Sobering thoughts on healthcare.

After all the controversy over the public option, people might think that everyone can sign up right away if Congress passes health reform.

Or that insurance premiums will go down.

Or that they’ll be able to shop around for insurance if they don’t like what their company offers.

Think again.

When it comes to the public option, for instance, only about 1 in 10 Americans will be eligible, mainly people who don’t get insurance through work. Only about 6 million are expected to enroll. The plan doesn’t even start until 2013.

And most people who get insurance on the job would have to stick with it. No shopping in the new “insurance exchanges” for them.

President Barack Obama and Democrats in Congress stand to reap the political rewards if they can pull off health reform, by achieving near-universal coverage, toughening regulations on private insurers and transforming the way health care is delivered.

But Democrats have glossed over nagging details of just how limited reform’s reach would be for some Americans. And if voters figure it out, experts warn there could be a political backlash.

Even some states are fretting about the feds meddling with their own meddling.

Healthcare overhaul bills working their way through Congress could jeopardize laws in California and other states that require insurers to pay for treatments such as AIDS testing, second surgical opinions and reconstructive surgery for breast cancer patients.

What’s more, the federal legislation could make it virtually impossible for states to enforce other consumer protection laws, such as the right to appeal if an insurer denies coverage for a particular treatment.

Healthcare overhaul bills in both the Senate and the House would open the door to insurers selling policies across state lines — which some lawmakers fear could allow health plans to take advantage of the lenient rules in some jurisdictions while avoiding tougher enforcement regimes in places like California.

“It would be a huge problem for California consumers,” said Rep. Jackie Speier (D-Hillsborough), who helped craft insurance laws when she served in the state Senate. “California is leading the way in terms of consumer protection, and I don’t want to see that lost.”

The proposals are part of the broader federal healthcare legislation that has been passed in the House and is still under consideration by the Senate. Before any of it can become law, both houses would have to agree on final language and President Obama would have to sign it.