Nearly 60 percent of San Diego County residents who were previously uninsured signed up for health coverage under the Affordable Care Act in 2014. And as year two begins, some 300,000 more Californians have already joined them.

Health exchange officials are calling the law a success. But 2014 was also the year of health exchange glitches, Medi-Cal backlogs and rising premium rates. And Obamacare is still in conservative lawmakers’ crosshairs. In March, House Republicans cast their 54th vote to repeal the law, and it won’t be their last.

But with no longitudinal data, it’s probably too early for anyone to say “I told you so.” So we checked in with four San Diegans who participated in our 2013 Second Opinion series to ask what worked and what didn’t in Covered California’s first year.

‘I’ll Take My Lumps’

Photo by John Rosman, KPBS
Photo by John Rosman, KPBS

This time last year, Michelle Huffaker and her family were riding out the final days of her COBRA health coverage. She had lost her job during the recession and the generous benefits package that came with it. For her, Obamacare came just in time.

“I started as soon as the (open enrollment) window opened,” Huffaker said. “I was so excited to get signed up.”

Flash-forward to Dec. 15, 2014 – the first deadline for coverage renewals on the state’s health exchange – and that drive is gone. Huffaker has a stack of letters from Covered California urging her to re-enroll and update her financial information. They’re all unopened.

“I’m beyond apathy,” Huffaker said. “I’m at the point of paralysis.”

She had enrolled her family in a silver plan. That’s Covered California’s second tier of coverage. Monthly premiums at the silver level are bumped up in exchange for not having to chip away at a deductible before prescriptions and nonessential treatments are fully covered.

Huffaker qualified for subsidies to bring her premiums down, but the $700 monthly cost was still a lot to take on. Huffaker was unemployed for much of the year, and she and her husband were putting their daughter through her first year of college.

To keep costs down, Huffaker only used her health insurance if it was a necessity. She put off getting recommended labs done. When her son gouged his knee, she found herself trying to make the call on whether he needed stitches instead of driving straight to the emergency room.

“I don’t like that those numbers are going through my head when I’m making choices about health care,” Huffaker said. “That’s where I see the problem still existing with Obamacare. The money situation is still so much a part of care.”

But Huffaker said she’ll take Obamacare over what she had before – “39 percent increases year over year, benefits decreasing and nothing we could do about it.”

“It hasn’t been a panacea for me, by any stretch, but it’s still so much better than what existed before,” Huffaker said. “There are certainly things to fix, but I think of it in terms of – not to go all JFK – it’s good for the country, so I’ll take my lumps.”

‘It Doesn’t Feel Like Welfare’

By John Rosman, KPBS
By John Rosman, KPBS

Becki Mendia keeps a stash of natural remedies – coconut oil and cinnamon for respiratory health and apple cider vinegar for digestive health – in her daughter’s City Heights home. She moved there after divorcing several years ago and started the homeopathic regimen to get by without health insurance.

In June, she became one of the 2.2 million Californians to join Medi-Cal. The Affordable Care Act expanded the state’s version of Medicaid to families and individuals earning up to 138 percent of the federal poverty level.

Mendia said the expansion – nearly 30 percent of Californians are now on Medi-Cal – reduced the stigma that had kept her from looking into the program.

“I always thought it was part of the welfare system, and maybe it still is, but it doesn’t feel like it,” she said.

Mendia hasn’t been to the doctor yet, but she said the change over last year is immense.

“Having insurance right now, it’s like a platform that I can go ahead and move around from and not be afraid,” she said.

Since getting on Medi-Cal, Mendia has put away some money and started taking classes to increase her job skills.

‘The Affordable Care Act Should Make Health Care More Affordable, Right?’

Photo by Brian Myers, Media Arts Center San Diego
Photo by Brian Myers, Media Arts Center San Diego

There are a lot of different takes on the recent health insurance rate hikes. Did the Affordable Care Act cause them? Would it have been a lot worse if the law didn’t exist? And what do we make of those plans that actually lowered rates (yes, they exist)?

All Jeff Schoellerman needs to know is written in plain English in his employer’s 2015 benefits booklet.

“ACA mandates have increased our financial responsibilities.”

Or, in plainer English, “Your premium is going up because of Obamacare.”

Schoellerman is a neuroscientist at a pharmaceutical company. He gets to the heart of the matter with all the precision you’d expect.

“It’s the Affordable Care Act. It should make health care more affordable, right?”

His increase amounts to a couple hundred dollars a year, but he’s taking it in stride.

“I see a little less in my paycheck every month, but it’s not so much that I’m not going to be able to put food on the table,” Schoellerman said.

For the avid cyclist – he rides to and from work everyday – the bigger disappointment is that the law hasn’t yet impacted the cost of emergency care. Before landing his current job and its benefits package, Schoellerman landed in the emergency room after a car hit him on his bike. He’s still paying off the $30,000 bill.

Indeed, the average cost of an emergency room visit went up $432 to $1,345 between 2009 and 2013, according to the U.S. Department of Health and Human Services. The numbers for 2014 aren’t yet available, but early studies suggest emergency room visits are leveling off, and even decreasing in some cases, under the Affordable Care Act. That could mean the cost to hospitals and patients will eventually level off.

But Schoellerman isn’t optimistic.

“It seems like this price gouging that happens with ambulance rides and emergency room visits is not going to change,” Schoellerman said. “I think that should have been the main focus of this health care plan.”

‘Let’s Get Crackin’ on Single-Payer’

Photo by Megan Burks
Photo by Megan Burks

Not much has changed for Sylvia Hampton since the rollout of Obamacare. She and her husband are on Medicare, which the health reform law left relatively untouched.

And her opinion on the law hasn’t changed much either, despite heavy news coverage of website glitches and dropped plans and the perhaps buried lead that 6.7 million low-income Americans gained Medicaid coverage by May. Before all of that Hampton was calling for a single-payer health system. And she still is.

“The single-payer system is what every other industrialized country has and it’s the gold standard for cost savings, efficiency and to cover everybody,” Hampton said.

But Hampton may be even more passionate about the idea after seeing how Obamacare didn’t work this year for her daughter, whose husband lost his job. She started out the year expecting she could pay her premium and ended it with one that’s stretching her bank account.

That’s because the law bases what you pay in premiums on what you projected your income will be. You can adjust your subsidy midyear if your income changes, but the option doesn’t exactly resolve the feelings of uncertainty Americans have felt since the recession.

While the law helped low-income Americans, Hampton said, it missed the boat for that other large group it aimed to help: middle-class workers cast out into the individual market.

“Now that they’ve cut down on the number of uninsured, the hospitals are doing better, and boy are the insurance companies doing better,” Hampton said. “But these people in the middle who don’t work for large corporations like Boeing or Qualcomm, and those who are making a little bit too much money to qualify for the subsidies, they are the ones who are upset and angry – mad as hell, actually – about what’s happening to them. They feel like the law didn’t help them at all, which in many cases it didn’t.”

Hampton said throwing out the law and starting from scratch isn’t the answer. But she said piecemeal change isn’t either.

“This is getting real old. I mean I’ve been working on this for 20 years,” said Hampton, who is the health care director for the San Diego League of Women Voters. “Let’s get crackin’ here.”

Megan Burks is a reporter for Speak City Heights, a media project of Voice of San Diego, KPBS, Media Arts Center and The AjA Project. You can contact her...

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