Rick Jervis, USA TODAY
Most Americans know the Affordable Care Act - aka "Obamacare" - as the legislation birthed from one of the most acrimonious political debates in years. In 139 days, the law will shift from talking points to the kitchen table, from an eventuality to reality. This sweeping government experiment, after all, stands to affect tens of millions of people.
Jan. 1, 2014, will be the official launch date for a federal endeavor that will reshape the U.S. health insurance market coast to coast. People without insurance can start signing up Oct. 1. Depending on where you live, your experiences with the new law - and your costs - could differ dramatically.
USA TODAY's Julie Schmit, Rick Jervis and Greg Toppo reported from California, Texas and West Virginia to see what people are seeing, and thinking, as the law is being rolled out in three very different ways in these three states.
• • •
AUSTIN - Sometimes Darrell Tatum's car gets only a quarter-tank of gas. Other months, the grocery list gets whittled down. Or the purchase of notebooks, pens and other school supplies for five children is postponed.
The budgetary gymnastics Tatum and his wife, Quintina, perform each month are necessary to meet the $500-to-$600 monthly health care premiums they pay - an amount that has risen steadily over the years and that he says is slowly drowning the Dallas couple in debt.
Tatum, 41, says he's stuck in financial limbo: He makes too much money as a municipal worker to qualify for benefit programs for the poor but not enough to cover the rising cost of health care.
"We're trying to do the best we can with what we have, but it's rough," he says. "It's almost like you're penalized for working."
HOPE OR HEADACHE?
For Tatum and thousands like him, the Affordable Care Act and the health insurance exchanges offer hope. Almost one in four Texans - more than 6 million residents - are uninsured, the highest rate in the nation, according to the Census Bureau. The Affordable Care Act could halve the Texas number by next year, according to a recent study by the Hobby Center for the Study of Texas at Rice University.
Welcomed by many residents and scorned by others, the law has been vilified by Texas' Republican leaders. Gov. Rick Perry has led the charge, criticizing the legislation as bad policy and the health insurance exchanges it creates as lacking appropriate funding. Texas, along with 26 other states, has opted not to set up a state-run exchange to market health coverage to the uninsured. For states with leaders who disagree with the initiative, it's the best way to protest the Washington directive. In these cases, the federal government will run the exchanges.
Texas would be better off receiving block grants from Washington to help the uninsured rather than being forced to participate in a federal system, says state Sen. Dan Patrick, R-Houston, an outspoken critic of Obamacare who has been a state senator since 2007.
"We're smarter about Texas than Washington is," he says. "This is the worst legislation I've ever seen from the federal government."
Despite the resistance from state leaders, grass-roots groups across the state are scrambling to inform Texans about the exchanges. Foundation Communities, an Austin-based group that helps low-income residents with their taxes, has set up two enrollment centers to help residents sift through the benefits of the law, says Elizabeth Colvin,a director of the group.
The key struggle is persuading residents that the exchanges will be available, despite highly publicized attacks from leaders in Austin, she says. "It's a challenge for Texans because there's no state leadership on this issue," Colvin said. "It's all coming from the local level."
Cost predictions have been elusive because the federal government has yet to release the health care rates that will be available through the exchanges, says David Warner, health and social policy professor at the University of Texas.
One group of Texans stands to instantly benefit: the "high-risk pool," those previously uninsurable because of pre-existing conditions or other factors. The new law will cut their premiums in half, Warner says.
Also set to benefit are individuals not part of a large employer insurance group. "They'll be able to get coverage, and it won't be totally unaffordable," Warner says.
That's welcome news for Will Love, 27, co-owner of an Austin video production company who has been uninsured for two years. After the Houston firm he worked for closed, Love paid for his own insurance from Humana. The rates steadily began to climb, from $125 a month to $150 a month, even though he remained healthy and incident-free. So he dropped coverage.
He says he's counting on a stable, affordable alternative with the exchanges. "I hope to find a reasonable price with a reasonable company that's not going to jack up the prices once you sign up," Love says.
Though Tatum first heard about the exchanges via a friend's Facebook post, he plans to attend seminars to learn more about the program he says could better his life.
"It'll give me a better feel for where my dollars are going and what I think is best for my family," Tatum says. "I'd just like to have that option."