Kelli Hoag is exactly the kind of person the Obama administration wanted to attract to the Affordable Care Act's online marketplace.

The 42-year-old Bettendorf woman didn’t have insurance. She didn’t use the doctor much. She wanted to get insured — and she was plugged in to what the law offered.

But last October, when she checked into, she hit the roadblock the rest of the country did. The website didn’t work.

Still, she persisted, and eventually, she spent a couple hours on the phone and got a decent plan. It costs her about $185 per month with dental coverage, and it meets her needs.

Hoag still isn’t crazy about the law's requirement that people have insurance or face a fine, but she adds, “I’m glad I have it. I’m glad it’s there if I need it.”

The question is: How many Kelli Hoags have signed up for coverage, and how many are still out there?

The six-month window set up by the Affordable Care Act to sign people up for health insurance will close on March 31, and only about 15,400 Iowans have selected private insurance coverage, according to administration figures released last week.

That's far short of the 33,000 that the administration last fall set as a target for enrollment by the end of February. They had hoped to have 41,000 signed up in the state by the end of March.

In Illinois, the picture is a little better.

There, nearly 114,000 had signed up by the end of February, just a bit short of what the administration had set out as a goal for the state in its memo last fall. Its end of March goal was 143,000.

Those numbers don't include the people who have signed up for Medicaid or the young people who were allowed, since 2010, to stay on their parent's insurance plans until they were 26. Both are key pieces of the law's multi-pronged plan to slash the number of uninsured around the country.

But is it working?

After all, the Affordable Care Act's main purpose was to cut the number of people without insurance. And it is still a mystery how many of the people signing up for coverage were previously uninsured — or are just switching from one plan to another.

Making an impact

The people who are helping with signups think they're reaching their target audience.

At the Moline Public Library last week, Jennifer Busch, a navigator for Genesis Health System, was direct when asked whether the people she is signing up were previously uninsured.

"Oh, yeah," she said. "I've had quite a few people who have lost their jobs."

Linaka Kain, a navigator with UnityPoint Health Trinity, says of the 1,561 people her unit has helped to enroll in both Medicaid and in private insurance plans since last October, all but 27 did not have insurance.

They are people like Kenny Simmons, a 58-year-old Rock Island man who had previously been diagnosed with lymphoma cancer and couldn't get coverage.

"The places I called, they turned me down," Simmons said, while waiting for a bus to take him home from work.

With Kain's help, however, he's now covered.

Genesis Health System said of the 1,000 or so it had assisted in enrolling, 95 percent were previously uninsured. Community Health Care said it had assisted nearly 700 and nearly nine of every 10 did not have insurance previously.

The vast majority of enrollments are in Medicaid.

Still, on a local or even statewide basis, it's almost impossible so far to tell by the data whether the Affordable Care Act is making a significant dent in the number of uninsured.

Iowans without insurance

The U.S. Census Bureau estimated that 250,000 Iowans did not have insurance in 2012.

In addition to the 15,400 Iowans who had selected a private insurance plan in the marketplace, another 72,000 had signed up for the Iowa Health and Wellness plan, the state's version of an expanded Medicaid program.

Roughly 58,000 of those enrollees were insured before via IowaCare. But that was a plan that was due to expire at the end of last year and offered only minimal coverage, anyway. The benefits they're getting now are far superior.

Another 29,000 people have been deemed eligible for Medicaid or other public coverage through the website. But most of those enrollments are duplicates, according to the state Department of Human Services.

The state and federal governments have been dealing for weeks with technical problems in transferring Medicaid enrollees at to the state.

As for those who have purchased private plans on the exchanges, it's a mixed bag of people switching insurance plans and those who are buying new coverage.

The federal marketplace doesn't ask enrollees whether that had insurance previously, and one of the main insurers selling plans on the exchange in Iowa said it doesn't have figures, either.

"It's a pretty good balance between those who are previously insured and those who are not," says Cliff Gold, the chief operating officer for CoOportunity Health.

Nationally, a McKinsey & Co. survey said that in February, 27 percent of the people who had signed up for private insurance coverage through the marketplaces said they were previously uninsured. The month before, the number of uninsured signing up was only 11 percent.

A challenging target audience

One analyst cautioned this is the first year of a process that will play out for several years.

Still, he acknowledges the challenges.

"The bottom line, to me, is we're in the implementation stages of a very complicated new program," says Peter Damiano, director of the Public Policy Center at the University of Iowa.

A study by the center last year found that the low- and moderate-income people who were the most likely to be eligible for the federal subsidies the new law offers were the least likely to be informed about it.

"You're really trying to reach a very challenging group of people to try to get them to change their behavior," Damiano says.

With just two weeks to go before the enrollment window closes, there is a push on the Obama administration's part to get people signed up for coverage.

Earlier this month, there were phone banks set up at televisions stations in Waterloo and Des Moines.

In Davenport, Mayor Bill Gluba has brought people involved in the enrollment effort to City Hall to speak at televised council meetings. An enrollment office also is open for walk-ins on 2nd Street in downtown Davenport.

Administration officials also are hoping for a late surge.

In Massachusetts, they have noted, many young people waited until the last minute to sign up for coverage when that state required people to buy insurance.

The signups for February in Iowa, however, didn't suggest a step up in activity. About the same number signed up in February as did in the month before.


Percentage uninsured by state

Field 1 Field 2 Field 3 Field 4 Field 5 Field 6 Field 7 Field 8 Field 9 Field 10 Field 11
Name Uninsured %
1. Texas 25.2
2. Nevada 24.5
3. Florida 24.1
4. Alaska 22.3
5. Montana 21.6
6. New Mexico 21.5
7. Oklahoma 21.4
8. Georgia 20.7
9. Arizona 20.4
10. California 20
11. South Carolina 19.8
12. Mississippi 19.7
13. Louisiana 19.4
14. Arkansas 19.4
15. North Carolina 19
16. Idaho 18.5
17. West Virginia 17.6
18. Oregon 17.4
19. Wyoming 17.3
20. Colorado 16.7
21. Indiana 16.6
22. Kentucky 16.2
23. Tennessee 16.2
24. Missouri 15.8
25. Washington 15.8
26. Alabama 15.8
27. Utah 15.7
28. New Jersey 14.6
29. Illinois 14.6
30. Kansas 14.4
31. Virginia 14.2
32. South Dakota 13.6
33. Ohio 13.5
34. Michigan 13.4
35. Nebraska 12.9
36. Rhode Island 12.8
37. New Hampshire 12.6
38. New York 12.6
39. Maine 12.4
40. North Dakota 12
41. Maryland 11.8
42. Pennsylvania 11.7
43. Connecticut 10.5
44. Wisconsin 10.4
45. Delaware 10.3
46. Iowa 9.9
47. Minnesota 9.2
48. Vermont 7.9
49. Hawaii 7.8
50. District of Columbia 7
51. Massachusetts 4.5