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NY1 Reports: Understanding The Affordable Care Act, Part 5

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The implementation of Obamacare is well underway in New York, but it's a different story in many states where the need for insurance is the greatest. Washington bureau reporter Michael Scotto filed the following report, part five of NY1's six-part series on the Affordable Care Act.

When President Obama signed the Affordable Care Act into law, he didn't count on his opponents rejecting key provisions of it. But that is exactly what is happening now.

"The administration, in this case, has faced astounding problems," says Sara Rosenbaum of George Washington University.

Take Medicaid. Last year, the Supreme Court ruled that the administration couldn't force states to expand it to poor adults making about $15,000 per year. As a result, according to the Kaiser Family Foundation, 21 states, with possibly more on the way, are planning to not add more people to their rolls, leaving about 6 million people, or two-thirds of those who would have benefited from the expansion, without any insurance at all.

"In the states that don't expand Medicaid, the poorest uninsured will have no help at all," says Stan Dorn of the Urban Institute. "People slightly above poverty will have some help."

According to health care experts, the states themselves may also get hurt. That's because, they will lose out on free federal money to cover the entire expansion for three years and will also get less aid to pay for costs associated with treating people who don't have insurance.

"For states that don't expand Medicaid, they get all the pain in their hospitals, but only half the gain," Dorn says. "Those hospitals are going to lose all of that reimbursement, but they're going to get only some of the increase in paying customers coming through the door. So those hospitals could really end up suffering."

The administration is also dealing with the enormous logistical challenge of setting up health insurance exchanges. According to Kaiser, 17 states have chosen to run their own, leaving the federal government to play a role in two-thirds of the country.

The undertaking has been difficult, to say the least.

"Congress did not appropriate enough money to support the rollout, especially a rollout that turned out to have to be a lot bigger federal rollout than anyone ever thought," Rosenbaum says.

Despite the bumps, it's expected that the law will still result in tens of millions of people getting health insurance.

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