For Some Uninsured, Simply Signing Up Is A Challenge : Shots - Health News Leaburn Alexander works two jobs and has a monstrous commute. There's no wiggle room in his budget to pay a health insurance premium — and no time even to meet with an enrollment counselor.

For Some Uninsured, Simply Signing Up Is A Challenge

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After the rollout of the Affordable Care Act last fall, a lot of Californians signed up for both the state's exchange and also Medicaid. But health insurance can be expensive, and there are millions in California still going without health insurance. Lisa Morehouse introduces us to one such man who sat it out last year.

LISA MOREHOUSE, BYLINE: At six in the morning, Leaburn Alexander is finishing his shift as the night janitor at the hotel near the San Francisco airport. He clocks out just in time to catch a shuttle to the airport.

LEABURN ALEXANDER: Right now I'm on the beginning of my commute. After an eight hour shift, my at commute is, like, two and a half hours.

MOREHOUSE: His trip to East Palo Alto is about 20 miles south, but it actually takes three hours and three more buses. He does this commute five days a week. It would be a lot faster, but three times more expensive, if he took the train. Alexander is considered the working poor. He says he makes just under $11 an hour, and after taxes, child support and other expenses, he brings home just enough to cover rent. His wife's been looking for work for over a year, and his oldest daughter's in college. His hotel job offers health coverage.

ALEXANDER: They informed me about the employees' packet - benefits and all that there.

MOREHOUSE: But Alexander says he can't afford it. With the money he earns at a second job, Alexander buys groceries and pays utility bills instead of buying health insurance. And because he'd been turned down for Medicaid in the past, he presumed he still wouldn't qualify, even under Obamacare. The 53-year-old admits he's trying to quit smoking, but otherwise he feels pretty healthy.

ALEXANDER: I mean, there's times when I be tired and fatigued at my age. And I know I got a little arthritis and stuff like that. But what might be going on inside me is a different story.

MOREHOUSE: Alexander's blood pressure is high. He got free pills from a clinic and plans to return when he runs out. He says there were a few years in his adult life when he had some healthcare.

ALEXANDER: I was incarcerated, actually, during that time.

MOREHOUSE: He says while he was abusing alcohol and drugs, he was involved in a bank robbery. He found it hard to get sober until he became a born-again Christian.

ALEXANDER: That was divine intervention. And it really happened. I've been clean and sober since July 2011.

MOREHOUSE: And so he's grateful for what he's got. He just doesn't know how he'd get insurance right now. There are millions of other Californians who still aren't insured. People who are undocumented don't qualify for Obamacare. Others who go to the California exchange, Covered California, can fall into what's called the Family Glitch, says Laurel Lucia of the University of California at Berkeley.

LAUREL LUCIA: Basically spouses and children who can get coverage through a family member's employer, but it's too expensive, when they go to Covered California, they're told they're ineligible for subsidies.

MOREHOUSE: That's a federal policy.

LUCIA: A second group is Californians who are eligible for subsidies through Covered California, but still find the premiums unaffordable.

MOREHOUSE: And Lucia says there may be more nearly 1 million Californians who are eligible for Medicaid, but don't know it or have had difficulties enrolling. That may describe Leaburn Alexander, but finding the time to sit down with a navigator to figure that out feels overwhelming.

ALEXANDER: Scheduling time to do that, you know, an appointment. It's kind of rough. It's kind of hard right now.

MOREHOUSE: Alexander says he gets his sleep in 20 and 30 minute naps on buses. He has one full morning off each week.

ALEXANDER: Come Wednesday, that's when my pastor comes, gets us and takes us grocery shopping.

MOREHOUSE: After a quick stop at his home to drop off a bag and take out the garbage, Alexander arrives at his second job washing dishes at a Stanford dining hall. He's optimistic his life might get easier.

ALEXANDER: For one thing, I'm hopeful that, you know, through prayer and everything that God will bless me with a better paying job. I kind of feeling that's coming because he knows my situation.

MOREHOUSE: Alexander wants a job closer to home - one that will give him the time and money to get health coverage. For NPR News, I'm Lisa Morehouse.

MARTIN: This story is part of a reporting partnership with NPR and Kaiser Health News.

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