Federal premium subsidies will ease the bite on many people's wallets. In California, individuals earning less than about $16,000 a year will qualify for an expansion of Medi-Cal, the state's Medicaid program for the poor. Above that threshold, individuals making less than $46,000 a year and families earning below $94,000 annually will qualify for federal subsidies.
One of the bigger risks is that high premiums turn off healthier, middle-income households that aren't eligible for that federal assistance and have to pay the full premium. Rates could skyrocket if the exchange fails to enroll enough of those people to offset the higher costs of sicker, poorer policyholders.
Katharine King, 59 and a self-employed concert and event producer in Santa Monica, already pays $497 a month for her individual health insurance from Anthem Blue Cross. She wouldn't qualify for federal premium help based on her income. Using the state's online calculator, which doesn't yet reflect the final rates, her premiums could shoot up to nearly $600 a month next year.
"The Affordable Care Act is still not all that affordable unless you qualify for a federal subsidy, which I will not," King said. "It will likely be another case of the middle class kind of getting screwed."
Alfredo Ceron, 44, an uninsured painter in Los Angeles, has less to worry about with these rates. He said he earns about $100 a day when he has work, which means the federal government would pick up most of the tab for him and his two adult children who still live at home.
"I'd like to get my family covered," he said while waiting in line at a recent downtown festival to get more information about the new insurance options.
The 13 health plans selected by the state include all four of California's largest insurance companies. They are Kaiser Permanente, Anthem Blue Cross, Blue Shield and Health Net.
The other nine health plans selected were smaller regional players and insurers that have traditionally served lower-income and Medi-Cal patients. They are Alameda Alliance for Health, Chinese Community Health Plan, Contra Costa Health Services, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan, Ventura County Health Care Plan and Western Health Advantage.
In Los Angeles County, which was divided into two regions, six companies will compete for policyholders. They are Anthem Blue Cross, Blue Shield, Health Net, Kaiser Permanente, L.A. Care and Molina.
California Insurance Commissioner Dave Jones said he was troubled by the lack of choice in some markets. "There are only three statewide health insurers selling in Covered California," Jones said, "which means less statewide competition than we'd hoped to see in the new marketplace."
Times staff writer Noam Levey in Washington contributed to this report.