If you live in California and purchase health insurance on the newly created exchange called Covered California, don't expect care at Cedars-Sinai Medical Center, the prestigous academic hospital in Los Angeles. That top-drawer care won't be covered by exchange plans. Many Californians will have to give up doctors and hospital they currently use if they want subsidized coverage.

That's one of the truths omitted from last Thursday's fanfare when Covered California unveiled the plans it will offer starting Oct. 1.

Covered California will be the largest exchange in the nation. So the unveiling attracted nationwide interest. Obamacare boosters declared victory. But the truth gap between what they claimed and what exchange consumers will actually get is wider than San Francisco Bay. Setting the record straight is important, because the problems in California will be repeated elsewhere.

Maine, for example, hasn't officially announced its exchange plans yet, but already consumers are outraged to learn that they too will have to give up their current doctors and hospitals if they enroll on the exchange.

Last Thursday, Democratic Congresswoman Nancy Pelosi of California boasted that California "will offer more than a dozen comprehensive health plans without the fear of higher premiums." Not true. Premiums for individual coverage on the exchange will average $321 per month for silver level plans (second cheapest). That's about 50 percent higher than individual coverage sold last year to Californians on EHealthinsurance.com, a popular insurance marketplace.

The exchange benefit package will include more. It has to. Obamacare specifies a list of benefits, whether you want them or not. The higher premiums will also cover $100 billion in taxes on insurers over the next decade and the cost of covering chronically ill people previously excluded from individual health plans.

"This is a home run for consumers," said Covered California's Executive Director, Peter V. Lee. Not exactly. To keep premiums from being even higher, insurers limit access to doctors and hospitals. Blue Shield of California, for example, will offer an exchange plan that includes only 36 percent of its regular physician network.

For the uninsured, it's better than no coverage. But for the rest, a 50 percent premium hike for fewer choices is not an improvement. Yet New York Times columnist Paul Krug hailed Covered California as "an overwhelmingly positive experience."

If you want the federal subsidy available to individuals earning up to $45,960 a year (and households of 4 with $94,200 combined income), you have to buy on the exchange. The tradeoff is limited access. Blue Shield offers care at UCLA Medical Center to its regular customers but not customers with exchange plans.

Insurers everywhere are concluding that low cost will be king on exchanges. Most exchange customers will be low-income, sensitive to price differences and dependent on a federal subsidy. To compete on cost, these insurers are limiting networks to hospitals and doctors willing to accept lower than customary fees.

This is Walmart style health care, similar to Medicaid. Only a small fraction of doctors are willing to accept these fees.

In Maine, consumers are upset to learn that they will have to change doctors and hospitals and possibly travel long distances for care covered by an exchange plan.

Anthem, the state's largest insurer, has devised a narrow network of hospitals to cut costs, excluding one-third of hospitals in the southern half of the state and physicians who practice at them.

Most Obamacare boosters are urging the young and healthy to sign up. But how long will these customers continue to pay their monthly premium?

The risk is high that Obamacare is headed for a premium default crisis similar to the mortgage crisis and college loan defaults. Take the case of a healthy single man in California who earns $29,130 per year ($14 an hour). This is the customer the Obama administration is targeting. If he buys the cheapest bronze-level health plan, after a federal subsidy he will still have to write a check each month for $137. The federal government says that's "affordable." But how many months go by before he decides to spend that $137 on a car payment instead?

Betsy McCaughey is a former lieutenant governor of New York, founder of the Committee to Reduce Infection Deaths and the author of "Beating Obamacare." She reads the law so you don't have to. Visit www.betsymccaughey.com. To find out more about Betsy McCaughey and read features by other Creators Syndicate columnists and cartoonists, visit the Creators Syndicate web page at www.creators.com.