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Experts Say It Could Be A Make Or Break Year For Obamacare


The annual sign-up period for Obamacare begins in less than two weeks. Experts say this could be a make-or-break year for the program. The Obama administration is hoping to enroll nearly 14 million people over the next few months, and the president himself made a pitch for sign-ups when he was in Miami today. NPR's Scott Horsley reports.

SCOTT HORSLEY, BYLINE: President Obama told students at Miami Dade College, in some ways, his signature health care law has done just what it's supposed to - provided health care coverage for some 20 million people who didn't have it before.


PRESIDENT BARACK OBAMA: Never in American history has the uninsured rate been lower than it is today - never.


HORSLEY: But Obama acknowledged the law, muscled through Congress without a single Republican vote, has its flaws. He argues that's a reason to improve Obamacare, not repeal it.


OBAMA: Think about it. When one of these companies comes out with a new smartphone, then it has a few bugs, what do they do? They fix it. They upgrade it unless it catches fire. Then they just...


OBAMA: Then they pull it off the market.

HORSLEY: Obama insists the problems with the Affordable Care Act are not so explosive as to justify going back to the health care equivalent of rotary dial phones. Those problems mostly affect the roughly 1 in 14 people who buy health insurance on the individual market, including the government-run exchanges set up by Obamacare.

Health care expert Cynthia Cox of the Kaiser Family Foundation says so far those exchanges have not attracted as many customers as expected, so some insurance companies are quitting the business.

CYNTHIA COX: They're not seeing enough young and healthy enrollment. And what that's meant is that their costs have been higher than they expected, and they're losing money in the exchanges, which is part of why you're seeing many of these companies exit right now.

HORSLEY: About 20 percent of people shopping for coverage on the exchanges this year will have just one insurance company to choose from. And with less competition, insurance premiums are rising sharply - about 25 percent on average. The administration hopes to counteract that by bringing more low-cost customers into the market. That was a big part of the president's message at the community college this afternoon.


OBAMA: The more young and healthy people like you who do the smart thing and sign up, then the better it's going to work for everybody.

HORSLEY: But it will take more than the president's promotional efforts to cure what's ailing Obamacare. Some observers suggest both carrots and sticks are needed, including more generous subsidies to defray the cost of insurance and stiffer penalties for those who don't sign up.

Health policy professor Sara Rosenbaum of George Washington University says similar adjustments were made to fix Medicare's prescription drug benefit introduced during the George W. Bush administration.

SARA ROSENBAUM: We know how to do these repairs - affordable subsidies, penalties for not enrolling. These are all very familiar terrain to health insurance policymaking.

HORSLEY: Obama even renewed the idea of a public insurance option which lawmakers rejected seven years ago. Many of these fixes would require at least some support from congressional Republicans. Obama says he hopes that might come easier once he's no longer in office.


OBAMA: They can even change the name of the law to Reagancare (ph).


OBAMA: Or they can call it PaulRyancare (ph).


OBAMA: I don't care...


OBAMA: ...About credit. I just want...


OBAMA: ...It to work.

HORSLEY: Of course Republican presidential hopeful Donald Trump has promised to repeal Obamacare altogether. So while he was in the swing state of Florida today, Obama also did some campaigning for Hillary Clinton. Scott Horsley, NPR News. Transcript provided by NPR, Copyright NPR.

Scott Horsley is NPR's Chief Economics Correspondent. He reports on ups and downs in the national economy as well as fault lines between booming and busting communities.