» By Associated Press

SACRAMENTO, Calif. (AP) — Swan Lockett had high hopes that President Barack Obama’s health overhaul would lead her family to an affordable insurance plan, but that hasn’t happened.
Instead, because lawmakers in her state refused to expand Medicaid, the 46-year-old mother of four from Texas uses home remedies or pays $75 to see a doctor when she has an asthma attack.
“If I don’t have the money, I just let it go on its own,” Lockett said. The federal health care overhaul has provided coverage for millions of Americans, but it has only chipped away at one of its core goals: to sharply reduce the number of people without insurance.
President Barack Obama announced last week that 8 million people have signed up for coverage through new insurance exchanges, but barriers persist blocking tens of millions of people around the nation from accessing health care.
Questions of eligibility, immigrant coverage and the response from employers and state legislatures mean considerable work lies ahead for health care advocates and officials — but cost remains a particularly high hurdle for low income people who are most likely to be uninsured.
“We think that most people will get insurance once it’s affordable to them,” said Cheryl Fish-Parcham, of Families USA, a health advocacy group.
Others earn too much for subsidies. Immigrants living in the country illegally can’t obtain care under the law.
Dozens of states haven’t expanded Medicaid.
And some employers have reduced staff hours to avoid being mandated to provide care.
“I’m a nurse, but my employer doesn’t offer health insurance,” said Gwen Eliezer, 32, who lives north of Asheville, N.C.
Eliezer works an average of 29 hours a week at a nursing home, so her employer isn’t required to cover her.
She qualifies for a subsidy but says the plan she found with a $200 monthly premium and $6,500 deductible is too expensive. “If I went through an emergency room, I can claim acute pain,” she said.
“But then I’d end up with a lot of debt to a hospital.”
Before the launch of the Affordable Care Act, about 48 million people, or 15 percent of the population, went without health insurance, according to the U.S. Census Bureau.
and Human Services spokeswoman Erin Shields Britt said Monday that the law has brought greater security for millions of Americans but more work remains. In addition to 8 million people who signed up for private insurance through exchanges, Medicaid enrollment has increased by at least 3 million.
The decline would translate to about 3.5 million people gaining coverage, according to the study.
Another study by RAND Corp. shows a larger number of adults gaining coverage.
The Migration Policy Institute estimates that more than 7.5 million people fall into this category and rely on emergency rooms and safety net clinics. About 1 million members of this population are from California.
“When I see there are American citizens who don’t have access to health care because they can’t pay for it.
“I figure that I’ll have even less of a chance to have access to health services,” said Jose Diaz, a 67-year-old day laborer in Pomona, Calif., who came to the U.S. illegally from Mexico City nearly a decade ago. “It’s very sad.”
Nearly 5 million low-income, childless adults are without health care, according to a December survey by Kaiser Family Foundation.
A Medicaid expansion could help close that gap, and the federal government has offered to pay states nearly all of the costs for covering individuals who earn up to $16,000 a year, 138 percent of the federal poverty wage.
However, 24 states have opted against it, saying they don’t trust the federal government to deliver on its promises and don’t want to be stuck with a program they can’t afford. Health advocates say getting those states to expand would reduce hospitalization and emergency costs across the system. Texas is among the states to reject the expansion, and Lockett says she’s been shut out.
“I was disappointed,” Lockett said, “because I was kind of excited about getting on the Affordable Care Act on the marketplace.” TAS