Beginning next month, thousands of central San Joaquin Valley residents will be enrolling in insurance plans — many for the first time — under the Affordable Care Act.
Under the new federal law, an estimated 45,000 people in Fresno County will be eligible to sign up for Medi-Cal, the joint state-federal health insurance program for the low income.
Another 65,000 in Fresno, Kings and Madera counties — and more than 100,000 in Tulare and counties north from Merced to San Joaquin — will qualify for federal tax credits to help pay for insurance plans.
Thousands more, who in the past have not been able to find private insurance policies for a reasonable price or have been denied coverage because of pre-existing conditions, will be able to buy insurance.
Many will look for it online through Covered California, the state's health benefit exchange that has been set up to offer affordable health plans.
Under the new law, most people without employer-sponsored health plans will be required to have insurance coverage or face a fine. They will have from Oct. 1 to March 31 to enroll in insurance plans for 2014.
Altogether, the Affordable Care Act could decrease the number of uninsured by more than 40% in counties from Tulare to Stanislaus, according to the Kaiser Family Foundation, a nonpartisan health care research group.
The largest group to remain uninsured will be about 300,000 undocumented immigrants who are ineligible for Medi-Cal or Covered California plans.
Getting more people insured will be good for the Valley, health experts say. Those with insurance are more likely to get preventive care and help to control chronic diseases, such as diabetes, heart disease and asthma.
Increased access to health insurance "will improve the health status of the community, no doubt about that," said Gregory Hund, executive director of CalViva Health, the locally governed Medi-Cal managed care plan for Fresno, Kings and Madera counties.
But the success of the new law rests on the public embracing it.
The Affordable Care Act, also called Obamacare, is the most massive health-care overhaul in the nearly 50 years since Medicare was created, and the task of explaining it to the public — and convincing them to participate — remains a hurdle.
A recent Kaiser Family Foundation poll showed two-thirds of the uninsured and a majority of Americans overall said they didn't have enough information about the Affordable Care Act or how it will affect them.
Valley residents could be among those who benefit the most — but they could be the toughest to enroll in insurance plans.
Many of the uninsured who will be eligible for Medi-Cal or the Covered California plans are people with limited English-speaking skills, and the Valley has one of the state's most diverse populations. That diversity, however, will be a challenge for outreach workers tasked to educate people about the new law.
Because the region also has a lot of low-income and part-time workers, Valley counties rank among the state's bottom 10 in median household income.
The new health insurance may not be affordable enough to dissuade those people from taking a penalty instead of buying subsidized insurance plans that may be cheap, but won't be free.
"Making the case to that community that the insurance is worth it remains our largest challenge," said John Capitman, executive director of the Central Valley Health Policy Institute at Fresno State.
Fresno musician Steve Ono isn't sure he will sign up for insurance come Oct. 1. "A lot depends on whether I'm able to pay my bills over the next several months," he said. Ono, 59, earns $30,000 to $40,000 a year.
He priced individual insurance policies last fall, before Covered California announced plan prices. The private plans that Ono checked had monthly premiums from $350 to $400.
Ono hasn't yet looked at Covered California plans. The system looks complex, he said, but from what he has heard, "so far, it appears to be not as cheap as I would like it to be."
He said he would need monthly premiums under $200.
Using the health benefit calculator on the Covered California website, Ono likely could get an insurance plan for $167 a month, but it would pay only 60% of health costs.
If he doesn't buy insurance, Ono will have to pay a $95 fine next year. "That's what the premium should be," he said. "And it shouldn't be so complicated."
Some health experts doubt that the "individual mandate" penalty will be a big enough club to get people to enroll, especially those younger than 30 who have been tagged "the young invincibles." Enrolling younger people, who tend to be healthy, in insurance plans is considered essential to keeping overall health plan costs down.
"For younger people, it's going to be a harder sell," Capitman said. "They're going to look hard at paying the penalty versus the cost of insurance."
In 2014, the penalty will be $95 per adult or 1% of family income, whichever is greater. The penalty increases over time and will be 2.5% of annual income or $695 by 2016. The penalty will have to be paid when income taxes are filed each year.
Monthly premiums — without subsidies — in Fresno, Madera and Kings counties range from a low of $146 for a 25-year-old to a high of $1,298 for a family of four for the silver plan, considered mid-range. People in those counties will be able to choose from four plan types offered by three insurance companies.
Tax credits or subsidies vary by income, family size and age, and it's hoped the subsidies will reduce monthly insurance premiums to affordable levels. They will be available to people earning between 138% and 400% of the federal poverty level.
People with incomes less than 138% will be eligible for Medi-Cal and not have to pay a monthly premium. An individual who earns $15,900 is at 138%; an income of $45,960 is at 400%.
A catastrophic plan for people ages 30 and younger also will be offered.
Price will determine the insurance decisions that Pheng Yang, 27, of Fresno, makes by March 31.
Yang is healthy and hasn't been to a doctor in probably five years. He wants insurance in the event he needs it, but he's not sure he can afford a Covered California plan.
He said he hasn't looked at the cost of premiums — yet: "I'm hoping they would have some discount programs for people."
Yang earned about $20,000 last year doing multimedia production, graphic design and web design for his Split Horn Productions. He also works part time at a television station but has no health insurance through his employer.
He's not sure how much he could pay for insurance each month, but about $100 monthly would be his limit.
According to the health benefit calculator on the Covered California website, Yang likely would pay a lot less. With a tax credit, his monthly premium could be as little as $25, depending on the plan.
Yang said he'll review his options once enrollment opens.
Few health experts expect a rush of applications for Medi-Cal or Covered California health plans on Oct. 1.
At least, that's the hope.
People should take time to decide on a health plan, said Carmella Gutierrez, president of Californians for Patient Care, a nonprofit organization for quality and affordable health care services.
"Oct. 1 is not the end-all, be-all," she said. "We would advise them to research, prepare and then let it sit, think about it and then come back to make the best decision."
The reporter can be reached at (559) 441-6310, firstname.lastname@example.org or @beehealthwriter on Twitter.