Affordable Care Act

Darnyi Zsóka / Creative Commons

When the Affordable Care Act is fully implemented, large companies will be subject to a penalty if they don't provide coverage for their workers. But life is also changing in unexpected ways for small companies as the health care rollout continues. could barely function on the day the health insurance marketplace debuted, and internal emails show at least some top health officials could see the failure coming.

While the health law's insurance markets are still struggling to get off the ground, the Obama administration is moving ahead with its second year of meting out bonuses and penalties to hospitals based on the quality of their care. This year, there are more losers than winners.

Medicare has raised payment rates to 1,231 hospitals based on two-dozen quality measurements, including surveys of patient satisfaction and — for the first time — death rates. Another 1,451 hospitals are being paid less for each Medicare patient they treat for the year that began Oct. 1.

Remember when President Obama said, "If you like your health plan you can keep it?" Now it's more like, "If you like your health plan you can keep it — for another year, and only if your insurance company says it's OK."

It's not clear whether the administration's proposal to let insurers extend the policies they've been canceling for the past couple of months will solve the president's political problem. But it's sure not going over very well with the insurance industry.

Pete Souza / Creative Commons

President Barack Obama will deliver a statement to the nation on Thursday about the Affordable Care Act. His remarks come after a House oversight hearing that focused on technical glitches at the website.

Watch the address live below.

A House oversight hearing examining the troubled start of was contentious from the start Wednesday, as Rep. Darrell Issa, R-Calif., sought to cut short the opening remarks of one of the first officials to speak, Frank Baitman, the deputy assistant secretary for Information Technology in the Department of Health and Human Services.

Issa, chairman of the House Oversight Committee, asked Baitman to conclude his statement, noting that the panel's time was short. The interruption came as Baitman discussed the work of his agency to save taxpayers money.

Democrats at the White House and in Congress find themselves in an ever-tightening vise over all those canceled health insurance policies.

House Republicans plan a vote as soon as Friday on a bill that would allow people to keep health plans they like, just as President Obama said they'd be able to (until it became clear they couldn't) under the Affordable Care Act.

Catie Talarski / WNPR

Last week, we recorded our second “Health Equity Forum” in collaboration with the Connecticut Health Foundation. In our first of these town halls, we began with these sobering statistics: In Connecticut, pregnant black women are 2x more likely to deliver a smaller baby early, black men are 2x more likely to die of prostate cancer than white men, with overall life expectancy for black men significantly shorter than for their white peers.

Alex Proimos / Creative Commons

Time for a health checkup on Connecticut's health insurance exchange. What is working? What improvements are still needed? Tell Faith and her panel of health care experts how it worked for you. 

The health care exchanges may be open, but there's no question they're still kind of a mess.

"The rollout has been excruciatingly awful for way too many people," Health and Human Services Secretary Kathleen Sebelius conceded to the Senate Finance Committee last week.

But mess or not, the law is going forward, people are trying to use it, and they have questions. Here are some of yours, and our answers.

Before the Affordable Care Act was even open for enrollment, Viviana Alvarado was already taking calls from people who wanted to know more.

She and about 40 of her colleagues are staffing the phones for Maximus, the company Connecticut has contracted to run its call center.

The government contractors running the troubled website have been under intense scrutiny in the past month, but those businesses aren't the only ones being paid to rollout Obamacare.

Lipothymia / Creative Commons

It's no secret to say that health care has been undergoing radical change in this country. But what's less well-known is that the state of Connecticut is going beyond the current changes in the Affordable Care Act to address the way we deliver care and pay for medical services. And some consumer advocates are disturbed by the results.

When the head of the agency responsible for the troubled went before Congress for the first time since its foibles became apparent Oct. 1, she probably didn't expect that many questions would be on something else altogether.

Chion Wolf / WNPR

Despite technical problems plaguing the rollout of the Affordable Care Act nationwide, U.S. Senator Chris Murphy said the launch in Connecticut has gone better than expected., the faulty website where people can sign up for health insurance under the Affordable Care Act, has become nearly synonymous with the word "glitch" — sometimes defensively, sometimes mockingly.

They've got a few weeks.

But if federal officials can't get the new online insurance marketplace running smoothly by mid-November, the problems plaguing the three-week-old website could become a far bigger threat to the success of the health law, hampering enrollment and fueling opponents' calls to delay implementation, analysts say.

Since the Affordable Care Act's health care exchanges launched to a long series of error messages Oct. 1, most of the "what went wrong" fingers have been pointing at software developers.

But some say there's more to it than that — that politics has played a role as well.

The Obama administration's hopes ran high that millions would flock to enroll for health insurance on state and federal exchanges established under the Affordable Care Act.

Those exchanges went online Oct. 1. The administration projected that half a million individuals or families would enroll within 30 days, according to The Associated Press.

But three weeks in, the data suggest the actual number of enrollments is lagging far behind that number.

Mackenzie Kreitler / Verizon Wireless

The Connecticut Coalition Against Domestic Violence received a grant form the Verizon Foundation Friday that will train Health Care providers to become effective domestic violence screeners. was meant to create a simple, easy way for millions of Americans to shop for subsidized health care.

Instead, in a little two more than weeks, it has become the poster child for the federal government's technical ineptitude.

Pete Souza / White House

This shutdown is getting old. Federal workers aren’t getting paid, and that means lots of people right here in Connecticut are affected directly - and a lot more are having problems, too.

Chion Wolf / WNPR

It's been two weeks since enrollment began under the new health insurance law known as Obamacare. First, the numbers. Connecticut has about 344,000 people without health insurance. Obamacare, or the Affordable Care Act, was designed to lower that number.

These first two weeks have been rocky for the state health insurance exchanges. The online marketplaces opened across the country Oct. 1, with computer glitches and staffing shortages.

Even the states that have agreed to run their own exchanges are having a hard time. In states that have not embraced the Affordable Care Act, the federal government is struggling to fill in the gap.

Matanya / Flickr Creative Commons

Quinnipiac University released their latest national poll on Tuesday, looking at American voters' attitudes about the government shutdown and Obamacare. The poll of 1,497 registered voters revealed that 72 percent are opposed to the notion of shutting down the government to stop implementation of Obamacare, and 64 percent oppose blocking an increase of the debt ceiling to derail the Affordable Care Act.

Chion Wolf / WNPR

Join us while we talk about the new Connecticut health care exchange on Where We Live. Listen live here.

9:11 am: Kevin Counihan, CEO of Connecticut's health insurance exchange, says Access Health CT is up and running. He says plenty of people are visiting the site and it's active. "It's a highly complex implementation," he says, citing lots of support in the state for the health care exchange.

Pete/Comedy_Nose / Flickr Creative Commons

Access Health CT, the state's new health care marketplace, goes live for customers today. Officials are encouraging people shopping for insurance plans to do it online, if possible, to limit paperwork. Officials are also sending workers into the community to work with low-income people who may not have web access, or may not be web-savvy. 

Update at 8:18 p.m. ET. Impasse:

As first day of a federal government shutdown came to a close, Congress was not any closer to a resolution.

Case in point: Republicans in the House proposed three bills that would have reopened national parks, the Department of Veteran's Affairs and kept the D.C. government afloat. But all three bills didn't even make it out of the House.

NPR's Steve Inskeep interviewed President Obama on Monday about the looming government shutdown, the upcoming debt ceiling fight and more. A full transcript of the interview follows:

STEVE INSKEEP: As you have watched what's happening in Congress, do you feel that House Republicans are coming any closer to anything that you could sign?

Today marks a milestone on the nation's long march toward universal health coverage: the launch of online marketplaces, called exchanges, designed to help people find insurance they can afford.

It's an idea pioneered by Massachusetts seven years ago. People here call their program a success, and say the state's exchange was an indispensable factor.

Chion Wolf

Today’s the day the new Affordable Care Act kicks into gear.  

The health care reform known as “Obamacare” is creating state exchanges where those without insurance can buy it.  But how do these exchanges work? Who’s eligible and who’s not? What about all the myths, mysteries and misconceptions? How much is it really costing us?