Ten million people still don't have health insurance two years after the Affordable Care Act went into effect.
Some never bought a policy. But 20 percent went to the trouble of signing up on HealthCare.gov, or one of the state insurance exchanges, and even made payments. Then, those 2 million people let their insurance lapse.
NPR asked visitors to our Facebook page to tell us why.
Many, like Laura Patterson, dropped their coverage when they got good news on the job front.
"I was a seminary student working part time at a church and I needed health insurance," she says. "I enrolled for the first half of the year in a plan that I knew, even if I just had a fairly minor accident, I wouldn't be able to pay all the bills. When I graduated from seminary and got a full-time job as a pastor, I had really great coverage through my church, so I dropped my ACA plan."
Others say they dropped their Obamacare health coverage because they found the plans too confusing, too expensive or not worth it.
Brendan Skwire tells NPR his insurance was too pricey. "Basically, my premiums doubled when my income imploded," he says. "I simply couldn't afford to pay the bill."
Several people say they were dropped from their health plan's rolls without warning. Elaine Marie was one of many who tell us they never knew their insurers were seeking more information from them.
"I was dropped from my plan last year for 'not providing additional income information,' " Marie says. "I check my mail regularly, and did not receive notice in the mail, or via email, or through the secure exchange system email."
Meanwhile, Vic Higgs of New York says the premiums and copays required in her current Obamacare plan are too expensive, relative to the small amount of medical care she uses each month. She plans to drop the plan in January.
"I only visit two doctors a year, and only receive one monthly prescription that — prior to having insurance — cost me 80 bucks a month," Higgs writes. "I think paying directly for the doctor visits and prescriptions is cheaper right now than having insurance."
As open enrollment begins this Sunday, these are some of the people Uncle Sam is going to try to re-enlist in the health care exchanges.
In the two years since the Affordable Care Act went into effect, most people eligible who actually wanted health insurance and could afford it have been enrolled.
The remaining patients who lack insurance will be harder to lure — and harder to keep, says Sylvia Burwell, secretary of the department of health and human services.
Burwell says people in this group tend to be young, and live barely above the poverty line. About a third are members of minority groups, and most are men.
"The remaining uninsured just get harder and harder to reach," says Larry Levitt, a health reform and insurance markets analyst at the Kaiser Family Foundation.
There's little information showing where people go when they leave the exchanges. A study of the California market found only 15 percent quit and remained uninsured. Levitt says the national figures are probably about the same.
So what's the government to do? HHS is trying a variety of strategies.
The agency plans to use email, text messages, Facebook and online ads to convince the holdouts to get insurance. It's also launching some new Web tools that will allow people to compare health plans more easily and estimate their cost.
A new app lets consumers input details of their medical needs, including the names of doctors and medications, to find appropriate plans. The app also allows them to estimate how many visits they expect to have, and prescriptions they expect to use, as well as estimate how much they're going to spend out of pocket, beyond of their monthly premiums.
And for the first time, HHS will talk about penalties. People who don't buy a policy of some sort will face a $695 charge per adult at tax time next year.
The agency will get lots of help from private groups in enrolling patients this year. For example, the nonprofit group Enroll America has staff in 14 states and works with community organizations across the country.
"We do a lot of work with faith leaders across the country," says Anne Filipic, the group's president. "We work with community colleges and small business owners. We work with restaurant associations and taxi cab associations. Perhaps we'll go to church on Sunday, and we'll actually stand up in front of the congregation and share with them the information."
Enroll America will be offering its own Web app to help with the comparison of health plans.
The hope is that extra clarity will reduce unexpected costs and help keep people like Dave Egbert and his partner Rich Davis motivated to get insured and stay that way.
Egbert, of Huron, S.D., also contacted NPR via Facebook. He says he and Davis each dropped their coverage because the fees for doctor visits and tests added up unexpectedly. They could pay the premiums, Egbert says, but the overall costs were too much.
"I couldn't afford to actually use the health insurance," he says.
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