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OAKLAND — Leyla Hilmi, 42, is counting the days to Oct. 1 when she'll be able to sign up for health insurance as part of the Affordable Care Act.
The self-employed San Francisco-area architect is getting divorced and will lose coverage. Because of a previous medical condition, she's been denied coverage in the past.
"I would be really, really stuck if it wasn't happening," Hilmi says.
Tremaine Manning, 30, a construction worker in central California, isn't as enamored of the new law. He's lacked health insurance for three years, rarely sees a doctor and struggles to make ends meet.
If he doesn't get insurance, he faces a penalty of 1% of his income in 2014, and more after that.
"If you don't have the money, you're going to get penalized. That seems like a double whammy," Manning says.
Given California's size — and the fact that it has one of the highest rates of uninsured residents in the nation, at 20% — its effectiveness in enrolling people such as Manning will be an important test of the new health care law, which requires most people over the age of 18 to have health insurance or pay a penalty starting in 2014.
"People will be watching California," says Paul Ginsburg, president of the non-partisan Center for Studying Health System Change.
California is one of 16 states (and the District of Columbia) that have set up their own marketplace to offer health insurance. The heavily Democratic state was the first to start setting up its own exchange under the federal act, getting a jump on other states in the process.
About 2.6 million Californians will qualify for federal assistance to reduce the cost, says Covered California, the agency running the marketplace, or exchange. An additional 2.7 million could buy through the exchange even if their incomes disqualify them for subsidies.
Covered California hopes to enroll up to 1.4 million people in insurance plans by 2015.
Many younger people won't sign up for the Covered California insurance because it'll cost them more than the annual penalty, says Sally Pipes, Obamacare opponent and CEO of the San Francisco-based Pacific Research Institute. In 2014, the penalty will be 1% of income or $95, whatever is greater.
Over time, the lack of younger people enrolling will make it less enticing for insurers to take part in Covered California and eventually lead to even more government involvement, Pipes says.
"We'll have Canadian-style health care," Pipes says. She sees Covered California as one more costly government program that will drive job-creating and wealthier Californians out of the state while those needing more services will continue to pour in. Only citizens and legal permanent California residents can participate, though, in Covered California.
What the uninsured will pay for coverage has yet to be revealed. But a sampling of proposed rates shows lower premiums for Californians than many expected.
"We've been pleasantly surprised," says Betsy Imholz, health care expert for Consumers Union.
Consumers will have at least two insurance companies from which to choose and up to six in more populated areas. Premiums vary by plan, coverage and consumer ages and locations.
For instance, a 40-year-old in Sacramento with a modified adjusted gross annual income of $22,981 to $28,725 a year might pay $206 a month for coverage from Kaiser Permanente.
In parts of Los Angeles, the cost would be $234 for similar coverage, Covered California says.
A federal subsidy — paid to Kaiser — would run $140 for the Sacramento client and $60 for the Los Angeles one.
Big enrollment is key to the plan's success because that will help spread costs, says Daniel Zingale, senior vice president of California Endowment, a private health care foundation.
One challenge will be enrolling the young and healthy. They'll pay premiums, but most won't need costly health care. The insurers need those customers to balance the cost of older enrollees who are more likely to need more services than their premiums cover, says Marian Mulkey at the California HealthCare Foundation.
Another big challenge: California's diversity.
More than 100 languages are spoken statewide. Of those eligible for federal subsidies, about 1 million speak limited English, a recent study showed.
To help spread the word, Covered California has issued $37 million in grants to 48 community groups and agencies, including unions and community clinics. Those groups will work with more than 200 others to reach out to consumers in such places as nail salons, farmers' markets, block parties, food distribution centers, even support groups.
The challenges facing Covered California were on full display outside a low-cost health care clinic on a recent afternoon in downtown Oakland. Here, Southeast Asian groceries and Mexican restaurants line the same street. English-speaking children translate for their Spanish-speaking mothers. The clinic is packed with people, many of whom greet the phrase "Covered California" with blank expressions.
Jesus Martinez, 23, who works in asbestos removal, is convinced any insurance offered by the government will be too expensive — even though he isn't familiar with Covered California.
Hilmi has gotten much of her Covered California information from unofficial Facebook postings — some of which were inaccurate. Insurance brokers lacked specifics, too.
Manning's girlfriend, Christina Fugazi, attended a recent town hall meeting, one of several state officials have held, to get information for him and other uninsured friends and relatives.
With Covered California, the cost for Manning to get insurance, she says, "is less than he pays for car insurance."