Two days before the launch of the groundbreaking health insurance exchange program, Californians are wondering whether Obamacare will work.

But it's already working. And so far, it's going better than expected.

When the Affordable Care Act was signed into law in 2010, more than 7 million Californians -- nearly 20 percent of the population -- had no health insurance. More than 30 percent of 18- to 34-year olds were uninsured.

Today, thanks to Obamacare, more than 1 million formerly uninsured Californians have coverage, and 400,000 younger than 26 have protection through their parents' insurance. Californians can no longer be denied coverage because of a pre-existing medical condition. Medical costs are dropping and premium costs for the state health insurance exchange, while the 10th highest in the country, are significantly lower than anticipated.

But that's not to say we don't expect plenty of problems Tuesday when the massive new system rolls out nationwide, we do. When Medicare was introduced in 1965, it stumbled over plenty of bumps in the road. Today, however, surveys show Americans with Medicare are far more satisfied with their coverage than those with private insurance. There's good reason to believe Obamacare eventually will be at least as popular.

Its ultimate success will hinge largely on two factors: how many people sign up for it and how efficiently the medical system will deal with changes in how care is provided to low-income people.


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The current system works well for the wealthy and the dwindling number of workers who have affordable insurance through their employers. But it does not for the 48 million Americans who do not have health insurance coverage, or roughly 15 percent of the population.

That affects all Americans in ways that many fail to recognize. Hospitals are legally obligated to care for people who arrive on their doorstep without the means to pay for care. The rest of us pay that cost, a hidden tax paid through insurance or actual taxes for public hospitals of about $1,000 per year per American family. Obamacare should cut that cost over time, if people sign up for it. As insurance companies react to the new realities, the costs are already dropping. For the first time in decades, health care costs are now growing at the same rate as the rest of the economy, at about 4 percent.

The nearly four out of five Californians who have health insurance through their employers or through Medicare will not be affected by the Affordable Care Act and do not have to do anything when sign-up begins Tuesday. But the 20 percent who were uninsured should sign up for it and they will see benefits that will, over time, lower health care costs and improve medical outcomes for all.