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By AP Photo/News-Gazette/John Dixon
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By AP Photo/Lynne Sladky
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By AP Photo/Lynne Sladky
BY RICARDO ALONSO-ZALDIVAR Associated Press
Contentious from its conception, President Barack Obama's health care law has survived the Supreme Court, a battle for the White House and rounds of budget brinkmanship. Now comes the ultimate test: the verdict of the American people.
A government shutdown could dampen the rollout Tuesday as insurance markets open around the country. But it won't stop the main components of "Obamacare" from going live as scheduled, glitches and all. The biggest expansion of society's safety net since Medicare will be in the hands of consumers, and most of their concerns don't revolve around ideology and policy details.
GETTING COVERED IN KERN
Option: Current Medi-Cal
Who is eligible: People with disabilities, pregnant women and low-income families with children.
When is coverage available: Now
How to apply: In person at Kern County Department of Human Services locations, call 631-6807 or toll-free 1-877-410-8812, www.c4yourself.com.
Option: Expanded Medi-Cal
Who is eligible: People with incomes up to 138 percent of the federal poverty level -- less than $15,856 for a single person and $32,499 for a family of four. Childless adults younger than 65, children, married and unmarried adults, and foster youth up to age 26.
When is coverage available: Jan. 1, pre-enrollment starts Oct. 1
How to apply: In person at Kern County Department of Human Services, call 631-6807 or toll-free 1-877-410-8812, www.coveredca.com.
Option: Kern Medical Center Health Plan
Who is eligible: Kern County residents ages 19 to 64 with incomes at or below 133 percent of the federal poverty level -- $15,282 for a single person or $31,322 for a family of four -- who are not enrolled or eligible for other state health plans.
When is coverage available: Now, enrollees will be rolled over into expanded Medi-Cal on Jan. 1
How to apply: Call 326-2392, option 4, download the application at www.kmchp.com. Applications can be submitted by fax at 326-2969, in person at KMC, or by mail to Kern Medical Center Health Plan, 1700 Mount Vernon Ave. -- Trailer #4, Bakersfield, CA 93306.
Option: Covered California
Who is eligible: Open to all income levels but people with incomes up to 400 percent of the federal poverty level -- $45,960 for a single person and $94,200 of a family of four -- will receive tax credits to reduce their cost of buying insurance on the exchange. On top of tax credits, folks with incomes less than about $27,936 for one person or less than about $57,636 for a family of four may also qualify for cost-sharing subsidies.
People who are eligible for Medi-Cal - those with incomes at or below 138 percent of the federal poverty level - can opt to buy a plan on the exchange but they won't receive tax credits or cost-sharing subsidies.
When is coverage available: Jan. 1, open enrollment starts Oct. 1
How to apply: Call 1-800-300-1506, www.coveredca.com.
Sources: Kern County Department of Human Services, Kern Medical Center Health Plan, Covered California
People want to know if they can afford the premiums, if the coverage will be solid, where the bureaucratic pitfalls are and if new federal and state websites will really demystify shopping for health insurance. Full answers may take months.
Expect the rollout to get off to a slow start, with some bumps.
People who don't have access to job-based health insurance can start shopping right away for subsidized private policies. Or they can wait to sign up as late as Dec. 15 and still get coverage by Jan. 1. Many will probably want to see how it goes for the first wave of applicants before they jump in.
Glitches are likely to pop up in the new online insurance markets. Over the weekend, several states were still struggling to get plan information to display accurately on their websites. Earlier, the federal government announced delays for small business and Spanish-language signups. A protracted government shutdown could slow needed technology fixes.
Consumers also could run into problems getting their right subsidy amounts. People with complicated tax returns and extended families living under the same roof could find they need personal assistance to work out the issues. Referrals to state Medicaid programs might go smoothly in some states, not so well in others.
"As this unveils, it is going to be very clear that everything can't be done on a computer," Christine Ferguson, director of Rhode Island's marketplace, said in an interview prior to the launch. "But by Day 60 to 120, and the year after that, it's going to get a lot more user-friendly and effective."
The Kern County Department of Human Services hired 61 people to beef up its call center staff to take calls from Covered California -- the state's health benefits exchange -- and to help manage new Medi-Cal cases.
Starting Tuesday, the call center will begin taking calls transferred to it by Covered California to assist people who might be eligible for expanded Medi-Cal next year. The call center will be open longer hours, until 8 p.m. weekdays and from 8 a.m. to 6 p.m. on Saturdays, to take calls from Covered California during the exchange's open enrollment period, which starts Tuesday and continues through the end of March.
"We're hoping everything is a go tomorrow," said Pam Holiwell, assistant director of the Kern County Department of Human Services, on Monday.
Eventually, at least half the nation's nearly 50 million uninsured people are expected to get coverage through the Affordable Care Act, either through subsidized private plans sold in the new markets or an expanded version of Medicaid in states accepting it for low-income adults. Immigrants in the country illegally will be the largest group remaining uninsured.
People who do have access to employer-based plans will also see changes. Starting Jan. 1, virtually all Americans will have a legal obligation to carry health insurance or face fines. Passing up the company medical plan in exchange for a bigger paycheck may no longer be an option. But employees who lose their jobs, entrepreneurs starting their own businesses and people in between school and work could have an easier time getting coverage.
Also as of Jan. 1, a pre-existing medical condition will no longer be a barrier to getting health insurance.
A partial government shutdown, driven by Republican opponents of increasing the federal role in health care, will not stop what they call "Obamacare." Core provisions and benefits are shielded from annual budget battles. If other government services are shut down, the health care overhaul can largely keep going -- much like Social Security and Medicare.
"Shutdown or no shutdown we're ready to go," Health and Human Services Secretary Kathleen Sebelius said Monday. Federally operated markets in 36 states open at 8 a.m. Eastern time. The remaining states are running their own markets.
Polls show the country remains divided over the law, with opponents outnumbering supporters. Nonetheless, a Kaiser Family Foundation survey released over the weekend found 56 percent of Americans disapprove of cutting off funding to expand coverage for the uninsured, as congressional Republicans are pressing to do.
The poll also found people in a fog about what the law means for them. Nearly three-fourths of the uninsured were unaware of the new insurance markets opening to serve them.
-- Californian staff writer Rachel Cook contributed to this article.