State officials report a surge in enrollment in the two-week grace period that ended Tuesday to enroll for insurance under the Affordable Care Act, but many more Californians have yet to sign up.
According to interviews with the uninsured and experts, many people are uninterested in the health insurance polices or are still skeptical or confused.
"I’ve been consumed with living my life, and I'm fortunate to be healthy," said Scott Belsha, a Long Beach native. He works as a musician and carpenter, and he's never had health insurance — not even as a kid. His parents, who own a small business, always paid cash for medical care — most of which they were able to get from a doctor friend
"I haven’t ever been to the hospital or broken a bone," he said. "But I’m 34, and I should probably start thinking about it.”
Steven Petersen, 40, of Los Angeles said he looked into his options, but couldn't afford $240 a month, the lowest premium he could find.
"My mom's been calling every day saying, 'You need to get health insurance,'" said Petersen, who manages a West Hollywood health store. "But I’m a pretty healthy guy, so I really don’t see the point of it because it’s so expensive."
He'd prefer a cheap "catastrophic coverage" plan, but those are only offered to consumers under 30 years old.
Lorenzo Hebert, 47, of Los Angeles works at a Pasadena thrift store that doesn't provide job-based health insurance to part-timers like him. He, too, says he's shied away from buying insurance, mostly because he just hasn't had time to figure out exactly what he's supposed to do.
"I've seen it on TV, but never had the time I could do it," Hebert says.
Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation, said he wasn't expecting every uninsured person to sign up during this first year.
"We're really early on," Levitt said. "The expectations are that enrollment will ramp up both in Medi-Cal and Covered California over a period of years."
Under the ACA, those who earn less than about $16,000 a year are eligible for low- or no-cost health insurance through Medi-Cal, the state's Medicaid program.
About half the states have opted to expand their Medicaid program with federal dollars offered under the law. The Congressional Budget Office estimates that, even years from now, the number of uninsured will remain significant: about 30 million nationwide.
Some portion will be those who live in states that have not opted to expand their Medicaid program for their poor; another faction will be immigrants who don’t qualify for coverage under the law.
"But the biggest category are people who simply will choose either not to enroll in Medicaid or not to buy private insurance," Levitt said.
This, despite the Affordable Care Act's mandate requiring nearly every American to have insurance or to pay a tax penalty. This year, that amounts to either $95 or 1 percent of income, whichever is greater.
But that tax is a fraction of what Beth Engel, of Oak View in Ventura County, would have to pay in premiums.
The 32-year-old mother of a nearly 3-year-old daughter, describes herself as among the early supporters of the ACA.
"I was very hopeful" when the Affordable Care Act passed, she said. "I thought, 'Wow! I can have a job that I love that doesn’t’ necessarily have insurance but get insurance affordably.'"
She chose not to buy insurance for herself this year, but signed her daughter up for Medi-Cal.
"I found that the premiums were still very high, and I just couldn’t afford out of pocket premiums that high for my daughter and myself," said Engel, 32.
Engel, who works part time as a hotel clerk, qualifies for tax subsidies that reduce premiums for her and her toddler to about $200 a month.
She didn't realize she could choose to take the subsidy upfront each month in the form of a reduced insurance premium. But even armed with that knowledge, she says she's hesitant to commit to buying a policy without thoroughly understanding the various plans offered through the state-run marketplace, Covered California.
"Maybe I’m reading these incorrectly," she said, "but it just didn’t make sense, and I thought I’m not going to put money I don’t really have to spend into a program that I don’t really understand."