Despite a surge in enrollment in the two weeks before the April 15 deadline to enroll for health insurance under the federal health law, many more Californians still haven't signed up, and they're unlikely to.
Many people are uninterested, confused or skeptical.
Scott Belsha, from Long Beach, Calif., falls in the skeptical category.
"I've been consumed with living my life, and I'm fortunate to be healthy," he says. He works as a musician and carpenter, and he's never had health insurance. His parents, who own a small business, always paid cash for medical care, most of which they were able to get from a doctor friend.
"I haven't ever been to the hospital or broken a bone," he says. "But I'm 34, and I should probably start thinking about it."
Steven Petersen, 40, of Los Angeles, says he looked into his options but couldn't afford $240 a month, the lowest premium he could find. He'd prefer a cheap, catastrophic plan. "I just take care of myself every day, and eat well and try to stay healthy," he says.
The Affordable Care Act's individual mandate requires nearly every American to have insurance or pay a tax penalty of either $95 or up to 1 percent of income, whichever is greater.
But Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation, says he wasn't expecting every uninsured person to sign up during this first year. "The expectations are that enrollment will ramp up over a period of years," he says.
The Congressional Budget Office estimates that even years from now the number of uninsured will be large: about 30 million nationwide. Some of those people will be living in states that have opted not to expand Medicaid to adults without dependent children. Others will be immigrants who don't qualify for coverage under the law. "But the biggest category are people who simply will choose not to enroll," Levitt says.
Beth Engel, in Ventura County, Calif., is a 32-year-old mother of a nearly 3-year-old daughter and describes herself as an early supporter of the Affordable Care Act.
"I was very hopeful," she says. "I thought, 'Wow! I can have a job that I love that doesn't necessarily have insurance but I get insurance affordably.' "
Engel works part time as a hotel clerk and qualifies for tax subsidies that reduce premiums for her and her toddler to about $200 a month. But she chose not to buy insurance for herself this year. "I found that the premiums were still very high, and I just couldn't afford them," she says.
Even though now she's armed with the knowledge that she can take the subsidy upfront in the form of a reduced insurance premium, she says she's reluctant to do that without thoroughly understanding the plans offered through the state-run marketplace, Covered California.
"Maybe I'm reading these incorrectly," she says, "but it just didn't make sense, and I thought I'm not going to put money I don't really have to spend into a program that I don't really understand."
Engel did get her daughter health coverage through Medicaid. People in California and other states that expanded can enroll year-round. As for her own medical needs? She'll go without health insurance and pay the penalty, which for her is less than the cost of insurance. She says she'll reconsider her options when enrollment opens again in November.
This story is part of a partnership with NPR, KPCC and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
DAVID GREENE, HOST:
This is MORNING EDITION from NPR News. Good morning. I'm David Greene.
STEVE INSKEEP, HOST:
And I'm Steve Inskeep. The deadline has passed for most Americans to buy health insurance through the Affordable Care Act this year. Now, if you change your status - for example, if you lose your job - you can sign up, but most people missed the window. And millions of people who could have bought insurance this year remain without it. Stephanie O'Neill from member station KPCC caught up with some people who to find out why - for now at least - they opted out.
STEPHANIE O'NEILL, BYLINE: More than 200,000 Californians signed up for health plans during the final two weeks of open enrollment that ended April 15, but drummer Scott Belsha was not among them. He was focused instead on practicing for several upcoming band gigs.
The 34-year-old California native says he's never had health insurance. His parents, who own a small business, always paid cash for medical care. So for him, health insurance has not been a priority.
SCOTT BELSHA: I've been consumed with living my life and I've been fortunate to be healthy. But I'm 34 and I should probably start thinking about it.
O'NEILL: But 40-year-old Steven Peterson of Los Angeles says he actually took the time to study his coverage options, but says he simply can't afford the $240 a month premiums on his salary as a manager for a West Hollywood health store.
STEVEN PETERSON: I wouldn't mind getting catastrophic insurance, like, you know, get into an accident or something like that, you know. But other than that, I just take care of myself every day.
O'NEILL: Despite the Affordable Care Act's individual mandate - which requires nearly every American have to insurance or pay a tax penalty of either $95 or up to one percent of income - whichever is greater - millions of Americans are expected to remain uninsured, especially this year.
LARRY LEVITT: You know, the expectations are that enrollment will ramp up.
O'NEILL: Larry Levitt studies health insurance at the non-profit Kaiser Family Foundation. He says the Congressional Budget Office estimates that even years from now the number of uninsured Americans will total about 30 million nationwide. About a third, he says, will be people who don't qualify for coverage; another faction will be those who don't live in states that expanded Medicaid.
LEVITT: But the biggest category are people who, you know, simply will choose not to enroll.
O'NEILL: People like Beth Engel, who lives just north of Los Angeles. The 32-year-old mother of a toddler says she's among the early embracers of the Affordable Care Act.
BETH ENGEL: I was very hopeful. I thought, wow, I can have a job that I love that doesn't necessarily, you know, have insurance but get insurance, affordably.
O'NEILL: But she says reality has tempered her enthusiasm.
ENGEL: I found that the premiums were still very high.
O'NEILL: Engel works part-time as a hotel clerk and qualifies for subsidies that bring insurance for her and her daughter to about $200 a month. She says she didn't realize she could choose to take the subsidies upfront each month, in the form of a reduced insurance premium. But even armed with that knowledge, she says that's still too much money for her. And, she says, the deductibles and co-pays were just too confusing to figure out.
ENGEL: And I thought I'm not going to put money I don't really have to spend into a program that I don't really understand.
O'NEILL: Engle did get her daughter health insurance coverage through Medicaid. As Engel's own medical needs, she'll go without health insurance and pay the penalty - which for her is less than the cost of insurance - and then reconsider her options when open enrollment reopens in November. For NPR News, I'm Stephanie O'Neill. Transcript provided by NPR, Copyright NPR.