Dylan Scott

Dylan Scott is a reporter for Talking Points Memo. He previously reported for Governing magazine in Washington, D.C., and the Las Vegas Sun. His work has been recognized with a 2013 American Society of Business Publication Editors award for Best Feature Series and a 2010 Associated Press Society of Ohio award for Best Investigative Reporting. He can be reached at

Articles by Dylan

Jane Orient, a physician in Tucson, Ariz., says she's never accepted a dollar of third-party medical payments, whether from a government program or a private insurance company. She has a "philosophical and ethical" opposition to the U.S. health care infrastructure, and she's put it into practice for more than 20 years.

But with Obamacare set to take full effect in January, Orient says more and more physicians are joining with her in opting out of a payment system that she describes as co-opted by "insurance cartels" and the nanny state.

Orient is the executive director of the American Association of Physicians and Surgeons, a free-market group that claims 4,000 members nationwide, including Sen. Rand Paul (R-KY). Paul himself hasn't endorsed physicians pulling out of the third-party system, but he has said that if a "right to health care" is invoked, then doctors could be conscripted against their will.

"It means you believe in slavery," Paul said in a clip from a Senate committee hearing posted by the AAPS YouTube account.

More than half of AAPS members have stopped accepting Medicaid payments, Orient says, though she stresses that they'll still see patients if they either pay for themselves or come to a free charity clinic. A smaller number of her membership is also bucking the private insurance industry, asking for direct payments from customers and telling them to seek reimbursements from their insurers on their own.

They see themselves as the front lines in the fight against a "plan ... to destroy the current infrastructure," as Orient put it in a recent interview with TPM. Winning that fight starts with convincing their peers and patients to break away from the system set up under the health care reform law.

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Enrollment on continued its upward swing this Tuesday, according to a report by the Washington Post.

Tuesday's enrollment was 27,000, the Post reported, citing "internal figures." As TPM reported Wednesday, enrollment on Sunday and Monday -- the first two days after the Obama administration declared the federal website fixed -- came in at 29,000.

That brings the three-day December total to roughly 56,000. Enrollment in all of October was less than 27,000 through

Official November figures are expected to be released by the middle of December. is having trouble transmitting data to state Medicaid agencies to verify that consumers are eligible for the program under Obamacare.

TPM reported Tuesday on the problem. A CMS official said that the automatic data transfer process is not yet fully functional, so Medicaid enrollment numbers through the federal website have not been finalized.

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States not expanding Medicaid under Obamacare will be collectively lose more than $35 billion in federal funds in 2022 alone, according to a new report from the Commonwealth Fund.

Texas ($9.2 billion), Florida ($5 billion), Georgia ($2.9 billion), Virginia ($2.8 billion) and North Carolina ($2.6 billion) will be the biggest losers, according to the organization, which supports Obamacare. The study's projections of the budget impact nearly a decade out relied on estimates of Medicaid expansion eligibility and spending in 2022 from the Urban Institute to reach its conclusion.

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Enrollment on in the first two days of December, after the Obama administration declared the website fixed, eclipsed enrollment in the entire month of October.

About 29,000 people signed up for health coverage on Sunday and Monday through the site, according to a source familiar with the numbers. October enrollment on totaled less than 27,000. State-specific data is not yet available, and the figures are preliminary.

The new enrollment data were first reported by Politico.

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Republicans aren't impressed with the Obama administration's claim that is now effectively fixed. That's not really the issue, they've started to say. No, the problem is canceled policies, lost doctors and higher premiums. Who cares if the website is working?

That is a far cry from the early days of October when a dysfunctional website was "proof" that Obamacare "has been an unmitigated disaster" in the words of House Speaker John Boehner in an Oct. 4 statement.

But that's no longer the preferred talking point. Instead, the GOP has become enamored with insurance cancellations that they say violate President Obama's "if you like your health plan, you can keep it" promise and claims of rate shock. Boehner reinforced that shift at his most recent press conference.

"It's not just a broken website," he said Tuesday. "This bill is fundamentally flawed, causing people to lose the doctor of their choice, causing them to lose their health plan, and if that's not enough, they have to pay more in premiums."

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President Obama urged supporters Tuesday to encourage people to return to or check it out for the first time now that the website is working better.

He made both a direct plea to those discouraged by the site's problems to come back and to supporters to "spread the word" about the law and its benefits.

"We need people now that we're getting the technology fixed, we need you to go back and take a look at what's going on because it can make a difference in your lives and lives of your families," Obama said at the White House. "And maybe it won't make a difference right now if you're feeling healthy, but I promise you, if somebody in your family heaven forbid gets sick, you'll see the difference."

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President Obama defended the Affordable Care Act in a Tuesday speech, asserting that is working better and people are getting covered.

"The bottom line is this law is working and will work into the future," he said at the White House. "People want the financial stability of health insurance, and we're going to keep on working to fix whatever problems come up in any startup or launch of a project this big that has an impact on one-sixth of our economy."

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Nearly 1.5 million Americans have enrolled in Medicaid or the Children's Health Insurance Program since the state Obamacare marketplaces went live on Oct. 1, according to a new report released Tuesday.

The report from the federal Centers for Medicare and Medicaid Services is the most comprehensive look yet at how the low-income public insurance programs are faring under the health care reform law. It covers the month of October, and CMS said that more reports would be released on a monthly basis.

The total includes both those who are newly eligible for Medicaid in states that expanded the program and those in all states who were already eligible. They were funneled to the program both through the state-based insurance marketplaces that have opened under Obamacare and other sources (applying through local government offices, etc.).

Coverage for those newly eligible under the Medicaid expansion starts on Jan. 1, 2014.

It does not, however, include those deemed eligible through, which is serving 36 states. According to CMS, the automatic transfer of applications from the federal website to state Medicaid agencies is not yet fully functional, so those numbers haven't been finalized. In the administration's last enrollment report, it said that 183,000 people in states using had been found eligible for Medicaid.

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President Barack Obama will aim to redirect the conversation about and the health care reform law in a Tuesday speech, emphasizing its benefits for Americans and warning about the dangers of repealing it.

It's yet another reboot of the White House's messaging campaign, a few days after the administration declared the insurance website fixed. The speech is the start of a three-week push, according to Politico, which first reported the White House's plans. That would take it up to Dec. 23, the last day people can enroll in a health plan that starts in January.

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