[Editor’s note: The following is the second in a three-part series examining the local impact of the Patient Protection and Affordable Care Act, or Obamacare.]

It was a slap in the face, Caren Rugg said.

Because Kansas is not expanding its state Medicaid program, known as KanCare, Rugg’s only option for health insurance is to go through a new insurance exchange, prompted by the federal government’s Patient Protection and Affordable Care Act, also known as Obamacare.

“My next option became waiting until implementation of the Affordable Care Act, in which, beginning in October, states are supposed to have health exchanges set up so that residents within the state have options and have comparisons so they can shop and compare and get the best deal,” Rugg, rural Ottawa and who is the vice chair of the Franklin County Democratic Party, said. “In the state of Kansas, Gov. Brownback has opted out of that system. He is not willing to invest in the people in this state who need health care. So now my only option has become, again, going to the federal exchange.”

Rugg, who works as an operator for two websites, is one of many who will be directly affected by the Affordable Care Act. For her and her husband, Terry, life has not been a picture of health.

‘I had no control’

“My husband had been disabled in 2000 as a result of a massive heart attack and then had gone on to have other medical events,” Rugg said. ”In 2010, he was diagnosed with thyroid cancer and a very rare anomaly known as pheochromocytoma.”

Pheochromocytoma is a type of tumor of the adrenal glands.

“He had, at that point, six years of an undiagnosed vomiting syndrome and was hospitalized fairly regularly,” Rugg said. “There was six times in 2009 alone.”

Rugg said that by 2010 she had quit her full-time job to help take care of her husband and raise her daughter, Molly. Her husband was not the only one, though, who would need health insurance because of illness.

“I looked into coverage for myself because I have rheumatoid arthritis, and I knew that diagnosis alone made me uninsurable,” she said. “I had the protection of a group policy at work, and needed to know that I could continue to have coverage. I found through my alumni association at [The University of Kansas] health care coverage that would be available to me. I looked into it, and they did not exclude rheumatoid arthritis.”

Rugg said she then left her job thinking that after her nine months of COBRA (Consolidated Omnibus Budget Reconciliation Act) was complete, she would have health insurance. The health care she found through the alumni association sent her a letter of acceptance, only to follow up a week later with a letter stating Rugg would have to pay a $65,000 per-year deductible on her rheumatoid arthritis treatments, she said.

“Essentially, what this company was saying is that they would be happy to take my $400 every month, but they were not willing to provide treatment for what was my only real medical condition at the time,” Rugg said. “I have, my entire life, tried to do things right physically. I’ve never smoked cigarettes. I don’t drink to speak of. I’ve tried to be physically active and take care of myself. It has really been a slap in the face to be held accountable for something I had no control over.”

‘Simple and entertaining’

The Affordable Care Act, which was signed into law by President Barack Obama on March 23, 2010, begins with enrollment Oct. 1 for coverage beginning Jan. 1, 2014. InsureKs.org is a website set up by the Kansas Insurance Office to inform residents about Obamacare and their health care options. The site also provides a link to HealthCare.gov, the federal marketplace where people can search, shop and purchase health insurance online. According to InsureKs.org, health insurance plans in the marketplace are categorized into bronze, silver, gold and platinum plans, with each category differing in the amount of premium and out-of-pocket costs.

The state’s site also features a computer-generated character named Alex, who will engage users in a conversation to explain the changes “in a simple and entertaining way,” according to a news release from the Kansas insurance commissioner. A cost calculator also is included on the site to help people estimate premiums and tax credits that could be available in 2014.

‘Quite a mess’

While Rugg is thankful for the benefit of having health care options from Obamacare, others do not share the same optimism about how the new law will affect individuals. Tab White, 54, Ottawa, works for Garmin International Inc. in Olathe, and, while he said the law will not affect him greatly, thinks it will create a messy situation.

“On a personal basis, it is politics as usual and I think the corporations and government employees are going to be taken care of,” White said. “The small businesses, the people who dream of starting small businesses and the middle class are going to find out [Obamcare] is going to be hard on them. I think it was a not very well-thought-out piece of legislation, and it will be quite a mess for individuals and small businesses.”

Christine Krin agreed with White on the issue of Congress deciding to opt out of the Affordable Care Act plan.

“If this is a good thing, why has Congress exempted themselves from it?” Krin wrote in response to a Herald Facebook post.

‘Doughnut hole’

Gene Meyer, who has been the chief executive officer of Lawrence Memorial Hospital for 16 years, pointed out flaws within the plan for providing health care to individuals.

“Because our governor, along with several other governors, didn’t expand Medicaid, you are going to have a lot of people who bring in $60,000 to $70,000 a year who will not be eligible for Medicaid and not be able to afford even the lowest premium plan from the federal marketplace,” Meyer said. “We call that the doughnut hole in the [medical] industry. It creates a gap.”

Meyer is expected to speak 5:30 p.m. to 6:30 p.m. at The Lodge, 502 Ames St., Baldwin City, for an information meeting about how the Affordable Care Act will affect families. It’s is an individual responsibility for everyone to seek out and educate themselves about the new health care law, he said, noting Ottawa has its perks with regard to the health industry.

“What the newly insured will have to do is establish a relationship with a primary care physician,” Meyer said. “Ottawa has great primary care physicians. That really should be your first point of entry into the health care system.”

Meyer is just one person involved in several meetings across the state set up to help inform people about the changes because of Obamacare. A Lunch ’N Learn” session presented by the Ottawa Area Chamber of Commerce and Franklin County Development Council is planned 11:45 a.m. to 1 p.m. Oct. 7 at Neosho County Community College, 900 E. Logan St., Ottawa, to inform businesses about how the Affordable Care Act affects the health care they offer their employees.

InsureKs.org also lists other nearby meetings for individuals hoping to learn more. Tentative meeting times include 7 p.m. Sept. 17 at the KU Edwards Campus, 12604 Quivira Road., Overland Park; 7 p.m. Oct. 3 at the Bowyer Building at the Lyon County Fairgrounds, 2700 W. Highway 50, in Emporia; and 7 p.m. Oct. 22 at the Donnelly College Events Center, 608 N. 18th St., in Kansas City.

‘It is law’

While opinions continue to clash over health care for individuals, Rugg pointed out that people in situations similar to hers will not necessarily have health insurance, but they will have choices thanks to the Affordable Care Act.

“We are not moving forward because there are people that believe that by implementing this, you working are going to be supporting me while I am at home with my husband,” she said. “That is not the case. It forces people to be responsible. It doesn’t say that all of a sudden magically we are all going to have health care; it says we now have options.”

No matter which side someone takes on the issue, Meyer said, everyone now has a big responsibility regarding health insurance.

“Whether you agree or not with (Obamacare) politically, it is law,” Meyer said.

Herald Senior Writer Doug Carder contributed to this report.