More than 7 million people have signed up for private health insurance under the system introduced last year for those who were uninsured or had policies considered substandard.
What happened to them since has varied greatly.
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Many have been happy with their new insurance, according to polls. Others are encountering a variety of snags — high premiums, telephone runarounds or difficulty getting care. Together their experiences provide a glimpse of how the largest social program launched since Medicare has worked out for the people involved.
With lessons learned, the program enters its second year with enrollment beginning Saturday.
NICK OF TIME
Shawn Turner didn't realize it when the health insurance program debuted last year, but she would become a dramatic example of its purpose.
A 54-year-old medical transcriptionist in the tiny Illinois village of Cisco, Turner had gotten health benefits through her job for 15 years. "The main reason I worked was to get the health insurance," she says.
Then, last year, she lost coverage when her employer outsourced her work to an Internet-based transcription service. Her husband, Lloyd, who owns an auto body shop, had been on her policy so he lost his insurance, too.
In December, the Turners signed up for a "silver," or medium grade, plan on the new government website listing policies available. They would pay $236 a month and the government would pay the insurance company $830 a month, a subsidy based on their estimated $22,000 income. Their deductible was $750.
A few weeks after her coverage started, she was suddenly doubled over with abdominal pain that sent her to the emergency room. It was uterine cancer.
"I was in shock, just kind of numb," she says.
From late January through July she endured two surgeries and chemotherapy. Blue Cross Blue Shield covered more than $265,000 in medical bills, a sum that otherwise "could have wiped us out I would imagine," she says.
Today, Shawn Turner says, her doctors believe she's cancer free. Her once-lustrous brown hair is beginning to grow back after chemotherapy. She's preparing to look for a part-time job as her strength returns. The Turners were able to keep their small house on the edge of town surrounded by corn and soybean fields.
"We got to keep our livelihood and we didn't become a detriment to society and our hospitals got paid," says Lloyd Turner.
MORE FOR MORE
For 10 years, Steve Duchesne, 49, carefully purchased health insurance that covered what he believed his family of five needed — catastrophic illness and injury — and that omitted what it didn't, such as full vision care services and treatment for drug abuse.
Now, under the new system, he has more insurance than he's ever had, but at a higher cost, and he's not happy about it.
The public relations consultant's old plan was canceled because it didn't include all the minimum services required under the new law. His monthly health insurance costs have risen from $645 a month to $1,033 a month for the new policy.
"We're a middle-class family with what I consider a middle-class income for our area," says Duchesne, who lives in Redondo Beach, California. No subsidies were available for a family of five with a household income of more than $110,000.
Duchesne says he's had to drop his adult dental coverage, reduce his contribution to his individual retirement account and cut other household expenses to make up the cost difference.
"The idea the government would destroy my health insurance policy — one that I was satisfied with, which met our needs and was affordable — and force us to buy a new product that's 60 percent more expensive, is shocking to me," Duchesne says.
A SEARCH FOR A SPECIALIST
Vince and Patty Mastracco, an enterprising Northern California couple, have always preferred to take care of themselves. He's a self-described "house rat," a real estate agent who loves to show houses and meet new people. She's a food stylist and recipe consultant with a bright collection of camera-friendly blouses ready for her TV cooking appearances.
They purchased their own health policies before the Affordable Care Act and never had difficulty getting care. Last year, they chose a similarly priced "bronze" policy on California's version of the health marketplace.
"I did not expect to be 100 percent happy with the changes, but at the same time I did not expect we would receive less bang for our buck," says Vince, 63.
A mysterious lump on Patty Mastracco's knee led to a maddening search for a bone specialist who would accept their insurance. Four different orthopedists rejected her without much explanation. An MRI showed the lump was probably nothing, but she still wanted a specialist to take a look.
"To date we still have not identified a doctor that accepts our insurance and will accept her as a patient," says Vince. It's a common pattern with the most economical policies: the insurance companies are paying doctors lower rates so fewer are joining their networks. A recent small national survey conducted by the Urban Institute found that 14 percent of newly insured adults with marketplace plans say they've had trouble finding a doctor.
"I believe that this is a case where, by design, (our plan) is now being made to resemble an HMO," he says, referring to the health maintenance organizations that inspired a patient backlash in the 1990s for limiting care. "An inferior HMO."
The couple will be shopping for a new policy this year, hoping for a better network.
Pat Barone has the willpower to lose 90 pounds and keep it off. She turned that perseverance into a weight-loss coaching business that has led to speaking engagements and clients on four continents.
But her resolve has been tested by the new health insurance system.
After losing her insurance following a divorce in 2013, Barone, 59, of Madison, Wisconsin, signed up for a new health plan last year that costs her just $50 a month and also covers her 21-year-old son.
But the technical snafus have been endless. In July she began getting requests from the plan's government administrator to send paperwork verifying her citizenship and income or her coverage would be terminated. She got the documents, but the system's website, HealthCare.gov, wouldn't upload them.
"When I finally got someone on the phone, they instructed me to mail the documents in. I did that, but I am being barraged by monthly email, snail mail and phone calls to get my documents filed, or I will lose coverage," Barone says.
The letters, she says, "are kind of demanding and threatening." For now she's decided to take the assurances from operators at the HealthCare.gov telephone help line that she can ignore the warnings. She hopes they're right.
Despite the problems, she says, she's delighted with the coverage. "It's a godsend to those of us who don't have other alternatives," Barone says. "I have used it for preventive care with no problems."
Associated Press medical writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson