jazeera. >> now, the 19th annual festival has kicked off in paris with a fashion show featuring masterpieces made of chocolate. they braced the catwalk, wearing designs by a world-famous chocolate maker. that's tonight's inside story. >> hello, i'm libby casey in washington. as the obama administration races to fix the healthcare.gov website, critics are turning up the heat. the latest issue, how many americans who have to pay for their own health insurance now

have to switch to fl comply with the law. we'll give the affordable healthcare act a checkup, who will have to change their plans and why, and how will it affect young healthy americans. the success depends on the young signing up in large numbers. >> on capitol hill today marilyn tavenar, the administrator for cms answered tough questions about the affordabl affordable . >> i want to assure you that it can and will be fixed, and we're working around the clock to deliver the shopping experience that you deserve. >> reporter: but new to the hearing, individuals receiving cancellation letters from their insurance providers. >> i would take them back to the free affordable care act days if

you were in the market, half the individuals in the market did not stay on their policies, they were kicked off for pre-existing conditions. they saw their premiums go up 20% a year. now, in fact, the issuer has decided to change the plan didn't have to. plans were grandfathered in in 2010. if they didn't make significant changes in cost sharings, they could keep the pan. >> reporter: the healthcare debut was riddled with problems. they were told they would be able to even their insurance if they liked their plan. >> the affordable care act is built on the premise that it is a privilege, not a right. >> reporter: now many may lose their insurance policies and sign up for something new, a plan that complies with the law. >> what everybody said all along there are going to be changes brought about for minimum

coverage. it's true there are existing healthcare plans on the market that don't meet those minimum standards, so therefore do in the qualify. >> reporter: centered on a mandate, the aca is counting on huge participation. americans need to sign up before april. that will keep premium rates low and keep it sustainable. but the program has only attracted 700,000 applications. >> this is creating a problem in the minds of the american people. >> make sure we get as many people who want health insurance-- >> the incompetence in building this website is staggering. >> everyone needs to chill out because it is going to work. >> reporter: but in the end the administration hopes to enlist young people, the healthiest most important demographic. if they opt out premiums could go through the roof.

and risk the failure of the over all law. open enrollment march 21, 2014. >> we have julie appleby. and from sacramento, california, michael weinberg, senior policy adviser to the bay area, and covered california, the california healthcare exchange and represents kaiser permanente and blue cross blue shield california. first things first, before we talk about the state of enrollment and healthcare.gov . let's talk about people who are getting notices, letters in the mail saying their insurance plans will be dropped. who is getting it and why. >> these are people who buy their own health insurance because they don't get it through their jobs. 14 million americans do this. think buy their own coverage and

150 million people get their coverage through jobs, we're not talking about them. but we're talking about those who buy their insurance. many are getting notices that their plans are being canceled or however it's worded, and that they need to have a new plan to have coverage for next year. the surers are saying their existing policies don't include all the essential health benefits or for some reason don't meet the standards of the health law and they're discontinuing them, and they're offering other options. >> michael weinberg, what are you hearing from the insurance companies and from californians as they get these letters in the mail? >> absolutely, the first point to make is that no one should have been saying after the law was passed in 2010 if you like your health insurance plan you can keep it. that's not what is in the law. the intention was always for people to be able to keep their grandfathered policies but not necessarily the policies that they bought since the law. but about 50%--

>> i want to catch on one thing. grandfathered policies. insurance plans people had before the affordable act kicked in back in 2010. there is a difference between an insurance plan you had then versus you might have bought six months ago or in january 2013? >> exactly. if you had it in march 2010, you can keep it. if you bought it since then you can't necessarily keep it. in california it's 50/50. 50% of the people in the individual market have a truly grandfathered plan, and 50% don't. >> so the obama administration said multiple times that you can keep your insurance policy, what have they been talking about and what about this miscommunicati miscommunication. >> they were looking at the employer market. they were trying to maintain the way people were getting their existing policy.

many people may like their existing policy, but they may have to change. >> if they have to change, and they're getting this letter in the mail, what option dos they have? >> they can go to healthcare.gov . they can browse, they can talk to an independent broker, they can shop around, they can buy through these new marketplaces or off the market places but they need to look and see what other options are out there for them and sign up for something. >> what aspects of these insurance plans aren't hitting the wall? why aren't they having to change their plans or getting cancellation notice. >> it may be that the actuarian levels might not be high enough. basically they're not compliant with the new system that they're setting up for health insurance. you cannot set up a new comprehensive program for health insurance and then allow everyone to opt out of it. >> i'm hearing from some people who are sending me their policies and telling me why

they're being canceled. it's a range of different things. one gentleman from florida said this is being canceled. it's one of the plans being canceled, it's an unusual policy where he was only paying $50 a month. his insurer said here is another option, and it's $200 a month, and he's not happy. but the original plan did not cover hospitalization and only $50 towards a doctor's visit. in california, a popular plan, $4,000 deductible. didn't cover maternity care, and those are being revamped. it's a range of things. if it's not covering the benefits, there is a range of things. >> what feedback are you hearing from clients? >> the whole healthcare reform relies on private health insurance companies having a

healthy risk pool, therefore they need to make these cancellations for those who don't have grandfathered policies. they're not happy to do it, but they're doing what they need to do to make the law work. >> when we come back we'll talk about the state of enrollment and healthcare.gov . al jazeera america... >>introduces... "america tonight". >>a fresh take on the stories that connect to you. >>grounded. >>real. >>unconventional. >>an escape from the expected. (vo) al jazeera america we understand that every news story begins and ends with people. >> the efforts are focused on rescuing stranded residents. (vo) we pursue that story beyond the headline, past the spokesperson, to the streets. >> thousands of riot police deployed across the capitol. (vo) we put all of our global resources behind every story.

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that person no one spoken to yet... >> you can't tell the stories of the people if you don't get their voices out there, and al jazeera america is doing just that. >> welcome become to "inside story" and our checkup of the affordable healthcare. with us is julie appleby and from california, michael weinberg, senior adviser to the bay area and member of the advisory board of cover california, the california health exchange. we've been talking about americans have been getting notice in the mail that their private insurance plans are being dropped or radically changing. julie appleby you said the next step for someone who is getting one of those letters in the mail is to go to healthcare.gov . >> so the website

healthcare.gov is covering 36 states, and then the other states are doing their own exchanges and market places. the one that is handling the federal government han handling most of the states has had the most problems. right now they're saying it's better. people are able to get on and browse without having to create an account. that was one of the problems. people couldn't create accounts, it was slowing down and freezing up. >> one of the last minute requests they had to create an account. >> now they've changed it, and they've made it so you can go on and look at costs in your area. these are estimates so they're not based on exact age. but people with go on there. they can put in basic information, their zip code, age, and get a choice of different plans and see those costs. but what consumer advocates are telling me is that people should look at what do they have now? what is the premium, and what is their deductible? how many are they responsible

out of pocket over the course of the year? what is the cap on that, and how much does their current plan cost and try to finding is comparable online or talk to an insurance broker and look around that way. that's one thing to understand. these policies are going to be a little bit different but you want to know what your deductible is, your premium so you can compare. >> we're hearing from the administration they're hoping to get the website, they say they'll get the website up and running by the end of november. michael weinberg, what if they don't? what are the consequences? >> the thing to remember here this isn't like medicare. it's not like children's health insurance. we can't take ten years to make this work. if we don't get the enrollment that we need and the website is just one piece of it, but a critical piece of making sure that happens is we don't get the risk pool that we need we end up with skyrocketing rates next year. >> the risk pool, julie, tell bus the essentials. who needs to be signing up for the health insurance plan to

make it work? >> well, nearly all americans are supposed to have health insurance or they might face a penalty fine. that's one thing. what the administration and other proponents are hoping for are younger healthier people had will sign up because insurance is a risk pool. spreads the risk. you want people who won't cost a lot of money to offset those who may have problems in a given year. we don't have statistics yet. there have been a few things discussed, about a third of the people were seen come together site enrolling was young people initially, but that was just one state. we're hoping that that plays out over time. a good chunk of the uninsured are young people. they really need to get, as mike has said, if they don't, that could mean higher premiums down the road.

>> you both mention using the healthcare website is one way to sign up. that's one avenue. but for young people, how persistent are they going to be if they log on, can't make it work, are they going to keep coming back and keep trying. >> the good thing about young people is they're procrastinators. if you look at massachusetts' experience they saw a real surge in enrollment four, five, six months in and i imagine people are reading the papers and holding off, and maybe young folks would be procrastinating any way. >> marilyn tavennar testified today. and tomorrow we'll here from kathleen sebelius. are you hearing anything newsbreaking on capitol hill. >> today marilyn t avennar did apologize.

she's the highest level so far who has actually apologized. with the secretary's tem i think we would like to know a little bit more about enrollment. we would like to know what are they doing to fix the problems. i don't know if we're going to hear that or not, but what are the specific technical things they're doing. we heard last week that they hope to have the you whole thing running smoothly by the end of november. is that still on track? that kind of thing. we may or may not hear about that tomorrow. >> michael weinberg how close are you watching these hearings. >> i'm focused on reality. people can spin this all day long. democrats, republicans, but at the end of the day either people will be able to get enrolled, will have a healthy risk pool, or rewon't. i'll read the stories about it, but i'm out here trying to make things work in california, where incidentally they are going a lot better. >> tell what's is happening in california?

>> well, we do have a website. we do have some issues that could be categorized appropriately as glitches. it's taken us a little while to get our provider director working the way we want it to. in the first calm of weeks we did have difficulty getting people enrolled. we're where we need to be. everybody has been pulling together as a team, insurers, consumer advocates, the navigators, the state agencies. that's what makes california very different from most of the rest of the nation. >> how important is california, to the bigger picture to get the affordable care act up and running. >> i'm a little biased. i think it's tremendous important. but 15% of the uninsured are in california. some of those folks are undocumented, but we do have a very, very large number of people here, and if we can't make it work in california with everybody pulling together, we can't make it work anywhere.

i think we're showing how health reform can work, but we will miles to go before we sleep. >> are there other key states who are running their own exchanges or have pushed the responsibility on to the federal government. >> california has one of the higher rates of uninsurance in the country. it's not the highest but one of them. they have a lot of potential there for people to enroll. other states that people are watching closely are in texas, they have a really high rate of uninsured there. some the other southern states. new york will be interesting to watch because their website is apparently running. people are signing up. they have 37,000 enrolled already, they said. kentucky's website appears to be working pretty well, and they've got a number of people enrolled. connecticut, district of columbia, they said their website are running. on the flip side . hawai'i couldn't get theirs launched until october 15th.

oregon you still cannot sign up online. not all the states where this do thei they dotheir own exchanges are d running smoothly. >> we'll pause there. more on the affordable care act, what's working, what's not. this is "inside story." (vo) gripping films from the world's top documentary directors. this sunday: it seemed like a normal adoption >> do you think this family has a lot of secrets? >> it's like there's an open book as far as the family goes. >> (son - off screen) i fully believe that i was adopted by strangers. (vo) until one day ... >> (son - off screen) i found out everything i thought i knew, was a lie. (vo) al jazeera america presents open secret determining using some sort of subjective interpretation of their policy as to whether or not your particular report was

actually abusive, because if it doesn't contain language that specifically threatens you directly or is targeted towards you specifically, they may not consider it abuse. they may consider it offensive. and in that case they just recommend that you block that person. >> i don't want to minimise this, because i mean, there's some really horrible things that are on line, and it's not - it's not just twitter, what has happened through social media and the anonymity of the net is that you see websites, hate-filled websites targetting all sorts of groups, popping up. there has been a huge number of those that exist as well. >> every morning from 6 to 10am al jazeera america brings you

>> welcome book "inside story." we're talking about the affordable care act. now we want to focus a bit on the future. still with us is julie appleby, around from sacramento, california, michael weinberg. micah, as we talked about the bottom line, to make this new law work, it's not young americans but healthy americans need to sign up. what is the difference between young and healthy, what is the significant? >> right now we're seeing a lot of people who are persisting in getting enrolled, particularly in california are people who may be young, they may be old, but they desperately need health insurance. it's wonderful that we're getting them this conscience that they haven't had in the past. but the problem is if we only have unhealthy people we don't have the risk pool that we need, the rates go through the roof,

and so on. >> and julie appleby, the people who are on insurance plans, people who are getting notices in the mail that they're about to be dropped, they're not necessarily getting the best health insurance already. three-quarters of medical bankruptcies that happen are people who do have health insurance, just not adequate health insurance. where do they look to next? >> a lot of folks who are losing their policies, they may have a policies that has a huge deductible, maybe a $10,000 a year deductible. for some folks that's fine. but some folks if they get sick they can't meet those deductibles . the new policies some of them have hefty deductibles as well. the cap now, the most that these new policies can charge you between a deductible and things like copayments and doctors office payments, and hospital care is

$12,700 for family. that sounds like a lot, and it is, but nearly a third of the plans sold have an out o out oft amount, and they have companies. >> for those who where subsidies for purchasing insurance, a whole lot of them will get a significant reduction in their cost sharing. 50% of post, they have significant help from the federal government with their out of pocket costs as well. >> we talked about the crucial deadlines set up by the obama administration, also members of congress who are watch to go hit some key markets, but julie, what are you watching by goals that have to be met by a certain time frame. >> there are a number of different dates. december 15th is important. the website needs to be running well by then because people need to sign up by december 15th. that's important date. obviously. i think, you know, the next important date may well be the

end of march. that's when open enrollment closes. that's when you have until to sign up and not face a penalty. then we'll have a better idea of who signed up, who hasn't, and how things are working. we're hearing from a lot of politicians that they would like to extend that open enrollment deadline. if we don't see improvements in the website by the end of the year i think those calls are going to get stronger and stronger. i think those are key dates. mid december and let's see how things are running, and what are the totals that we see in march. but ultimately that's just the first year. so i think a lot of folks are hanging on this number, o they estimated that 7. million people play sign up for coverage in the first year. that he injures the first year. we'll have to see what happens down the line. >> what does failure look like? >> i mean, i think that failure is something that everybody on every side of the political spectrum should be worried about.

what people don't remember, i think, when they argue against this law is that they were vital reasons why we passed it, and there is no back to go to. we can't just wipe this away and go back to the system that we once had. the system we once had is broken. people rooting for the plane to crash in the mountain should remember that they're in this plane. so i think it's really important that people do what we've done in california, which is whatever it is that you might think about the law, pull together as a team and try to pull together a better healthcare system for the united states. >> you're a member of kaiser permanente blue cross, blue shield california. >> they have been very engaged in helping set up this law. you know, what they and other insurance companies have said is it's actually not as simple as just, well, let's extend the open enrollment period. well, let's just take away the individual mandate.

the open enrollment needs to be what it is, and the individual mandate needs to be stronger than it is and make sure we have everybody in the pool so when we set rates next year we don't have this ridiculous amount of rate shock. the politicians calling for these periods to be extended need to be careful about the implications of that. but that said if people can't enroll in health insurance it's difficult to require them to do so. >> one member of the house has said let's extend this grandfather period. if you bought health insurance by january 2013 could you get your flanagan fathered in, you wouldn't need to find a new one if you have individual private insurance. >> that means the way the law is now if you bought your plan after march 2010 it's likely not grandfathered or if you made changes to it, it's likely not grandfathered. they would not be able to keep it. they would have to change the plan. it sound like what they want to do is extend the deadline to

january of this year so people who bought their policies could potentially keep their plans. in the individual market people go in and out of insurance. it's not unusual that people would not have had a policy and would have bought it more recently and/or would have changed their policy in some way. each year people got increases. individual markets before the healthcare law it was often double digits. one the ways you could slow that down was by raising your deductible, but that automatically kicked you out of the grandfathered status. >> that's it for now from the team in washington, d.c. and for me, libby casey. up keep this conversation going by logging on to our facebook page or send usous thoughts on twitter. our handle is a.j. inside story a.m. thanks for watching. .

. . welcome to qadri jamil. here are the top stories at this hour. >> the white house continues to answer questions on the problems which plagued the affordable care act website. on wednesday health and human services secretary kathleen sebelius will testify in a house hearing. the administration's first apology for the failures came tuesday from the head of medicare. marilyn tavenner, who said most problems with the site should be fixed by the end of november. >> america's spy chief denies reports the nsa eavesdropped on thousands in france and spain. >> keith alexander says they conduct legal activities and makes no apology. the dire.