More than 6,000 residents in Sonoma County and 400,000 in the state are getting an early taste of Obamacare, receiving a version of health care coverage promised to 30 million Americans nationwide.
The coverage is part of California's early expansion of the federal Medicaid program, a key component of the health care law promoted by President Barack Obama. Only six other states in the country and Washington, D.C., have such programs.
Meanwhile, Texas, Florida, Wisconsin and Mississippi are among the states vowing not to participate in the 2014 expansion of Medicaid and the creation of state health benefit exchanges. Their refusal could leave millions without health care coverage.
"California took the lead on implementing the spirit of the Patient Rights and Affordable Care Act," said Marion Deeds, interim assistant director of the Sonoma County Human Services Department. "It's really the first generation of expanded Medicaid."
For decades, Medicaid has paid hospital and health care bills for the nation's poorest residents. But many working people without company-paid health insurance often didn't make enough money to pay for private insurance, leaving them uninsured during medical emergencies or when their health failed.
The intent of the health care bill is to bring that huge segment of the population into government-funded health care coverage by 2014, largely through local clinics such as the Santa Rosa Community Health Centers or the Petaluma Health Center.
What that will look like nationally already is happening in Sonoma County under a program called Path2Health, a precursor to Obama's health care expansion.
After years of living with no health insurance, Billie Jo Bianchi, 63, of Petaluma now finds herself with a Path2Health insurance card.
While she appreciates the coverage, she said that filling out all the paperwork to get it has been a byzantine process.
Bianchi, who has fourth-stage liver disease and other health issues, said the last time she had health insurance was when she worked for Viacom two decades ago. If she had continued her health insurance, she might have been able to treat her illnesses earlier.
"It's been one thing after another," Bianchi said. "The only thing I don't have yet is diabetes."
Path2Health is open to adults between the ages of 19 and 64 and it has no property or asset restrictions for qualifying.
It is part of California's low-income health program aimed at helping local governments transition to federal health care changes. The cost of funding the programs is split 50/50 between counties and the federal government.
But in 2014, and for two years after that, the federal government will assume 100 percent of the cost of expanded Medicaid coverage. After 2016, the federal share will drop to 90 percent.
The federal government allowed counties to set income limits, and in Sonoma County, the income eligibility for Path2Health coverage was set at 100 percent of the poverty level. By comparison, the income ceiling for Medi-Cal, the state's health care program for the poor, and the county's own health coverage for the indigent is 66 percent.
There is also no share of cost as there is with Medi-Cal, where 19 percent of enrollees split the cost with the program. Among this group, the average share of cost is $445 a month.
Deeds said that in the 1980s, Medicaid covered a larger segment of the population, but the program was scaled back because of the severe recession during that decade.