James S. Wood for The New York Times NYT2013120812405206C NYTCREDIT: James S. Wood for The New York Times
Ray Acosta, a small-business owner in Sierra Vista, Ariz., who qualifies for Medicaid under the Affordable Care Act.
Since his chronic leukemia was diagnosed in 2010, Ray Acosta has paid dearly for health insurance: more than $800 a month in premiums, plus steep co-payments for the drug that helps keep him alive.
Mr. Acosta, 57, owns a small moving company in Sierra Vista, Ariz., which he said had barely made it through the recession. He was thinking about dropping his coverage, but the insurance company beat him to it, informing him recently that it would cancel his policy at year's end.
He sought advice from an insurance agent who had used his moving company. She connected him with an application counselor at a community health center, who found — to Mr. Acosta's astonishment — that he qualified for Medicaid under the new health care law, the Affordable Care Act, which gives states the option of expanding the program to include more low-income adults.
"I'm kind of in a disbelieving fog," Mr. Acosta said last week, two days after completing an application. "I'm just hoping, keeping my fingers crossed, that this might really help me out."
The rollout of the health care law has been plagued with problems so deep that even some of its strongest supporters have soured on its potential. The bottlenecks in the federal online insurance exchange, which serves 36 states; the cancellation of hundreds of thousands of policies that did not comply with the minimum requirements of the new law; and the high price of some plans sold through both federal and state-run exchanges have all cast a pall over President Obama's efforts to win support for the law.
But for all those problems, people are enrolling. More than 243,000 have signed up for private coverage through the exchanges, according to the Kaiser Family Foundation, and more than 567,000 have been determined eligible for Medicaid since the exchanges opened on Oct. 1. For many, particularly people with existing medical conditions like Mr. Acosta, the coverage is proving less expensive than what they had. Many others are getting health insurance for the first time in years, giving them alternatives to seeking care through free clinics or emergency rooms — or putting it off indefinitely.
Not all who need health insurance are happy with their new options. Many have complained that the prices are too high, especially if they earn too much to qualify for federal subsidies. And many will have a limited choice of doctors and hospitals under the new exchange plans, which have "narrow networks" to hold down premiums.
But Mr. Acosta, like the people in the following profiles, says the health care law has given him a cautious sense of hope.
He lives alone and has turned to his siblings at times for help with his insurance and medical costs. And those costs have at times been high: He sees an oncologist in Tucson twice a year and sometimes needs expensive tests that his current insurance does not always cover. He has also recently been stretching his medication, a drug called Gleevec, which helps make his type of leukemia manageable, to ensure he would have some on hand if he became uninsured.
"After being gouged all these years, trying to make ends meet, to all of the sudden get this?" he said. "I'm really blown away."
Claire He grew up worrying about her parents' health. Her mother, who is a waitress, and her father, who is a cook, work long days at a Chinese restaurant in Battle Creek, Mich., where they settled after immigrating from China 14 years ago. Health insurance has always been a luxury they could not afford.
Whenever her parents got sick, it fell to Ms. He, who is now 23, to help them navigate the patchwork of low-cost health services available in their city. Members of the community came together in 2012 to pay her mother's medical bills after tests uncovered precancerous cells that, left untreated, could have led to cervical cancer. Her mother receives care from a clinic that treats women and children, but Ms. He has had less luck finding a doctor to care for her father, who suffers from smoker's cough and other ailments. Both of her parents are in their 50s.
"My dad, he's getting older, and frankly he's having a lot of health issues," said Ms. He, who is studying public health as a graduate student at the University of Michigan. "It breaks your heart."
Ms. He and her brother, who is a year older, did not have health insurance growing up, aside from a few years when they were teenagers and enrolled in Michigan's health insurance program for children. "If we had the flu," she said, "we just stayed home and waited it out."
Twice, the family has combined visits to China with comprehensive medical checkups, paying out of pocket to visit doctors and stock up on prescription medicine, which Ms. He said are less expensive there.
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