Changes

The ACA as passed assumed that the eligibility for [[Medicaid]] would be automatically expanded in all 50 states.  However, some states appealed this provision, and the US Supreme Court ruled that each state would have the right to decide whether to continue Medicaid on its present terms or to expand Medicaid to cover more low-income individuals.  Although the ACA provided for the federal government to pay for all costs of medicaid expansion during the first four years, there was no statutory guarantee for full federal funding after that time.  So, some states, particularly those with Republican Governors or Republican-controlled legislatures, refused to expand the eligibility requirements for the Medicaid program in their states.  However, hospitals faced financial pressures to limit or end free charity care for indigent patients under the new structure, leaving low-income people in a difficult, un-insured dilemma.

The ACA as passed assumed that the eligibility for [[Medicaid]] would be automatically expanded in all 50 states.  However, some states appealed this provision, and the US Supreme Court ruled that each state would have the right to decide whether to continue Medicaid on its present terms or to expand Medicaid to cover more low-income individuals.  Although the ACA provided for the federal government to pay for all costs of medicaid expansion during the first four years, there was no statutory guarantee for full federal funding after that time.  So, some states, particularly those with Republican Governors or Republican-controlled legislatures, refused to expand the eligibility requirements for the Medicaid program in their states.  However, hospitals faced financial pressures to limit or end free charity care for indigent patients under the new structure, leaving low-income people in a difficult, un-insured dilemma.

Individuals and families who earned enough money to not qualify for [[Medicaid]], and were not covered by employer-provided insurance, were then required to purchase insurance through health care exchanges in order to receive federal subsidies of insurance premiums and deductibles.  However, there were massive problems with the online health care exchanges operated by the federal government for states that did not set up their own exchanges.  This was true at the start of the open season in October 2013 as well as toward the end of the open season in March 2014.  Despite these problems, 7.5 million people signed up for insurance on the exchanges.<ref name=Sebelius/><ref>{{cite news|url=http://www.whitehouse.gov/blog/2014/04/01/more-7-million-americans-have-enrolled-private-health-coverage-under-affordable-care|title=7.1 Million Americans Have Enrolled in Private Health Coverage Under the Affordable Care Act|work=whitehouse.gov|date=April 1, 2014}}</ref>  This number does not indicate a growth in the number of people covered by private health insurance.  First, the 7.5 million includes people who became covered by Medicaid expansion.  Second, some of the people were already covered by a grandfathered health plan, but were forced to purchase on the exchange so as to receive premium and deductible subsidies.  Third, some states, like California, required insurance companies to cancel their existing insurance plans as a precondition of offering plans on the health care exchanges. Forth, purchasing a plan and signing-up are two very different criteria in determining the viability of government healthcare. The Obama administration has declined to provide "paid for" statistics.  

Individuals and families who earned enough money to not qualify for [[Medicaid]], and were not covered by employer-provided insurance, were then required to purchase insurance through health care exchanges in order to receive federal subsidies of insurance premiums and deductibles.  However, there were massive problems with the online health care exchanges operated by the federal government for states that did not set up their own exchanges.  This was true at the start of the open season in October 2013 as well as toward the end of the open season in March 2014.  Despite these problems, 7.5 million people signed up for insurance on the exchanges.<ref name=Sebelius/><ref>{{cite news|url=http://www.whitehouse.gov/blog/2014/04/01/more-7-million-americans-have-enrolled-private-health-coverage-under-affordable-care|title=7.1 Million Americans Have Enrolled in Private Health Coverage Under the Affordable Care Act|work=whitehouse.gov|date=April 1, 2014}}</ref>  This number does not indicate a growth in the number of people covered by private health insurance.  First, the 7.5 million includes people who became covered by Medicaid expansion.  Second, some of the people were already covered by a grandfathered health plan, but were forced to purchase on the exchange so as to receive premium and deductible subsidies.  Third, some states, like California, required insurance companies to cancel their existing insurance plans as a precondition of offering plans on the health care exchanges. Fourth, purchasing a plan and signing-up are two very different criteria in determining the viability of government healthcare. The Obama administration has declined to provide "paid for" statistics.  

Some people thought that they had purchased insurance through the exchange, but because of malfunctions in the back office of the exchange, the insurance providers did not receive any record of the insurance purchase.  The Obama Administration  launched a crash program to fix the federal exchange software and in January 2014 replaced the contractor responsible for building and operating the healthcare.gov website.<ref>{{cite news|url=http://www.washingtonpost.com/blogs/post-politics/wp/2014/01/10/obama-administration-to-replace-top-healthcare-gov-contractor/|title=Obama administration to replace top HealthCare.gov contractor|date=January 10, 2014|accessdate=April 3, 2014|work=Washington Post|author= Juliet Eilperin and Amy Goldstein}}</ref>

Some people thought that they had purchased insurance through the exchange, but because of malfunctions in the back office of the exchange, the insurance providers did not receive any record of the insurance purchase.  The Obama Administration  launched a crash program to fix the federal exchange software and in January 2014 replaced the contractor responsible for building and operating the healthcare.gov website.<ref>{{cite news|url=http://www.washingtonpost.com/blogs/post-politics/wp/2014/01/10/obama-administration-to-replace-top-healthcare-gov-contractor/|title=Obama administration to replace top HealthCare.gov contractor|date=January 10, 2014|accessdate=April 3, 2014|work=Washington Post|author= Juliet Eilperin and Amy Goldstein}}</ref>