SCHUYLER, Neb. — Neil Robles was optimistic when he opened his clothing and jewelry store in downtown Schuyler about a year ago, but he knew he couldn't afford to buy health insurance on his own.
The upfront cost of rent, inventory and other expenses was too large to even think about personal coverage. So Robles, who is raising six children, relies on the high-deductible plan he receives as a maintenance and production worker at a nearby corn-processing plant.
“I worry, because the cost is always going up,” Robles said. “Personally, I don't take the kids or myself to the doctor unless there's a real need. We can't afford it.”
Despite the promises of the federal health care law, many residents in Schuyler said they're still worried about their costs and coverage options. And groups that are working to enroll people through the new insurance marketplaces acknowledge it's hard to reach those who need the insurance most, given that many are low-income, are scattered through small communities and have never had insurance.
In eastern Nebraska's Colfax County, where Robles lives, more than one in five residents lacks health insurance, according to 2011 Census data. Nebraska's uninsured rate of 13.3 percent is lower than the nation's, but the proportion of uninsured is greater in many small towns, according to the Small Area Health Insurance Estimates survey.
Adding to the confusion was President Barack Obama's announcement that Americans could re-enroll in their plans if they were kicked off because of the law's requirements. Many residents in Colfax County, with a population of roughly 10,500, were taking a wait-and-see approach.
“Quite honestly, we're all scared to death of what's going to happen,” said Gil Wigington, a local real estate agent and county commissioner. “No one knows for sure what these new laws are going to do.”
Jaidy Lopez faces a tough choice for her family and the auto repair shop she runs with her husband: Find a new health-insurance plan quickly or pay twice as much in monthly premiums.
The mother of two wants to keep her children healthy and the business afloat. But the family received word several months ago that their plan's premiums were expected to double in December, from $400 to $800, in part due to changes mandated in the federal health care law.
“We're going to have to save money and not spend on other things in order to pay for it,” Lopez said as she manned the front counter at El Pueblo Tires in Schuyler. “If it doubles, that's a lot of money.”
The family moved to Schuyler from Mexico in 2002 and started working its way through the immigration process. Jaidy (pronounced “Heidi”) and her husband, Victor, went without health insurance until she became pregnant with their first child.
Dan Brichacek, a Colfax County farmer, said he was notified this year that his monthly premiums would increase by about $100 a month because of the law. Over time, he said, the increase could force him to delay equipment purchases and other farm-related expenses.
“You've got to scale back someplace to make ends meet,” he said. “You can't just give them an IOU.”
Groups that are enacting the law at the local level also face a challenge in reaching out to residents in the most remote parts of the state.
“You're talking about a relatively small group of people, scattered over a huge geographic area, with limited communication vehicles,” said Jon Bailey, research director of the Lyons-based Center for Rural Affairs. “You don't have as many newspapers. You don't have any set infrastructure, like you would an urban place, where you can get a lot of people information quickly. And you don't have the people to do the outreach.”
One of the organizations, Community Action of Nebraska, received a $562,000 federal grant to help about 42,000 residents enroll through the new federal insurance marketplace. The group already has a regional network and a regular clientele that qualifies, but a large part of the budget was set aside for travel costs, said Roger Furrer, the group's executive director.
Furrer said some eligible families can't afford to make a trip to the nearest Community Action office, or have work obligations that prevent them from leaving their towns.
“You're often spending $120 in gas to go and talk to 10 people,” Furrer said. “It's very important that we talk to those 10 people, but that's just the reality of serving those communities.”