BC-US--Healthcare Overhaul,ADVISORY, US

Staff Writer
Columbus CEO


On Tuesday, the Affordable Care Act, often called "Obamacare," will become a reality for consumers. That's the date when open enrollment starts for the health insurance exchanges, or marketplaces, set up in each state and people can start shopping for health plans. Actual coverage begins Jan. 1.

The AP has offered a robust package of content ahead of Tuesday's opt-in date. The stories and most of the photos were transmitted on Sept. 11 for immediate release. Videos are moving this week and next, and are listed below. Details on the roll-out of the interactives and print graphics also are listed, along with the stories that have moved.

Questions can be directed to Managing Editor Kristin Gazlay at kgazlay@ap.org or 212-621-1611.

The AP

The rundown:


WASHINGTON — Having health insurance used to hinge on where you worked and your medical history. Soon that won't matter, with open-access markets for subsidized coverage coming Oct. 1 under President Barack Obama's overhaul. But there's a new wild card, something that didn't seem so critical when Congress passed the Affordable Care Act back in 2010: where you live. Entrenched political divisions over "Obamacare" have driven most Republican-led states to turn their backs on the biggest expansion of the social safety net in a half century. If you're uninsured in a state that's opposed, you may not get much help picking the right private health plan for your budget and your family's needs. And if you're poor and your state rejected the law's Medicaid expansion, odds are you'll remain uninsured. By Ricardo Alonso-Zaldivar. SENT: 1,400 words, photos


WASHINGTON — Getting covered through the health care law might feel like a combination of doing your taxes and making a big purchase that requires some research. A step-by-step guide to applying for coverage under the law. By Ricardo Alonso-Zaldivar. SENT: 920 words, photos

— HEALTH OVERHAUL-TIMELINE — Key dates in the saga of the health care law. SENT: 1,000 words.

— HEALTH OVERHAUL-GLOSSARY — Major new laws come with their own jargon, and the health care overhaul is no exception. With the first open enrollment season kicking off for the uninsured, here are some terms consumers might want to get familiar with. SENT: 700 words.

With these archetype profiles:


As many as 9 in 10 Texans buying health insurance on the new federal exchange will get a break on costs, according to federal health officials. Steve and Maegan Wolf will not be among them. The Wolfs, who run their own business and live in an upscale area outside Austin, make too much money to qualify for tax credits that will help other people pay for health insurance. That leaves them wondering how much they'll wind up paying. By Carla K. Johnson. SENT: 750 words, photos


SEATTLE — President Obama's health care reforms will be a huge boost to the working poor but are likely to make life more expensive for Aaron Brethorst and others like him. The Seattle software developer and consultant doesn't have a problem with that because he figures he'll be able to afford quality insurance. He says his annual income is in the low six-figures, and he expects to receive better coverage once the Affordable Care Act kicks in. Yet that outlook is not likely to be universal among those who are self-employed. Individuals who have an adjusted gross income of more than $33,000 a year will not be eligible for government subsidies when they shop for insurance on their state exchange. By Donna Gordon Blankinship. SENT: 600 words, photos


MIAMI — In the decades before she was diagnosed with bipolar disorder, 32-year-old Jessi Spencer-Hammac thought she was just a moody, restless dreamer who had trouble finishing projects. Hammac, who says she can't afford health insurance, pays for all of her treatment out-of-pocket. But under the Affordable Care Act, insurers are barred from turning away those with pre-existing conditions. For Hammac, it could mean an end to buying her $100-a-month mood-stabilizing medication at a discounted price in Canada and the chance to see her therapist more regularly. By Kelli Kennedy. SENT: 590 words. Photos, video.


PHOENIX — Helena Gudger is the type of person health insurers need on the books as the new health care overhaul law rolls out: young, relatively healthy and hungry for coverage. The 26-year-old Phoenix resident has gone the past four years without health insurance, using clinics and the county hospital for checkups, routine tests and visits to a gynecologist. She pays cash, checks prices and tries to go when doctors are offering discounts. But she's also aware that she'll be in a lurch if she gets sick, which is why she is seriously considering buying private insurance when Arizona's exchange opens for enrollment in October. By Bob Christie. SENT: 700 words. Photos, video.


LANSING, Mich. — Eric Jones has an incentive to end his monthly trips to the party store for cigarette tubes and tobacco, the roll-your-own supplies used to fill a pack-a-day habit. The 40-year-old from Charlotte, Mich., now has no health insurance from his $9-an-hour job at an ice-manufacturing plant. Under the federal health care law, he's eligible for help from the government to buy a private insurance plan. But to qualify, he'll almost certainly have to quit smoking. As a smoker, he may face a financial penalty ranging from roughly $1,600 to $1,900 a year that effectively will make coverage unaffordable. By David Eggert. SENT: 640 words, photos


ALBANY, N.Y. — Restaurant owners Colleen and Tim Holmes were considering opening a third business in a growing upstate New York suburb but decided against it. One factor was the risk in expanding their staff beyond 50 full-time employees and having to provide federally mandated health coverage next year. Despite knowing the penalty provisions for noncompliance have been postponed one year, the couple said their margins are thin and the requirements and costs of the health care law are not yet clear. By Michael Virtanen. SENT: 630 words, photos


DENVER — He makes just $10,000 a year as a clinical professional counselor, so Morgan Kinney decided to spend what little extra money he had this year paying down student debt rather than buying health insurance. The 31-year-old Denver man figured he would have no choice but to buy insurance next year to comply with the new federal health insurance mandate, so last month he entered his personal information into the online calculator of the Colorado insurance exchange. Yet instead of a cost estimate, he received a rejection notice saying he was not eligible to shop on the exchange: "I was telling my girlfriend, 'This thing is broken, it won't let me in,' and she looked and said, 'I think it's because you're supposed to be on Medicaid.' I said, 'No, that's for poor people.' Well, sure enough, that was me." By Kristen Wyatt. SENT: 570 words. Photos, video.


LAWTON, Okla. — When Chris Gatliff's health insurance runs out at the end of the year, the 38-year-old diabetic plans to stock up on as much medication as he can afford and hope for the best. A part-time worker at a pizza shop, Gatliff is one of about 30,000 Oklahomans who receive coverage through Insure Oklahoma, a state program funded partly with Medicaid dollars that is scheduled to cease operating on Dec. 31. The federal government did not renew the program, nor did it accept the expansion of Medicaid offered under the Affordable Care Act. The expansion would have provided medical coverage to as many as one-third of Oklahoma's 636,000 uninsured citizens. By Sean Murphy. SENT: 690 words, photos


A series of consumer-oriented questions about the opening of the health care exchanges and what the Affordable Care Act will mean to individuals. Among the issues to be explored will be the individual mandate, the color-coded health plans, the effects on those with employer-sponsored care and expected changes related to the actual delivery of health care. SENT: 1,750 words.


A 500-word primer on the actual changes to health care under the Affordable Care Act, including an explanation of the 10 essential benefits that must be offered, the role of the exchanges in offering dental and vision coverage, and details about out-of-pocket requirements and lifetime coverage caps. SENT: 620 words.


—HEALTH OVERHAUL-PROFILES: Videos of individuals in Seattle, Miami, Denver and Virginia who will be affected by the Affordable Care Act. Produced by Ted Shaffrey. Moves Wednesday, Sept. 25 at 1 a.m. EDT.

— HEALTH OVERHAUL-EXPLAINER: "Obamacare" how-to with Associated Press writer Ricardo Alonso-Zaldivar, a Q&A produced by Kelly Daschle. Moves Monday, Sept. 30.


Sept. 11

— INTERACTIVE: An overview of the ACA, with primer video/FAQ and timeline of implementation; animated explanations of what the law does, how it is implemented, and where personal data goes during the application process.

— PRINT GRAPHIC: Graphic timeline of developments since the passage of ACA in 2010 and state-by-state look at key statistics: how many Medicaid patients, uninsured, employer-insured, where Medicaid is expanding, which exchanges are run by states, feds, or partnership.

Sept. 20

— INTERACTIVE: State-by-state look at various metrics affected by ACA; calculator for consumers to estimate approximate costs and government subsidies, with personally tailored results and details on how insurance payments might vary.

— PRINT GRAPHIC: Examples of how health care consumers in five broad demographic categories would be affected by provisions in the law that have taken effect.

Sept. 27

— INTERACTIVE: An animated video tour of the application process for health care coverage and tax credits through the new marketplaces known as exchanges, including an overview video and annotated application form.

— PRINT GRAPHIC: Application process graphic including how to access forms, how people not online can apply, what information is required and application flow through federal data hub.


The following stories that moved earlier this year also will be retransmitted for those wanting additional material for websites or for publication. All of them offer forms of localization opportunities:

Originally moved April 16


CHICAGO — It has been six decades since the medical community concluded that addiction was a disease that could be treated, but still today no other medical condition dwells more in the shadows. Just 1 cent of every health care dollar in the U.S. goes toward addiction, and few alcoholics and drug addicts receive treatment. One huge barrier, according to many experts, has been a lack of health insurance for the disorder. But that barrier crumbles in less than a year. In a major break with the past, 3 million to 5 million people with drug and alcohol problems — from homeless drug addicts to working moms who drink too much — suddenly will become eligible for insurance coverage under the new health care overhaul. But those eager for a new chance at sobriety may be surprised by the reality behind the promise. The system for treating substance abuse is small and thinly staffed and already full to overflowing in many places. Six months before enrollment begins for the new health insurance plans, addiction treatment represents an extreme example of one of the new health law's challenges: actually delivering all the care that people are entitled to. By AP Medical Writer Carla K. Johnson. RETRANSMITTED. 1,500 words, photos

— HEALTH OVERHAUL-ADDICTION-GLANCE — A state-by-state list of those receiving treatment and eligible for treatment under the Affordable Care Act. RETRANSMITTED. Table.

Originally moved June 22:


COLUMBUS, Ohio — Getting face time with the family doctor could soon become even harder. A shortage of primary care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage under the federal health care law next year. Doctors are preparing for backlogs, and patients could find it difficult to get quick appointments. Attempts to address the shortage have taken on increased urgency ahead of the law's full implementation on Jan. 1, but many of the potential solutions face a backlash from influential groups or will take years to bear fruit. Lobbying groups representing doctors say many of the proposed changes, including expanding the role of nurse practitioners and pharmacists, will create a two-tiered health system that offers unequal treatment. As fixes remain elusive, the shortfall of primary care physicians is expected to grow from an estimated 40,000 today to 65,000 in little more than a decade. By Ann Sanner. RETRANSMITTED. 1,300 words, photos

— HEALTH OVERHAUL-DOCTOR SHORTAGE-GLANCE — A state-by-state chart showing the number of physicians per state, the rate per capita and each state's ranking nationally. RETRANSMITTED. Table.


— A report shows the number of physicians per state, the rate per 100,000 residents and each state's ranking nationally, according to the Association of American Medical Colleges. Table 3 shows the number primary care physicians per state. These numbers represent the active primary care doctors who self-reported direct patient care, as opposed to primary care doctors who are teaching or doing medical research or administrative work. See the full report here: https://www.aamc.org/download/263512/data/statedata2011.pdf


In the link below, you will see regions and counties that are designated by the federal government as having a current shortage of primary care services. You can then contact doctors, patients, health centers and others in those areas to get a better sense of the need. Here are step-by-step instructions:

1. Go to this site: http://hpsafind.hrsa.gov/

2. Select your state from the drop-down menu.

3. Highlight "All Counties" under the County section.

4. Highlight "Primary Medical Care" under the Discipline section.

5. Click "Show me the HPSAs."

6. The site will generate a report.

7. Ignore the columns FTE and #Short. To see your state's shortage areas that are more severe, look at the column headed "Score." It's on a scale of 1 to 25, with higher numbers indicating greater problems with access to primary care. The "score" is a government designation that includes: population-to-primary care physician ratio, percent of the population with incomes below 100 percent of the poverty level, infant mortality rate or low birth weight rate (whichever scores more highly), and travel time or distance to nearest available source of care (whichever scores more highly).

8. Focus on the geographic areas or counties that have been designated as having a shortage. (Some facilities, such as prisons, receive designations, as do some health centers because of their funding. The federal government also tracks population groups, such as Native Americans, who are underserved.) Note these shortage areas do not take into account that other providers such as nurse practitioners or physician's assistants might be available to provide care.

Originally moved March 4


OAKLAND, Calif. — Set on a gritty corner of Oakland's International Boulevard, the nonprofit Street Level Health Project offers free checkups to patients who speak 22 languages, from recent Mongolian immigrants seeking a doctor to Burmese refugees in need of a dental exam. It also provides a window into one of the challenges for state officials who are trying to implement the Affordable Care Act, President Barack Obama's sweeping health care overhaul. Understanding the law is a challenge even for governors, state lawmakers and agency officials, but delivering its message to non-English speakers who can benefit from it is shaping up as a special complication. That is especially true in states with large and diverse immigrant populations. By Garance Burke and Judy Lin. RETRANSMITTED. 1,400 words. Photos, video.



The most recent U.S. Census language estimates are from 2007 and are broken down by state.

A link to the press release can be found here: http://1.usa.gov/9dW69h


Download the following spreadsheet to get a list of the state tables (see tabs at bottom of Excel chart):



To find the most commonly spoken languages besides English by county, go to the U.S. Census Bureau's American Fact Finder and find the dataset you want to sort:

— Go to: http://factfinder2.census.gov

— Click on Advanced Search.

— Click on "Show Me All."

— Click on the Topics menu on the left-hand side of the web page. A pop-up box will appear. Click "+'' on Dataset to expand the selection. Click on "2011 ACS 5-year estimates" and close the window.

— Click on the Geographies menu. A pop-up box will appear. You will be asked to select a geography type. Click on "county" in the drop down menu. Select a state. Select all counties or a specific county. Then click "Add to Your Selections." Close the window.

— Under search results, you will see "Narrow your search" or "Refine your search results" next to a search field. Type in "B16001" for the dataset on language use at home. Hit go. Click the small box on the left to select that dataset and then click on view to get your results.

— You can download your results into Excel to sort.

The AP