The nation’s ever-controversial health care law suffered a black eye last week after the federal government announced that next year’s premiums for those who depend on the Affordable Care Act would increase by an average of 22 percent.

But the blow won’t be as painful for most of the 1.4 million Californians who get their health coverage through Covered California, the state’s health insurance exchange: The average 2017 premium increase will be 13.2 percent after two years of modest increases.

Healthcare experts say these are some of the reasons why:

The Golden State was the first to establish its own insurance exchange under Obamacare, giving California a huge head start and allowing it to negotiate directly with insurers to get the best rates, networks and benefits. It’s mostly the states that decided to go with the federal exchange that are facing the 22 percent increase.

California’s large population helps attract more insurers, which makes the marketplace more competitive.

California was one of the first states to expand Medicaid (Medi-Cal in California) to low-income adults without children. A recent study shows that Obamacare premiums are 7 percent lower in states that chose to expand the program.

Despite howls from hundreds of thousands of Californians who wanted to keep their inexpensive, barebones plans purchased after Obamacare became law in 2010, Covered California — like several other state exchanges — canceled them. By outlawing those policies rather than “grandfathering” them in, as most other states did, the exchange created a much bigger pool of insured people, which has kept rates relatively stable.

“Covered California is doing better than a lot of the exchanges,’’ said Gerald Kominski, a professor of health policy at UCLA. “The big problem with Obamacare in a lot of places is that the markets are too small. When you have a small market, all it takes is a handful of really high-cost cases to blow up the premiums.’’

As a result, while insurers in other parts of the country are pulling out of the Obamacare markets because they cannot spread the costs, the companies on California’s exchange are staying put — as many Californians will find out Tuesday when open enrollment begins.

The exchange’s four biggest players — Blue Cross, Blue Shield, Kaiser and HealthNet — account for 90 percent of the market. That’s something that gives Covered California added stability, Kominski said.

So does the continued political good will in this solidly blue state toward the Affordable Care Act.

“We wanted it to succeed — unlike other states that have attempted to sabotage health care reform,’’ said Anthony Wright, executive director of Health Access California, a statewide health care consumer advocacy coalition.

Some of Obamacare’s current problems around the country can be traced to a June 2012 decision by the U.S. Supreme Court.

Most Americans remember that a divided court voted 5-4 to uphold the Affordable Care Act as constitutional when Chief Justice John Roberts joined the four liberals on the bench. But fewer people recall that Roberts in that decision joined his fellow conservatives to rule that the federal government couldn’t require states to expand Medicaid, even if the feds were picking up almost all of the costs.

The fact that exchange costs are lower in the 31 Medicaid “expansion states” should not surprise anyone, said Robert Laszewski, a health care policy expert based in Virginia.

Low-income individuals tend to be sicker because they have traditionally lacked health care services. So if Medicaid wasn’t expanded to include them, that means that these generally sicker people eventually end up “coming into the exchange and upping the exchange costs,” he said.

Still, most health care experts agree the biggest reason behind the premium price hikes in 2017 is the end of a temporary provision of the Affordable Care Act designed to cushion insurers from losing money on low-cost, high-risk policies during the exchanges’ first three years.

Peter Lee, CEO of Covered California, has said that factor alone accounts for 4 to 6 percentage points in next year’s 13.2 percent premium hike.

Health care experts say insurers underestimated how much health care enrollees in their plans would need. So many insurers underpriced them.

The truth is that the average premium in 2017 will be pretty much what the Congressional Budget Office had projected just before the law passed in 2010. That means that many consumers buying Obamacare plans were actually paying lower-than-projected premiums the first couple of years.

“As a rule, insurers don’t provide charity care,’’ Kominski said. “At a minimum, they attempt to minimize their costs and make some money.’’

And Kominski also points out that the price hikes for around 85 percent of those who get their insurance through the Obamacare exchanges will be blunted because their policies are heavily subsidized by the federal government.

Not all health care experts remain as optimistic.

Laszewski, for example, notes that Covered California’s two biggest insurers, Anthem Blue Cross and Blue Shield, had average rate increases of 17 percent and 19 percent in 2017.

And to reduce costs, Anthem Blue Cross next year will convert a majority of its PPOs (Preferred Provider Organizations) in California to EPOs, or Exclusive Provider Organizations, which offer no coverage out of network, except in emergencies.

To avoid huge premium hikes, Lee and others are encouraging Covered California consumers to look for lower-priced plans with other carriers.

No one has to tell Danville resident Bill Lewis that.

Like hundreds of thousands of Californians who are not eligible for subsidies, Lewis has watched his monthly premiums soar from $330 in 2011 to $680 today. Next year, he said, his Blue Shield premium was set to jump to $833 a month.

That’s among the reasons why the 62-year-old executive recruiter is joining his wife’s Anthem Blue Cross plan with the Roman Catholic Diocese of Oakland, where she works. He says he could have gotten an Obamacare plan from Kaiser Permanente for $655 a month, but he didn’t want to change doctors. “Even though it will cost a little more, it’s worth it,’’ Lewis said.

“My whole point here is that there has got to be a better way to insure those 12 million people rather than causing this chaos,” Lewis said, alluding to the number of Americans who get their plans through the Obamacare exchanges.

But for John Seyfarth’s family, Covered California remains a godsend.

“Clearly the costs, without subsidies, are getting painful,’’ the Los Altos resident said. “But without Obamacare, there are no other alternatives for those with any sort of pre-existing conditions who are not eligible for corporate group plans.’’

OBAMACARE OPEN ENROLLMENT

Open enrollment for 2017 plans begins Tuesday and ends on Jan. 31.

For health care coverage in 2017, 11 insurers are listed on the Covered California exchange. That means that more than 90 percent of consumers will be able to choose between three or more plans.

Exchange officials say consumer can save money by switching to the lowest-cost plan within their current level of coverage, such as “bronze” or “silver.” But they warn that might mean giving up familiar doctors and hospitals.

Anyone thinking about going without coverage may want to consider the penalty: For tax year 2016, the penalty for not having insurance will rise to 2.5 percent of your household’s adjusted gross income, or $695 — whichever is higher.

For tax year 2017 and beyond, the penalty will remain at 2.5 percent and the flat fee will be adjusted for inflation.

Source: Covered California