The last time John Nunnemacher had health insurance was 15 years ago, when his employer paid for his coverage.

Since then, the freelance graphic artist hasn't been able to afford a policy. Luckily, he didn't get seriously ill or have a bad accident -- which could have left the San Jose man bankrupt.

But as of New Year's Day, the 43-year-old Nunnemacher was once again insured.

Nearly four years after Congress passed a controversial health care law, tens of thousands of Californians like Nunnemacher can now see a doctor without begging for charity care.

A portrait of John Nunnemacher, 43, of San Jose at his home on Jan. 3, 2014.
A portrait of John Nunnemacher, 43, of San Jose at his home on Jan. 3, 2014. (Dai Sugano/Staff)

More than 400,000 Californians have signed up for a private health care plan through the state's new online insurance exchange that opened for business Oct. 1. An additional 460,000 are now eligible for Medi-Cal, the state's health program for the poor that was expanded under the Affordable Care Act, commonly known as Obamacare.

"The day I signed up for it, I was literally in tears," said Nunnemacher, who immediately tweeted the news to friends and family, who quickly congratulated him.

Despite all the new potential patients, hospitals and medical clinics from San Jose to Oakland to Walnut Creek reported that they haven't yet been overwhelmed with previously uninsured people seeking care.

Several medical facilities reported being busy since the new health plans kicked in Wednesday. But that, health officials said, was mostly because people were suffering from the seasonal flu.

In Oakland, 32-year-old independent music producer Clifford Brown said it's been five years since he's had medical insurance. Brown said he's been able to support his family and maintain a "pretty good quality of life," as long as he doesn't "get too sick."

Brown initially thought he was eligible for an exchange plan as well, but his income is too low to qualify for a private plan. So he's reluctantly joined Medi-Cal, with the hope of moving to a Kaiser exchange plan later this year if he makes more money.

"I'm not super excited about it -- it doesn't sound like fun," Brown said of the hassles that can surface with Medi-Cal, such as less availability of medical specialists. "But it's better than nothing -- and definitely better for a catastrophic situation."

Nunnemacher's monthly premium for his Anthem Blue Cross of California plan, priced at $360 on the state's online Covered California health insurance exchange, was reduced to about $100 because his modest income makes him eligible for a federal subsidy.

Still, it was evident Friday that some people who qualify for low-cost insurance aren't yet aware of it, despite Covered California's massive TV and radio advertising campaign.

Inside a "patient access" room across from Santa Clara County's Valley Medical Center, Nick Edwards, a 56-year-old construction project manager from San Jose, waited to talk to someone about paperwork related to his emergency room visit at VMC last week because of a worrisome pain in his leg.

He hasn't been insured since he lost his COBRA plan from his last employer 18 months ago.

Edwards said that even though the pain turned out to be nothing serious, the few hours he spent in the ER will cost him thousands of dollars. It's time, he acknowledged, to get health insurance.

"I thought it only applied to people who already had private insurance," Edwards said of the Covered California exchange. He added that he was heading home to study his options on the exchange.

Not everyone is pleased with the law.

Five million Americans, including some 900,000 Californians, were notified by their insurance companies late last year that their plans were being canceled, mostly because they didn't conform to the requirements of the new law. And many of them were outraged.

President Barack Obama eventually agreed to allow each state to decide if it wanted to extend those policies through 2014. But Covered California's board refused to go along. Then, just days before the late-December sign-up deadline, the Obama administration quietly decided to allow those people to keep their old plans through this year.

By then, however, many of those had signed up for a new exchange plan, which in many cases was not only more expensive but also didn't include some of their doctors or hospitals.

"This should have been transparent from the get-go," longtime Los Gatos resident Phil Brouwer said of the controversy over the narrower health care networks.

He said that out of the five doctors he and his wife use, only one has decided to stay in the couple's Blue Shield of California network.

"Doctors are fleeing and refusing to go along" with lower rates that are being imposed through the new law, Brouwer said.

Others, meanwhile, are frustrated because they have yet to receive any confirmation from insurance companies after paying the first month's premium.

Successfully signing up for a plan doesn't guarantee coverage unless consumers pay first. The payment must be received by the insurance company by Monday. Some insurers, however, may extend that deadline.

Still, the promise of being able to finally go to any doctor far outweighs the law's kinks and shortcomings.

Said San Jose's Nunnemacher: "I hoped this day would come. I worried that it wouldn't. And I'm very glad that it finally has."