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White House watches anxiously as Obamacare comes into effect White House watches anxiously as Obamacare comes into effect
(about 1 hour later)
Barack Obama’s signature experiment in government-facilitated healthcare came into force on New Year’s Day, extending medical coverage to millions of Americans for the start of 2014.Barack Obama’s signature experiment in government-facilitated healthcare came into force on New Year’s Day, extending medical coverage to millions of Americans for the start of 2014.
The White House said six million people had enrolled to receive coverage under the new healthcare exchanges or via the expanded Medicaid provision for vulnerable and low-income Americans.The White House said six million people had enrolled to receive coverage under the new healthcare exchanges or via the expanded Medicaid provision for vulnerable and low-income Americans.
Administration officials are cautious, warning that the technical glitches that have affected online healthcare exchanges could further complicate the rollout of coverage in the coming days. Administration officials are cautious, warning that the technical glitches that have affected online healthcare exchanges could further complicate the rollout of coverage in the coming days. 
There was no speech or major announcement from Obama or his health secretary, Kathleen Sebelius, to mark the historic moment. Instead, the White House opted for a low-key approach, publishing a blogpost profiling Trinace Edwards, a brain-tumour victim who recently discovered she was eligible for Medicaid coverage.There was no speech or major announcement from Obama or his health secretary, Kathleen Sebelius, to mark the historic moment. Instead, the White House opted for a low-key approach, publishing a blogpost profiling Trinace Edwards, a brain-tumour victim who recently discovered she was eligible for Medicaid coverage.
Later on Wednesday, David Simas, a senior White House advisor, said: "Today, for the first time, many Americans for whom insurance wasn't previously a possibility can say that they are covered. And many folks who had insurance previously just saw their coverage improve." 
He added: "That's what the president has been fighting for, and why this law is so important."
More than 2.1 million Americans have signed up to plans using state and federal exchanges, despite calamitous problems with websites that began in October and took administration officials weeks to fix. Those enrolees should qualify for coverage, some of it subsidised by the government, from Wednesday, although administration officials and insurers are anticipating some teething problems.More than 2.1 million Americans have signed up to plans using state and federal exchanges, despite calamitous problems with websites that began in October and took administration officials weeks to fix. Those enrolees should qualify for coverage, some of it subsidised by the government, from Wednesday, although administration officials and insurers are anticipating some teething problems.
“We’re very excited about tomorrow, but we’re vigilant,” Phil Schiliro, a White House health policy adviser, told MSNBC on the eve of the plans coming into effect. “We don’t want anybody to have problems, but we know some people will.”“We’re very excited about tomorrow, but we’re vigilant,” Phil Schiliro, a White House health policy adviser, told MSNBC on the eve of the plans coming into effect. “We don’t want anybody to have problems, but we know some people will.”
One concern is that some people who presume they are covered do not actually have insurance, because of administrative delays or legacy problems related to the plagued website, or because they have not yet made their first premium payment. The administration is bracing itself for horror stories of people turning up at hospitals discover they have no coverage. To counter the threat, the White House has lined up its own case studies showcasing individuals – such as Edwards – who are benefiting from the reforms.One concern is that some people who presume they are covered do not actually have insurance, because of administrative delays or legacy problems related to the plagued website, or because they have not yet made their first premium payment. The administration is bracing itself for horror stories of people turning up at hospitals discover they have no coverage. To counter the threat, the White House has lined up its own case studies showcasing individuals – such as Edwards – who are benefiting from the reforms.
The Affordable Care Act, which was passed into law three years ago, remains as contentious as ever. Republican opponents of the law are poised to exploit any perceived failings now it has become operational, calculating that controversy will provide an advantage in the 2014 mid-term elections.The Affordable Care Act, which was passed into law three years ago, remains as contentious as ever. Republican opponents of the law are poised to exploit any perceived failings now it has become operational, calculating that controversy will provide an advantage in the 2014 mid-term elections.
The beleaguered federal online exchange, healthcare.gov, has received most attention in recent months, but Wednesday also marked the introduction of several other pillars of the law, which is commonly known as Obamacare. Medicaid, the government safety net for the most vulnerable and poorest Americans, is being significantly expanded in around half the states. Just under 4 million people have taken steps to enrol in the Medicaid program, according to federal figures.The beleaguered federal online exchange, healthcare.gov, has received most attention in recent months, but Wednesday also marked the introduction of several other pillars of the law, which is commonly known as Obamacare. Medicaid, the government safety net for the most vulnerable and poorest Americans, is being significantly expanded in around half the states. Just under 4 million people have taken steps to enrol in the Medicaid program, according to federal figures.
The law also imposes new restrictions on private insurers, which must now pay a fee that, in total, is expected to provide more than $100bn of much-needed revenue over the next decade. They are also barred from denying health insurance to an estimated 129 million Americans with pre-existing conditions, or charging higher premiums to women than men.The law also imposes new restrictions on private insurers, which must now pay a fee that, in total, is expected to provide more than $100bn of much-needed revenue over the next decade. They are also barred from denying health insurance to an estimated 129 million Americans with pre-existing conditions, or charging higher premiums to women than men.
The law also requires insurers to provide more comprehensive insurance packages, including mental-health and maternity care, which some packages previously omitted.The law also requires insurers to provide more comprehensive insurance packages, including mental-health and maternity care, which some packages previously omitted.
Although 1 January is a major date for the reforms, the effective deadline for one of the most crucial provisions in Obamacare has still not arrived. The so-called “individual mandate”, which compels most Americans to obtain healthcare coverage or face a fine, kicked in on Wednesday. However, the guillotine will not fall for another three months.Although 1 January is a major date for the reforms, the effective deadline for one of the most crucial provisions in Obamacare has still not arrived. The so-called “individual mandate”, which compels most Americans to obtain healthcare coverage or face a fine, kicked in on Wednesday. However, the guillotine will not fall for another three months.
There are several exemptions to the individual mandate, which is intended to encourage predominantly young and healthy people to obtain insurance. Fines for the uninsured will be increased over time, and in 2014 they will be relatively small. People without insurance for three months in a calendar year will have to pay 1% of their income or $95, whichever is greater.There are several exemptions to the individual mandate, which is intended to encourage predominantly young and healthy people to obtain insurance. Fines for the uninsured will be increased over time, and in 2014 they will be relatively small. People without insurance for three months in a calendar year will have to pay 1% of their income or $95, whichever is greater.
In practice, that means most uninsured Americans will need to sign up for new coverage by the end of March, in order to avoid the potentially unpopular fines – which many perceive as the real crunch-point for Obamacare.In practice, that means most uninsured Americans will need to sign up for new coverage by the end of March, in order to avoid the potentially unpopular fines – which many perceive as the real crunch-point for Obamacare.
On Tuesday, only hours before the law was due to take effect, the reforms faced yet another setback when a supreme court justice blocked a provision in the law that would have forced Roman Catholic-affiliated groups to provide their staff insurance that includes birth control coverage and contraception. Justice Sonia Sotomayor issued an order that stops the US government enforcing the so-called contraception mandate against Baltimore-based Little Sisters of the Poor and Illinois-based Christian Brothers Services, plus related entities.On Tuesday, only hours before the law was due to take effect, the reforms faced yet another setback when a supreme court justice blocked a provision in the law that would have forced Roman Catholic-affiliated groups to provide their staff insurance that includes birth control coverage and contraception. Justice Sonia Sotomayor issued an order that stops the US government enforcing the so-called contraception mandate against Baltimore-based Little Sisters of the Poor and Illinois-based Christian Brothers Services, plus related entities.
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