DENVER — President Obama's legacy just might be in the hands of people such as Matt Wright.
The 31-year-old real estate agent worries less about his lack of health insurance coverage than he does about the costs of buying it when the Affordable Care Act mandates kick in, on top of all the expenses of providing for his 4-year-old daughter. "I have an open mind with a bunch of 'if's,'" he says.
In Colorado and across the country, the insurance marketplaces known as exchanges are scheduled to open Tuesday, and the success or failure of Obama's signature legislative achievement is at stake. Passing the health care overhaul defined much of his first term in the White House, and defending it from Republican assault has defined much of his second — including in the current budget showdown.
Americans who don't have insurance, or who have been buying individual policies, or who work for some small businesses, are urged to go online to shop for plans and to determine if they're eligible for federal tax credits to help cover the cost. Whether the system is easy to navigate and the plans judged a good value are likely to set attitudes toward a law that at the moment remains unpopular — shaping Obama's legacy.
USA TODAY decided to explore the issue in Colorado, one of the nation's most critical swing states and the place where Barack Obama was nominated for president in 2008 with a pledge to overhaul the nation's health care system. The news organization sponsored a statewide poll this month and convened a focus group of 10 Denver-area residents who don't have health insurance.
What we found underscored the uphill battle for "Obamacare" three years after it was signed into law. Confusion about the law is widespread, including among those who are supposed to benefit from it, and opposition as fierce as ever.
By 52%-33%, Colorado residents disapprove of the Affordable Care Act. More than two-thirds say they don't understand it very well, and a majority predict the overall effect of the law on the country in coming years is going to be mostly negative.
Among those who disapprove of the law, an overwhelming majority (54%-37%) want elected officials who agree with them to do what they can to make the law fail. Even though Democratic Gov. John Hickenlooper and the Colorado Legislature back key provisions — expanding Medicaid eligibility and establishing a state exchange — approval of the law is lower in Colorado than nationwide, and the opposition is more fervent.
During a roundtable discussion that stretches nearly two hours, the uninsured who are intended to benefit from the law express skepticism and confusion about it. Not one understands how to shop for a plan, and some hadn't realized that the law requires them to get coverage next year or pay a fine.
Asked to describe Obamacare in a word or phrase, Robert Widgery says, "Government boondoggle." Catherine Campbell: "Worried I can't afford it." Elizabeth Espinosa: "I don't know what it is."
Neil Carr offers, "Not perfect but on the right track" and Mary Anne Torongo says simply, "A relief."
When Torongo, 57, the mother of two grown children, sliced her thumb recently, she called a friend who is a nurse instead of going to an emergency room. The friend used superglue to close the wound. "I didn't even ski last year because I don't have insurance," Torongo says, for fear of taking a bad fall. "I don't want to have to limit myself in living my life because I don't have health insurance."
She works as an aesthetician, giving beauty treatments, and her employer doesn't offer health insurance. "Once this Obamacare comes into play, we will be able to have our coverage this time," she says. She and her co-workers "are very happy."
Wright is still trying to figure out how it will work for him. "I think I have the idea behind it, probably comparable to car insurance, where we have to have it, so do I go with Allstate? Do I go with Progressive?" he says. "I'm hoping that the competitive environment of a marketplace would have prices become more reasonable, with multiple options." But he adds, "At this point, it's to be determined, right?"
'FIND IT AND FIX IT'
There's a frantic energy on the 26th floor of the tony Denver office building where workers at Connect for Health Colorado are trying to fix glitches in the computer system before enrollment opens Tuesday.
They have updated placeholder numbers that mistakenly put premiums for some dental plans at $9,999 a month. They've flipped the display of plans that automatically had listed the highest-cost offerings first; now shoppers will start with the most affordable ones. They have had to deal with the complications of letting people search by ZIP code while the plans are being offered by county, a problem because some ZIP codes include more than one county.
"On a daily basis, our motto is find it and fix it," says Patty Fontneau, CEO of the non-profit organization running the Colorado exchange. Not all the glitches will be caught before consumers go online, she acknowledges. When problems inevitably arise, "you fix them, and you move on."
That's one reason she urges state residents to call the toll-free service center or contact one of about 400 health coverage "guides" or nearly 1,500 brokers and agents who have gotten training on how the exchange works and when subsidies are available. Street teams are beginning to work at festivals and fairs around the state to distribute pamphlets in English and Spanish and answer questions.
One morning last week, Brenda LaCombe and Mirna Castro stop by a meeting of the Denver Latino Commission, gathered in a room at Denver Fire Department Station 26, to explain their outreach efforts. "We know from our research that it will take seven to 12 'touches'" to convince people to sign up, Castro tells them, "and they have to come from a trusted source." For instance, she works for Servicios de la Raza, a social services agency for the Hispanic community that was established in Denver four decades ago.
There is one glossy TV ad that depicts a man who signs up for coverage on the exchange being hoisted on a racehorse and presented with a silver cup, and another that shows a couple who pick a plan and suddenly find themselves dancing in Las Vegas with an Elvis impersonator. "When health insurance companies compete, there's only one winner: You," the announcer declares.
Still, just one in five Colorado residents say they have seen or heard the ads. Half of those polled say they know only a little about the exchange; a third have heard nothing.
"If it's such a great idea, why do they have to spend millions of dollars convincing people that it's a great idea?" scoffs state Sen. Kevin Lundberg, a Republican member of the legislative oversight committee for the exchange. He says anything short of repeal of the Affordable Care Act and a return to free-market solutions for health care coverage would be "the equivalent of rearranging the chairs on the deck of the Titanic."
When the exchanges open, he predicts, "a lot of stuff is going to hit the fan when people try to sign up and find all the 'gotchas' in there that add up to, 'I can't afford this.'"
The Centennial State ranks close to the middle of states in terms of the percentage of its residents who are uninsured: 14%, according to Census data, a bit better than the national average of 16%.
On the Colorado exchange, 18 insurers will offer a total of 541 plans for individuals and small groups.
Fontneau estimates that 125,000 to 140,000 Coloradans will sign up for insurance through the exchange during its first year, most of them by the time open enrollment closes next March. That group (which includes some people who have insurance as well as many who don't) will begin to reduce the ranks of the more than 700,000 uninsured in the state.
PLEASE, NO AMBULANCE
In the USA TODAY statewide poll, 83% say they have health insurance.
Among those who don't, six in 10 say they plan to get insurance in the next six months, though most say that's not because of the new law. Just 3% say the law has had a positive effect on them or their families. One in four predict it will have a positive effect in coming years.
Count Lynette Langlois, 56, among those optimistic about what lies ahead. She has been worried about "falling through the cracks" ever since she lost her health care coverage soon after being laid off three years ago. "I think this will allow me to be able to get affordable health care without a company telling me, 'Well, we can't cover you' or 'Yeah, that's $1,200 a month.' It'll lift a burden off my shoulders."
She and others around the table talk about the strategies they have devised to handle health care without insurance.
Widgery, 62, takes care to avoid injury at work, no small task since he does demolition at construction sites. He's trying to "hold on" until he's eligible for Medicare in three years. He's considering paying the fine rather than complying with the law.
Carol Bergschneider, 55, relies on a sympathetic doctor who charges her $50 a visit. One of his staffers gives her insulin to treat her diabetes, and she has found a non-profit site online where she buys syringes at a reduced price. Her cobbled-together system sometimes breaks down. When she passed out in her office last December, a co-worker took her to the emergency room, generating a $1,800 bill that she hasn't been able to pay and that has been turned over to a collection agency.
When Wright dislocated his shoulder, he pleaded with his friends not to call an ambulance; he called a buddy instead. "The reality for me is that the cost is more burdensome than the actual injury," he says. He hopes the new system will work better for him, but he's not confident it will.
"The rollout determines what happens next," he says. "A lot of people are uncertain, right? So their decisions are going to be made while they're in it, while finding themselves in the exchange and having to deal with these monthly costs. And what are the costs? I think a lot of people are, like, 'What's the catch here? What are we giving up?' I think it's to be determined. Just like an election, people will be swayed."