Despite Obamacare, Why Some Choose to Skip Health Insurance

By Stephanie O'Neill, NPR

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.

State of Health reported earlier this week that California health policy experts say it will take three years to get complete picture of enrollment in the state.

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,

"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.