malcolm web, al jazeera, kampa kampala, uganda. >> and a quick reminder that you can keep up-to-date on all the stories we're reporting on. >> self insured people, better or cheaper options. the affordable care act c has reduced the number of uninsured people, but a number have dropped their coverage. what's the diagnosis? shopping for care, it's the

"inside story." welcome to "inside story," i'm ray suarez. when the first enrollment period for the rg affordable care act began, the websites didn't work and tens of thousands of americans didn't understanding how the law worked. those that weren't teacted by it all, the websites worked, some of the most post officed state governments have cooperated, a little, many haven't. as the insurance marketplace prepares to open again, we'll find out who the affordable care act is working for, in a few

weeks ads like these will be back. encouraging millions of unassured americans to buy -- uninsured americans to buy insurance under the affordable care act. >> we don't want people to settle with the penalty. we want people to realize that this is an opportunity for them to be covered. >> as the campaign gets underway, the program is facing another challenge, keeping the enrollees it already has. in february of this year about 11.7 million people were enrolled in federal and state-run marketplaces but by the end of june that number dropped by 15%, town to 9.9 -- down to 9.9 million. >> waiting for a job, others didn't realize how expiive it woulexpensive itwould be. others were ineligible to buy insurance on the exchange. it varies a lot.

>> the cost of insurance, some of the most difficult places to afford health care are in these 20 states. those are the states that haven't expanded medicaid. but the obama administration insists despite the challenges the new system is working. >> five years in and mlions have new coverage. and the annual uninsured rate has been reduced to the lowest levels on record. >> the rate of uninsured people is down to 11.6%. health officials estimate about 10.5 million your honor insured people are still eligible for coverage. this new enrollment period will be the toughest yet. >> most of the low hanging fruit so to speak has already been picked. those who benefit the most from subsidies have already enrolled. they think they can live without it, convincing them they

actually do need insurance, that's going to be the challenge. >> while our goals are harder to reach we're working harder to reach them. we know americans are depending on it, and we're doing everything we can to find the coverage they need. >> the obama administration will market to areas dallas,ing miami, northern new jersey. 2016 will be the true test of the affordable care act and this time the ads will need to be a lot more convincing. minnesota, land of 10,000 reasons for getting health insurance. >> the affordable care act two years after the deeply troubled rollout. grace mari marie turner. robert grayboy, senior research fellow at george washington

center. and jay angoff, jay, in the original design, was it already understood that there was going to be a certain amount of churn, people signing up, dropping out, signing up, dropping out, there would be a constantly changing population? >> sure. churn is giving companies a chance ting the price low. people can compare, come close to doing apples to apples comparisons. that's be 97 for companies to pry low. whether you call it churn or something else it benefits consumers because for the first time, insurance companies really do have an incentive to compete on price rather than on differentiating the benefit

package and things aconfuse consumers. >> we don't have a big idea, but over two years, does that give incentive to keep prices low? >> people on both sides acknowledge it's working. it's here to stay, there can be changes made. i think there ought to be changes made. for example, i think the benefits should be more standardized so people can more easily compromise. competitive bidding, insurance companies know if they offer too high a price they can't sell on the exchanges. but the structures in place, and as i said, it's here to stay. and you know, 10 million people have gotten coverage on exchanges. 7 million off the exchanges. 14 million new people in medicaid. again i'm not a defender of every aspect of the affordable care act. but this really made a tremendous difference and it is here to stay. >> grace marie turner, when you look at things how they are

going now and how they have gone over the arc of the last two years, what do you make of it? are there aspects that are working? >> first of all, we needed big changes. when you talk about churn and you talk about price you have to think about what has been the consumer's experience. at least 6 million people lost the coverage that they had before obamacare because it didn't comply with this avalanche of rules and regulations. they lost the coverage they liked, they were forced into coverage the cookie cutter coverage, essentially, and many say it provides too many benefits, more coverage than they want or need and mostly at a much higher price. we have seen the price increases that are coming this year, 20%, 30% in many of the plans. yes there should be competition. but consumers are saying i don't like the churn. i don't like the price. and particularly, they don't like these extraordinarily high

deductdeductibles. >> roberts grayboy, i wonder and i've looked at a lot of the research talking to consumers since then. there are some that are used to getting insurance for their employers didn't know how to shop for health insurance in the first place. >> i don't think consumers got what they expected, i still don't think they're getting what they expect. i'm in this fo as a business. it's no huge surprise that consumers are crank their heads, saying i didn't know this was in there. i'm critic of both parties, growth ideologies or health care. -- both ideologies on health shoourn. some have more, higher deduct

inls, some lower, there isn't a criterion that said, what does it mean that obamacare is working? it's never been stated. >> let me refine the question a little bit more. as people lived through this experience longer can we expect that they will become better shoppers, better able to navigate the shop windows in their states, and better able to compare plans in 2017 than they were in 2014? >> i think it's going to be a permanent state of instability. i think there are just too many cogs, too many wheels, many of which don't mesh. and again i'll state, i try repeatedly state, i don't think the opponents have any particularly good ideas how to deal with it. but yo no, i don't think it's going to stabilize. 2017 will be just a very bad year, that's when the risk

partly ends and some programs will go away. >> stand by. ful years since the passage of the affordable care act. what difference the low level of cooperation with state governments make in the program's early successes and failures. had states opened their cases would the number of uninsured be significantly lower today, or would the problem of the aca have problems all its own? stay with us, it's the "inside story."

>> our american story is written every day. it's not always pretty... but it's real. and we show you like no-one else can. this is our american story. this is america tonight.

>> you're watching "inside story," i'm ray suarez. the obama years have seen a strong move to republican governors and state legislatures. blue states electrepublicans, red states and competitive states that still had democratic governors. help the mechanisms embedded in the affordable care act work. still with me is grace marie turner, in some states when you called the state department that deals with health care and health insurance, they wouldn't help you use the healthcare.gov site for that state. now, that may be -- we can talk

about the wisdom of that but they were under orders not to help you because the governors were against the law and didn't want to help in its implementation. did that make sense? >> that was a federal -- if they were under the federal, health care.gov exchange not running their own exchange they didn't know any more than the average consumer would, a lot of people running that website didn't know what is was going on. they couldn't offer advice and help because they didn't know what was going on either. >> of course they knew what was going on. this is a classic example of biting off your nose to spite your face. some of these republican governors went out of their way to sabotage act. for example in texas, the state with the biggest percentage of uninsured in the country. the state that would benefit the most from expanding medicaid. the governor there said we're not going to expand medicaid. he's getting texas taxpayers to

expand medicaid in other states but in his own state he's keeping people uninsured. >> isn't that a fair comment that some of the states with the highest concentration of uninsured the governors were adamantly opposed to -- >> because the governors did a survey and they said expanding medica is going to cost us even with 100% match in the first couple of years is going to cost our state $you 118 billion that we did not have. >> over what period of time? >> over years, that's going to take money from roads and education and public safety. so they're saying we don't want to expand medicaid. two able bodied working adults who thirds of them with the option, where should we expand medicaid with those options whether there are other options for them? >> i got say, there's something

i find pretty cynical, it doesn't come from a magic atm in the sky. we're going to tax him, give it to you and if you don't take it -- >> but the money doesn't get spent. >> exactly. the money comes from somewhere and these governors in a lot of these states say we don't want a part of this and -- >> but what about jay's point? a taxpayer in fort worth was paying for medicaid in massachusetts and not in dallas. >> precisely the same when you go to a restaurant with a bunch of friends, saying i'm not getting the $50 desert, wh disey not? everybody else is paying for it. >> when there were navigators in states paid for by private dollars to tell you --

>> taxpayer dollars. >> the state person who answered the phone couldn't tell you go to a navigator instead. >> i used to be the insurance commissioner in missouri. and at that time we had a cooperation agreement with the federal government. what missouri did was pass a law which prohibited any state official from even cooperating with the implementation of obamacare. so my friend who is the insurance commissioner now, is he prohibited by missouri state law by cooperating, and if he does cooperate then under this law any missourian can sue him personally because he is violating the law. that gives you an example how much opposition there has been. >> because the citizens of missouri passed a law that they did not want obamacare obamacare implemented in their state. he is responding what the voters said.

this law in 200 different surveys only one law has shown the law more popular than unpopular. people don't like this law. they don't want to be told they have to pinches health insurance. >> i'm going to have to leave it there. whether we return, has the affordable care act as suggested earlier in the program, already picked the low hang fruit? boosting the ranks of the insured under the ones in line to receive the largest subsidies? are the young so at risk to make obama obamacare work, enough carrot and stick to push them to sign up? when the windows open in a few weeks, will there be enough to sign up? shopping for care, it's the "inside story."

♪ >> welcome back to "inside story." i'm ray suarez. obamacare was drafted to push

the uninsured to buying their own health care. it tried to create incentives for getting health care and costs without it. inducements and punishments radically increase the pool of insured. expensive years of care and too few healthy low-need premium payers to keep the whole thing solvent. so what happens now? are there fixes, the actual day-to-day obamacare needs, impossible under the current conditions. is the current marketplace seeing enough young enrollees the keep the health insurance participating? >> with me are my decembers, from the demographic front? >> there's encouraging news that has nothing to do with all this stuff. for 70 years we've talked about insurance insurance insurance, coverage coverage, how many people have a plastic card.

there are 320 million americans and since obamacare we have the same number of doctors, same number of nurses, probably fewer hospitals, fewer other resources, nothing has changed in the supply of what treats us. until we change that, until we fundamentally alter care and how efficiently we dlir it none of this again it's going to be revisited. we're e-going to give some of your care away, give it to him and give some of his to you. there, by the way, i promised i think twice that i can get in on the more conservative states. they tend to be highly destructive on things like telemedicine. none of these things are part of the conversations on health care reform and they are all way more important how you tweak the insurance system. >> go ahead. >> young people are not signing up in the numbers that they need to in order to make these pools stable. we have seen, for example, five

of the citizen be-run cooperatives go under. part of it was because they were getting older and sicker people so that they didn't have the numbers that they needed to make this work. >> doesn't the nip turn into a real bite to force young persons in? >> the penalty becomes higher every year but young people look at a deductible of $6,000 a year. which is the average deductible in the exchange policies. they're saying i'd rather take my chances, pay the fine or, there are 31 different ways you can get out of paying the fine and get excused from it. they'll figure out some way to get around it and they'll say it's just not worth the money. with the high premiums and high deductibles for a young healthy person you have to provide real incentives for them to get in. everyone says you have to have the same benefits package but the young person says, give me a

catastrophic policy only. >> you're right. in the first year the penalty and maybe you said this too, maybe you're right too. in the first year the penalty was next to nothing, it was a hundred bucks. all groups acknowledge the people who come in in the first year are going to be disproportion addly unhealthy. the worst risks come in in the first year. that's good news for 2016. the worst risks are already disproportionately in the system. the risks coming in in 2016 have to be better risks. >> if they come in. >> right, the incentive for them to come in, the minimum penalty is seven times what it was in 2014, so young healthy people have a great incentive to come in. a lot of them if they do the arithmetic, paying $7 and

getting nothing or paying a little more with all the subsidies and getting quite a bit. let me say a word about the subsidies, something we haven't touched on. the people who are insured today who didn't have insurance before they benefit under obamacare. but i think a very underreported story is, the insurance companies benefit too. the government is telling people, they must buy the insurance company's product. >> and they were delivered customers. >> if you were penalized $650, do the math, if you make emotional maybe $40,000 a year as an individual, you are not going to get any subsidy at all. so there's not going to be a subsidy. >> and most data shows that the only people who are really buying in big numbers are those

getting the maximal subsidy. slightly higher, they're still saying no thanks. >> and we can argue where the exact line is. but let me agree with one point that she made. i'll put a lilt different twist on it. there's no question but that high deductibles are being institutionalized. i don't blame obamacare for that. but it's not just a question of coverage. its the type of coverage you get. so one of the reason insurance companies are doing so well, the stocks of the big insurance companies have more than tripled since obamacare has been enacted, there are a lot of people who don't blow through their deductible. that's pure profit for the companies. there's a good argument to be played that the government should be a little more proactive and standardize, in such a way that these deductibles are not as high as they are today. >> i want to thank robert

grayboy. grace marie turner. and jay angoff. i'll be back in a moment with a final thought on politics, health care, and what if anything, we owe each other. send us your thoughts on twitter, @ajinsidestoryam, or follow me and get in touch at raysuareznews. what do you think works and doesn't work with the affordable care act. we'd love to read it.

>> the introduction, the debate'debate's over, the mud w. the implementation of the affordable care act has been full of surprises. for years people were telling me how much they hated their insurance companies. the prospect of regulating them, so they couldn't drop you when you were sick, suddenly jack up rates or deny you a procedure or drug recommended by your doctor i figured would be welcomed by anyone who heard or experienced horror stories about away insurance companies had treat their customers.

i had totally missed the stampede, changes in an insurance system that people hated, were perceived as risky, heavy-handed, socialist or whatever. suddenly complaining about what you had was replaced by nervously sticking by what you had. but a big part of the blame goes to the obama administration. the tens of millions who got coverage from their jobs whose lives were barely going to be changed 50 laws, were listed as warriors of the affordable care act, are charging into a vacuum left by a president who had fought the political but not the informational battle. the story of the implementation of obamacare is not over. this is a titanic business political and social story with the final chapters yet to be written. so stay tuned. thanks for joining us for "inside story." i'll see you next time. i'm ray suarez.

>> this is aljazeera america, live from new york city, i'm tony harris. day of rage. palestinians launch attacks against israelis, and israel vows an aggressive response. confirmation what brought down malaysian 417. and democratic candidates hold their first debate. and a mega merger is brewing between the top beer companies.