Obamacare is here.
Nearly 1,300 days after President Barack Obama signed his signature health care reform program into law, its most important feature finally takes effect. Americans are about to get their first hint of whether Obamacare will work for the 48 million people who lack health insurance and the millions more who buy coverage on their own.
Beginning on Tuesday and through March 31, consumers will be able to use a new system to buy health coverage: online insurance exchanges in each state, accessible via HealthCare.gov, that let people compare plans and learn whether they qualify for financial help.
Obamacare guarantees everyone access to coverage, whether they're sick, healthy, young or old. It establishes a baseline set of benefits and stronger consumer protections. And it offers low- and middle-income people help paying for coverage.
In short, it aims to transform the insurance market for people who don't get benefits at work. Now a skeptical public finally can judge whether it's a success, as Obama said in a speech last week promoting the health care law.
"You can go to the website. You can check it out. You can see if what I'm saying is true. You can sign up next week. You can sign up next month. You can sign up two months from now, three months from now. But you can sign up," he said of the exchanges. "See for yourself what the prices are. See for yourself what the choices are. Then make up your own mind."
Obamacare, officially known as the Affordable Care Act, is the product of a raucous debate that lasted 14 months from 2009 to 2010 and passed on a party-line vote in a Democratic-controlled Congress.
The law has survived a poisonous political environment, poor public support, a Supreme Court challenge, a presidential re-election campaign, resistance from Republican state officials and more than 40 attempts by congressional Republicans to repeal it -- most recently a House effort that appears to have shut down the government.
Now, Obamacare has to survive its own debut and win over a public that remains dubious and ill-informed about what the law does.
This year, 7 million people are expected to use the exchanges to buy private insurance, according to the Congressional Budget Office. Another 9 million are expected to enroll in Medicaid or the Children's Health Insurance Program, two federal-state health programs for the poor. By 2016, 25 million fewer people will be uninsured than would have been without Obamacare, the CBO projects.
Robert Hogg plans to be one of the 7 million people to buy insurance on the exchanges this year. Hogg, 61, is a self-employed accountant living in LaGrange, Ga., about an hour's drive southwest from Atlanta. He earns between $20,000 and $40,000 a year and has been uninsured since 1987, when he was diagnosed with a previously undetected heart murmur. His insurance plan at the time deemed it a pre-existing condition and promptly cancelled his coverage.
A few years ago, Hogg tried to find insurance again but couldn't afford the more than $700 monthly premium he was quoted. Being uninsured cost him this January, when surgery to remove his gallbladder came with a $37,000 bill he doesn't expect to ever pay off.
At the upper end of his income range, Hogg could buy a mid-level "silver" health insurance plan on an Obamacare exchange for about $317 a month, including tax credits that cover more than 40 percent of the price, according to an estimate generated by the Henry J. Kaiser Family Foundation's insurance-cost calculator. A higher-deductible "bronze" plan would cost him about $225. At the lower end of his income range, Hogg could get a silver plan for $85 a month or a bronze plan at no cost, according to the calculator.
Hogg plans to get health insurance. "Absolutely," he said. "I couldn't even get coverage before." When that insurance kicks in next year, he plans to finally get the colonoscopy he's been putting off because of the cost, he said.
Obama has to hope that millions more make the same decision about the exchanges, especially the approximately 2.7 million younger, healthier people the White House believes are needed to balance the higher medical costs of older, sicker patients.
More than half of the uninsured will be able to get coverage for less than $100 a month, according to the Department of Health and Human Services. Prices will vary widely from community to community and from household to household. And people with higher incomes will have to pay the full sticker price.
The early days of the six-month sign-up period will likely be rocky. The federal government and several states already have delayed some functions of the exchanges as computer glitches surfaced. Agencies and private contractors were racing to find and fix failings -- including erroneous pricing information -- in the final days before launch.
Significant setbacks, like crashing websites and endlessly ringing telephones at call centers, could entrench public mistrust. And the ceaseless, vicious political debate -- including tea party campaigns to discourage people from buying health insurance -- threatens to leave Americans sour about Obamacare.
Sixteen states and the District of Columbia will operate their own exchanges under names like "Covered California" and "kynect" in Kentucky. Residents of other states can use marketplaces operated wholly or partly by the federal government because those states declined to take on the task.
Exchange customers -- online, in person, on paper, or by telephone -- will provide information like their ages, incomes, addresses, the sizes of their families, and whether they smoke, all of which goes into determining their costs and whether they can receive tax credits to discount the price of insurance. Help is available to people signing up.
Those who earn up to four times the poverty level, or about $46,000 for a single person, are eligible for tax credits. Medicaid benefits are available to people who make up to 133 percent of the poverty level, or around $15,000. But only about half of states are using Obamacare funds to expand the program.
Health plans purchased on these exchanges take effect as soon as Jan. 1, if selected by Dec. 15. Insurance chosen after that date is subject to a waiting period of a few weeks.
Not everyone will like what they see.
People who buy their own insurance may find their current, less-expensive plans often have skimpier benefits than exchange plans and won't be available, so they will have to pay more than they do now. This especially applies to younger and healthier individuals who benefited from the market's exclusion of sick people before Obamacare. And some people, especially part-time workers and retail employees, will see their job-based benefits eliminated.
People who get health benefits from their employers usually won't use the exchanges and will still be covered through work. Americans in government programs like Medicare also won't shop on the exchanges. These types of coverage satisfy Obamacare's individual mandate that most Americans have health insurance or pay a tax penalty, which would be the greater of $95 or 1 percent of their income in 2014.
Ariel Edwards-Levy contributed reporting.