NAPLES — Lee Lattier has coped with life-threatening cancer and getting treatment while being uninsured.
The 26-year-old Naples resident says he would like to buy health insurance through provisions of the Affordable Care Act, also called Obamacare, but he's realistic.
"I can't afford insurance," said Lattier, who works for his father in the cabinetry business. "I think it's a really good idea, though."
Although few health-care consumer organizations have surveyed the uninsured, the expectation is vast numbers won't comply with the requirement that they buy insurance starting in 2014 if it isn't offered by their employer.
The law also will expand Medicaid but Florida Gov. Rick Scott opposes expanding the government insurance program to cover more Floridians.
There are numerous hurdles in getting more people insured, even with subsidies to offset premiums.
Foremost is educating them about the advantages of medical coverage to improve access to medical care, the value of being healthier and the language itself about insurance.
"It's overwhelming and foreign to them," said Leslie Lascheid, executive director of the charitable Neighborhood Health Clinic near downtown Naples. "These are people who all their life probably didn't have insurance. And it absolutely doesn't matter what (their) first language is."
For those who don't acquire insurance coverage in 2014, they will face a penalty of $95 or 1 percent of family income, whichever is greater. Exempt are those who don't file a tax return because their income is too low, undocumented immigrants or members of Indian tribes.
The penalty, scheduled to increase yearly, will be $695 in 2016.
About 30 million Americans are likely to remain uninsured by 2016, but 18 million are expected to be exempt from paying the penalty, according to estimates from the Congressional Budget Office. The remainder likely will be granted hardship exemptions or given a pass because of religious beliefs.
In September, the budget office revised estimates upward for how many are expected to pay the penalty in 2016. The latest estimate is 6 million, an increase from earlier estimates of 4 million.
Florida CHAIN, a leading health-care consumer advocacy group in the state, hasn't surveyed uninsured Floridians to assess how the individual insurance mandate will shake out in the state, according to Laura Goodhue, the group's executive director.
"People don't know enough about subsidies or the penalty at this point," she said. "There are many misperceptions out there about the Affordable Care Act. We are working to change that."
Goodhue said the organization will work on getting people informed about what the law will mean to them through a network of grassroots organizations, community providers and civic organizations.
"The best messengers are those who communicate directly with the community as well as those who are willing to put a 'face' on the issues and impart to others the deep and personal impact this law has on the lives of individuals and families," Goodhue said.
A few months ago, Lascheid, of the Neighborhood clinic, attended a conference of the National Association of Free and Charitable Clinics and asked an official from the U.S. Department of Health and Human Services how the agency was preparing to roll out the insurance requirement in 2014.
Lascheid said she was told insurance "navigators" would be used, but the official had no other details to share.
"We can't have volunteers trying to be the navigators," she said. "What's concerning to me is nobody truly knows how this is going to work, the complexity of the bill, and at the end of the day, how many will qualify."
* * * * *
Jennifer Romero, a dental assistant in Naples, understands the benefits of having insurance coverage but that doesn't mean she can afford it.
"I will try my best to get insurance because you never know when you will get sick," Romero, 26, said. "A lot of people think they can just go to the emergency room. They don't help a lot of people out. They send you home."
Romero, a patient at the Neighborhood clinic, has gallstones now and needs surgery. She's been a patient at the clinic for a year and doesn't know how she would be getting needed medical care without it
Nancy Lascheid, who co-founded Neighborhood Clinic in 1999 with her husband, said the need for charitable clinics won't go away under health-care reform.
"It's cheaper to pay the penalty," she said, referring to the $95 penalty for those who decide not to buy insurance in 2014. "To my knowledge, we haven't had any patients ask what is going to happen with this clinic. Donors and volunteers ask."
Many clients don't file income tax returns to be assessed the penalty and she's heard the cheapest private insurance may carry premiums of around $250 a month.
"I honestly don't think anything is going to change," she said, referring to the clinic. "We're not going to go away. The need is not going to go away."
With 53 million uninsured people in the U.S. today, about half are expected to gain coverage through an expansion of Medicaid and the insurance requirement, according to the Congressional Budget Office.
Dr. Allen Weiss, president and chief executive officer of the NCH Healthcare System, which operates NCH Downtown and North Naples hospitals, is upbeat that many more people will be insured and have access to health care. The process will take a few years.
"It won't be overnight," Weiss said. "I think American entrepreneurs will take over and insurance companies will sell policies that are understandable."
He also expects that people who become insured will share their experiences with others, so word of mouth will help increase the insured ranks.
Lattier, the cancer patient at Neighborhood clinic, understands that his treatment for testicular cancer, as a pre-existing condition, can't be used against him by an insurance company to deny him coverage. Still, he's not optimistic about his prospects.
"I will pay the $95," he said.