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Just over a year ago, Healthcare Triage's first video was on the opening of the exchanges mandated by the Affordable Care Act, and what people in the US should do about that. It's a year later, and we thought you might enjoy an update.
How are things going with the ACA, or Obamacare? What's changing? What do you need to be worried about now? We'll answer all that, and more, on this week's Healthcare Triage.

Many of the references for this can be found at a recent piece Aaron wrote for the JAMA Forum:

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
Just over a year ago, Healthcare Triage's first video was on the opening of the exchanges mandated by the Affordable Care Act, and what people in the U.S. should do about that. It's a year later, and we thought you might enjoy an update. How are things going with the ACA, or ObamaCare? What's changing? What do you need to be worried about now? We'll answer all that and more on this week's Healthcare Triage.

Last year around this time, the news was saturated with how bad the roll out of the exchange websites were going. Not only were they nearly impossible to use, and slow as stink, but when someone was actually (and rarely) able to complete an application, the data on the back end were often corrupted. It seemed likely at the time that those setbacks would significantly reduce how many people would be able to sign up for insurance plans.

But the administration made a number of moves to ensure that didn't happen. By April, when open enrollment ended, about 8 million people had signed up for exchange plans. This was more than the 7 million people that had been predicted to sign up for private insurance plans in the first year. In other words, things went even better than expected. The exchanges surpassed their benchmarks.

Opponents of ObamaCare argued that many of those who signed up for plans might not pay for them. They'd just go through the motions of signing up, but balk when the bill came. And of course, paying for a plan is the real metric of obtaining insurance. But by the summer, data showed that about 7.3 million people had payed their bills, meaning still, the benchmarks had been beat.

Other opponents claim that those signing up for plans were already insured- in other words, we weren't helping the uninsured as much as we'd hope. That turned out to be wrong too. Surveys by the Kaiser Family Foundation show that most of those who got insurance under the ACA didn't have it before. Further, poll after poll from organizations such as Gallup and the Commonwealth Fund show that the uninsured rate in the United States has dropped significantly this year.

So what was the next argument against the ACA? Some said that sicker or older people would preferentially sign up for insurance. Others said that regulations would make insurance much more costly than expected. Both of these issues would show up as significantly increased premiums for 2015 than we saw in 2014.

Did that happen? No. A number of different analyses, using a number of different methods, have shown that premiums appear to be increasing much less than you'd predict historically. In some areas, they're going down. Amazingly enough, overall healthcare spending is growing at one of the lowest rates we've ever seen. Now it's not clear whether this is because of the Affordable Care Act, or because of transient factors outside of its control, but given that spending growth is lower than expected, it's hard to argue that the ACA has made health care much more expensive.

And that's only the exchanges. What about the medicaid expansion? It, too, has only grown in the last year. Although many states have still refused to accept it, since a year ago, many states have joined the program: Indiana, Michigan, Pennsylvania, Iowa, Utah, even Tennessee, all appear to be moving towards, or have achieved some sort of compromise with the federal government. Why? Cause for many of them, it makes really goo economic sense. Hospitals and states with the Medicaid Expansion are reporting real increases in patients with Medicaid insurance and even larger decreases in patients who are uninsured. It's better for them, or course, to have patients with any insurance at all than no insurance.

In fact, states that have refused the expansion have seen their uninsured admissions go up. Research shows that states that don't expand Medicaid are not only leaving billions of federal dollars on the table, they'll also see increased state spending on uncompensated care, to the tune of more than a billion dollars in 2016 alone.

But that doesn't mean that things don't remain somewhat precarious. There are still a number of factors threatening the long-term viability of the affordable care act, including many politicians who are still wanting to see it repealed. These include a legal threat that still could lead to subsidies being denied to eligible individuals in many states.

But what does this mean for you? That's what we really care about here at Healthcare Triage, so let's spend a few minutes focused on that. There are still many people out there who qualify for Medicaid who have not signed up for it. You should check. Go to and fill in your information. That should tell you if you can get it. There's no open enrollment period for Medicaid, so don't wait. Just go.

Everyone else who doesn't have insurance, or who got it during the open enrollment last year- you need to go to the website between November 15h and February 15th. That's the open enrollment period for 2015. Even if you've already got insurance from the exchange already, you really, really should go again. It's true that if you don't, you'll just be re-signed up for the insurance you chose last year, but it's possible that some of those plans aren't there anymore. It's also possible that the plan you chose last year cause it was cheap is much more expensive this year. Benefits and prices can change. You all- all of you- should go and check.

The enrollment period is shorter this year than last year. And, it seems that 9 out of 10 Americans are unaware than open enrollment is about to start. We assume that you Healthcare Triage viewers are more informed than the average person, but it's still likely that a lot of you don't know about it.

Of course, if you have insurance through your job, or if you have Medicare, or if you have VA insurance, or if you're already on Medicaid (and all of those, that's the vast majority of of people in the United States)- there's nothing for you to do right now.

But as I said earlier, all 7.3 million people who have exchange plans need to go look at them again. If a better option is available, you might want to change. Millions more are still uninsured. You need to go check out your options, and claim the subsidies that may be available to you. Everything I said last year still holds true. Open enrollment starts November 15th, and it's a great opportunity. Don't miss it.