and that i'm doing well. >> al jazeera, newport, rhode island. >> thanks for watching al jazeera america. i'm morgan radford. "inside story" is coming up next. . >> back in october the hoped for 7 million enrollments under the affordable care act looked pretty doubtful. 8 million sign ups later , is the president's initiative working well enough to run on in november? that's the inside story. >> hello, i'm 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 wasn't in the law. governors worked hard to make it fail. oh, yeah, and the main purchase point, the healthcare.gov website didn't work. the enrollment period ran until the end of march, and plenty of analysts felt confident the administration's 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. it's mid-april. 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 don't 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 it's time to move on. >> they still can't 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 the repealed debate is and should be over.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 i'm 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 didn'ts 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. that's $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. we're 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 isn't 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. that's going to have an impact on premiums in the future years. it's 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. >> you're 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 it's working? >> so i'm going to disagree with you. we still don't 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 won't 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 high-cost patients. my best guess after 2016 and 2017 is really one we're 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 you're signing up, but it's 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 people's 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 so-called invincibles stayed out of the market praise? >> sure. that's why they're trying to do as much as they can to get those folks to participate. most of those can be well managed. it's 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. it's hard, i'm 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 haven't mentioned there are a lot of people, probably 5 million, who have purchased off the exchanges. they'll 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 we've sort of ended the battle? you've got the 8 million enrollments, and people are where they are. is this a time where people didn't 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. i'm a journalist. we'll 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, they're getting more for their insurance but they don't say that. the democrats have to come out with those who say for years i didn't have coverage. i was depressed because i had a condition, i didn't 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. >> aren't there a lot of people with 25-year-old kids, people who were locked in jobs because of pre-existing conditions and couldn't change employment because they couldn't change insurers. you start to add those people up and it's a lot of people. >> it's a lot of people we got to hear from them we got to have a face.

we don't want numbers. we want a face. we want stories. every news feature there has got to be a story. we need stories of people's 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 it's costing more. >> we're going to take a short break. when we come back we'll talk about how this thing rolls out in the medium term. are there hidden time bombs waiting down the road? this is inside story.

>> welcome back to inside story. i'm ray suarez. on this edition of the program we're talking about the affordable care act. the enrollment phase for 2014 is over. here's what we know. 8 million people signed up. 35% of them are 35 and younger. here's what we don't 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 it's time to move on. as part of the problem with the roll-out 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 don't understand what deductibles are. they few health insurance as being relatively free. that's a massive obstacle to

selling the affordable care act to people who may have never had insurance before. they never needed insurance, they don't think they do. or people who have been on a sponsored coverage before, they no longer have it, and now they're out in the wild. it's extremely difficult, and i'm 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 to--it 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 it's 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. they'll change the language to become more accessible, but you'll 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 i'm 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 it's about many other market forces taking place. >> people's 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 didn't like the mandate. they didn't 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. that's what people don't like. even if it's 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. it's wrong because it's too much big government. ideologues believe if it's wrong it can't work. even if it does work they won't be convinced by this. >> i would never imply that you're 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 it's up, run, and for better or worse, it's 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. i'm 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 we're going to start seeing republicans start to shift away from repeal to replace strategies that are more focused on fixing the law, deregulating it. they're going to critique the law. that's going to be a big part of the platform, but it's going to be more constructive critiques. i think we're going to see changes down the pike sometime after the midterm elections. you can only oppose the law for so long. eventually you'll 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 didn't believe it one bit. they continued to say that it is wrong even know th even though s working. >> we'll 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. >> results of analyses were skewed in favor of the prosecution >> the fbi can't force the states to look at those cases >> the truth will set you free yeah...don't kid yourself >> the system has failed me only on al jazeera america

>> welcome back to inside story. i'm ray suarez. problem said the affordable care act is working. he remembered republicans to drop it as a political issue while acknowledging the law can't 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 60's pee were skeptical of medicare for years until people realized it

helped lift seniors out of poverty. with us bill snyder, in new york, yegeny, research associate at manhattan institute, and cee cee connolly, price water cooper health research institute. on the road of this latest enrollment period, one very damaging thing happened, and that is people started to lose their health insurance while other people were trying to gain some by signing up. that ended up being one of the unpredicted impacts of all of this. did it have to go down that way? and has it readdicted who is in and who is out in the near term? >> yes, absolutely, ray, and talk about confusing. some how no one involved, government, private industry, media, too, were able to clearly

explain what was happening. people who were in essentially inadequate or sub-par plans. >> under the affordable care act. >> no, prior to the affordable care act were going to have the opportunity and in some respects the requirement to move into plans that covered ten basic elements of care so for many of them it was going to be great news. but some how they got consolation notice, an --cancellation notices, and it has been much more challenge to go really understand who are the new enrollees. who are people france significances. don't forget we have many millions more who are enrolled in medicaid. so again there are so many millions of people that are suddenly signing up for some insurance coverage it will take a while to get to the bottom of all of this. >> it did great damage to the

president's brand. >> of course it did, devastating damage, and i don't think we'll be willing to overwoman. people believe now that the president lied to them. he said if you like your healthcare plan you can keep it. later he was abashed when he said well, that wasn't exactly right. for most people it was plane and simple. he lied to us. he never recovered from that look, all plans in america have to do this, this, and this. are we getting people out of sub-par insurance into better programs? >> i think the government defining what sub-par insurance is problematic. you do want to have consumer protections. there were problems with

recessions and the previous insurance market where insurers would refuse to cover services and some plans. that didn't happen much. it was relatively rare. but the plans that were canceled were plans that people did like. it increased the price of insurance and the underlying premiums. i don't think that was ever a real necessity. you have to set some baseline but it didn't have to be as drastic as we set up. >> does it make it harder to know how many net increases we were getting in these newly insured? >> oh, 100%. i think it will be another year or so before we know how many people lost their plans, and how the uninsured rate really changed from 2013 to 2014. >> is it going to be harder for a democrat to run this fall because of the way this all worked out, or as of the other day with the president taking a victory lap maybe a little easier? >> it's going to be harder for democrats running in states that

are hostile to the president to begin with. there are seven democrats running in romney states for the senate. seven democratic senators running in states that obama did not carry like north carolina. he carried it once. louisiana, arkansas, montana , alaska. those states people are starting out very hostile for obama, and very hostile to obamacare. the evidence that appears to be working, it's going to be very hard to sell this program. it will be a big issue in those races . >> are we close enough to the threaten cost. >> my opinion of the vast majority of the insurance ceos. many of them have been getting on earnings calls recently having to talk about some numbers, and no one right now is speaking about death spiral.

it certainly appears there is robust enrollment in the majority of states. there could be a few wishes because each state is a little bit different, and there are going to be some health insurance companies that will fare better than others. they went in with different strategists. this is capitalism. we'll see how it shakes out in the market. but about by and large the talk of death spiral has disappeared . >> to my guests, great to see you all. this story continues. that brings us to the end of this edition of inside story. thanks for being with us. the program may be over but the story conditions. for more on this or any day's show log log on to our facebook page. we'll see you for the next "inside story."

in washington, i'm ray suarez. >> you desperate search for survivors as the death toll rises to 32. >> hello, you're watching am al jazeera. later on this program, journalists are freed after being held in syria for ten months. and the worst avalanche to take place on the world's highest