our discussion of the affordable care act.

and we want to bring up again the map we showed you in our opening segment. there are 26 states that will not have expanded medicaid funding under the new healthcare law by january 2014. according to an analysis of census data in "the new york times," 60% of the country's working poor are in those 26 states. joining us now to discuss medicaid expansion and the affordable care act, michael canyon at the cato institute. brian toomey, and still with us is jeffrey young, healthcare reporter for the huffington post. michael, why is it a good idea, those states who thinks not to expand medicaid to cover the working poor. >> this is an ineffective program. the most reliable program we have just released in july of this year, and it had no impact

on measured health incomes. >> the oregon study. >> here is a program the federal government wants to throw trillions of dollars at this program. we've been throwing trillions of dollars at it over the last 40 years. there is no evidence that it is helping, and they are prudently saying they're not going to three good money after bad. >> through there are studies that the healthcare study eliminated catastrophic medal expenses and had a big improvement in mental health outcome. >> there have been supporters of the law who initially after the first year's batch of results that people reported better se self-reported health. and then when more reliable measures were released and found there is no difference between

people who got medicaid and didn't get medicaid then they called into question the validity of the study, and it cast doubt because this was the population targeted by the obama healthcare law that was most vulnerable to getting sick and suffering ill health because they didn't have health insurance and yet still not able to find any effect, answered benefit in terms of measured medical health outcome. >> what does it mean for your clients, your patients who rely on you for health services in north carolina if they are not able to get into this medicaid expansion. these would be the working poor who don't--aren't in a salary bracket that is low enough for medicaid and not in a salary bracket high enough for support from the administration. >> we know in our state there is

approximately 700,000 people who would be eligible for the medicaid expansion that will not have access to it. we think having access to care. i understand the argument of making sure that money is spent wisely. we've done that effectively for 50 years, and we whic think we'e very prudent with the bubble dollar. we take that situation serious seriously. >> what about america's most vulnerable working power end up without insurance. >> this was not how it was intended to work. medicaid today is primarily for children, single parents, low income women mostly and pregnant women, people with disabilities. generally you have to have very low incomes below the poverty

level-- >> in some states less than $3,000 a year. >> in many states it doesn't matter how poor you are, if you're a single, childless, adult male you can't get on. what the affordable care act intended to do was establish a new minimum standard of 133% of the poverty left, $11,000 to $12,000. when the supreme court ruled the law was constitutional it also said that states could opt out of this expansion. that's a new policy. it used to be that you did medicaid under federal standards or you didn't do it. but no one was expecting that when they wrote the law. subsidies are available. for private insurance if you make the poverty left up to four times that amount but not if you make below. >> that's the donut hole. >> that's right. if you live in texas, and you

learn 100% of poverty you can get a tax credit to buy private insurance, and maybe you can afford it that way, make you can't. if you make less than that, you get nothing and those people primarily remain without health insurance. >> having coverage is better than not having any coverage. what would you say to people who find themselves in this position where they're not poor enough or not, if you were rich enough. >> having coverage is no better than not having coverage. the supporters of this law, an economist in boston has estimated that of the people who would be covered by this expansion, 8 out of 10 all right have private health insurance today. one thing that tells you is of that 10 only 2 are currently

uninsured. this law would cover two unininsured people at the price of ten. >> but that's millions of americans. >> that's true, but it does not mean that everyone who enrolls in this program had no other opportunity to get coverage. if you cover the most vulnerable in society. then you don't want to expand the healthcare program, you want to put more pressure on producers to reduce the cost of care so it comes within the reach of people who can't afford it now. when do you that, when you use price competition in order to make healthcare for the poor, you're not trapping them in low-wage jobs in a way like a program in medicaid does. it creates an incentive for you not to climb the economic ladder. >> do you agree that there are perhaps ways to go about this, or is medicaid what we got now

and that should be the way forward because we know that it works at least on some levels and try to fix it later? >> that's pretty much the summation of what i think. let's start where we are and improve it as opposed to wait for perfection before we get going. because we won't get to that perfection. i totally agree we need to be responsible with the dollar. i just think it's important to start in one place because we all know the infectcy we have now. we take the approach that we have yet to see that price competition in any part of healthcare has driven cost down. what we see is the more people that get in the market the more prices go up for a variety of people and there is a slippage into the most expensive care which is the emergency rooms and we all pay for that in some ways. just not directly.

with think if we're more straightforward on this, more people hold us accountable as providers, we can do an exceptional job, but we just need a chance. >> we'll take a short break and then we'll come back to medicaid and the affordable healthcare act. what happens when social media uncovers unheard, fascinating news stories? >>they share it on the stream. >>social media isn't an afterthought. it drives discussion across america. >>al jazeera america social media community, on tv and online. >>this is your outlet for those conversations. >>post, upload, and interact. >>every night, share undiscovered stories.

>> welcome back to inside story a.m. we're continuing our discussion of the medicaid expansion of the affordable care act. >> jeffrey, turning to you, the

question of falling between the cracks. it surely means that people end up in emergency rooms. that has another burden of cost that ultimately goes to the state. >> yes, when someone goes to the emergency room and they don't have health insurance hospitals are required by law to treat anyone who has an medical emergency regardless of ability to play. that's true of community health centers like the one in north carolina in that we're talking about today. and in the er some of that is absorbed by the taxpayers and then they're compensated for treating that person. all they receive at that moment is juvenile treatment to get them out of the hospital alive. they have to be treated, stabilized and released. >> so underlying health issues are not debt with, and anything longer term is not debt with. >> that's right. and there is a major problem for people who are low-income and

low-education, getting them to follow up. they may not have access to regular doctor, the money for bills, prescriptions, whatnot. that's one of the reasons why people sort of cycled back and forth to the emergency room is that they perceive that it's the only place they can go, or it actually is. >> brian toomey, how will this change in law effect the kinds of services you're able to able to offer in your clinics. >> we're looking forward to seeing people who haven't been seen before. we find a great number of people, especially now, it's not just the poor and older and what everybody is talking about, but a great number of people in small businesses who are the bread and butter chamber of commerce who can't afford to see people for primary care let alone for pharmacy drugs. we've done two things to dress that, and we think this expansion would just give us

exponential growth. we have our grant with unc healthcare where we take the unininsured out of the emergency room. people who come there frequently and can use a primary care provider. they're preferred to us for primary care visits, and we looked at the numbers there and it's straightforward. we're saving uncompensated care cost in that emergency room to the toon of $3 million to $4 million a year. that's just in one emergency room with our program. in addition to that we've done something with the five local chambers of commerce that rebelong to called our small business plan because they were precluded from qualifying for medicaid or any other kind of insurance programs so that we had a small business plan if anybody worked for chamber of commerce business or family members of those people we would see them for a reduced fee of $60 a visit and $10 prescription. we just want people to stay

healthy so they can go to work and produce revenue for all of us and make us a better economy. >> given the problems with the roll, the technological glitches that we were talking about earlier with jeffrey, this donut hole in the middle where you have this 7 million to 8 million who are going to be left uninsured, which was not the intent of the original act. are these flaws that will make the affordable care act unworkable or will these things be worked around or will things have to be addressed now that it's the law of the land. >> these are effects are not the intent of the authors of the law but the states were asked to implement part of it, and they refused. this is the intent of the public that opposes this law and would prefer to go about making health insurance more accessible in other ways. like the states who refused to i

am pled the medicaid expansion, you have the two-thirds who refuse to create the exchange. i think that both of these effects and the resistence that we've seen with this law argue that perhaps they should delay this for a year in order to see if they can get it running better or let another election or maybe the people elected to congress will want to make changes to the law. >> the federal government was going to pay for three years is hundred% of the cost of expanding medicaid in all states and 90% after that. is it a rational choice for these states to have made to opt out of this funding, and part of the reason that they've opted out of the fund something they're concerned in the future the federal government will not honor its commitment financially. >> that's one of the arguments that you hear at the state level, yes, they'll pay 190% of the costs now, but we look at federal spending and the federal

debt and at some point they're going to renege on that promise which is conceivably true. this white house, anyway, has clearly as it cannot while obama is president. of course, with that argument leaves out i think is that a state can opt into the medicaid option now and then five years now the federal government cuts that from 100% to 50%, you can opt that out. it's difficult because then you're taking benefits away from people, but states have the ability to come in and out of these things as they see fit. there is more to it. underlying a lot of this is just--this is similar to what michael was just saying, at the state level whose policies makers who think this is a bad idea period. >> thank you very much. we have to leave it there. thank you, gentlemen, that's it from the team in washington, d.c. thank you so much.

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