In a month, the search begins.
Starting Oct. 1, a web of Quad-City health care providers, social service and community action agencies, advocates for ethnic groups and the elderly will go into the field.
With newly trained employees and, in some cases, federal grant money, they'll seek out their quarry: The approximately 39,000 non-elderly people in Scott and Rock Island counties who don't have health insurance.
Three years after the Affordable Care Act was signed into law, there perhaps is no greater key to its success than the soon-to-start effort to sign up the young and the old, the poor and middle class, the healthy and the sick.
Whether they enroll in an expanded Medicaid, children's health insurance programs or the new online insurance marketplaces, the goal is to get as many people as possible into the system. And to a large extent, it is local organizations with roots in their communities that are being charged with finding them.
In the Quad-Cities, Genesis Health System and UnityPoint Health Trinity are a big part of the effort.
Many of those people will be the uninsured who walk through their doors every day. But they also both plan on robust outreach efforts to reach people who aren't sick. After all, signing up the healthy is important so insurance pools aren't weighed down by older and costlier patients.
Genesis won a federal "navigator" grant last month and plans to hire certified application counselors. Trinity says it intends to hire certified application counselors.
Federal officials say both types of enrollment assistance carry with them strict requirements, although "navigator" rules are more stringent. For example, they must undergo 20-30 hours of training while application counselors have to do five hours.
Then, there are others who are being enlisted to help direct people to the exchange website (healthcare.gov) or a national toll-free number (1-800-318-2596), where trained personnel can help.
Community Health Care Inc. will be a major player, too, having itself been awarded a grant to help.
Tom Bowman, the chief executive officer at CHC, said the agency got $168,000 in federal money and is hiring three people for its effort.
Several other local groups have said they are interested in getting involved in some way.
"We'd like to be involved in pointing people in the right direction," said Leslie Kilgannon, executive director of Quad-Cities Interfaith.
Finding the uninsured, particularly people who don't frequent hospitals and health centers, won't be simple. There's no central database to work from.
"I consider it hunting mosquitoes with a shotgun," says Michael Woods, executive director of Casa Guanajuato, the Moline-based Latino and immigrant advocacy organization.
With a large Latino base of clients, the group has a database of 5,000 people that it serves.
With a $30,000 grant, Casa Guanajuato plans to screen incoming clients for insurance, as well as reach out to places such as churches to try to find the uninsured.
Its goal is to enroll 500 people by next March. The enrollment period will last six months.
Federal officials say there are no localized goals for overall enrollment. But they note the Congressional Budget Office estimates by the end of 2014, a net 14 million new people will have signed up for Medicaid, state children's health insurance programs and online health insurance marketplaces.
The latter will feature private insurance plans and will open for business Oct. 1.
The CBO projects enrollment will rise in later years.
Extrapolated to Scott and Rock Island counties, that would mean between 9,000 and 10,000 more people will be insured by the end of 2014.
A little less than half of those people would go to the online exchanges if the CBO's national projections hold here.
Iowa, Illinois differ in approach
There is a difference in how the outreach effort is progressing on the Iowa and Illinois sides of the river, and it could make a difference in how many people eventually are enrolled.
In Illinois, the state announced more than a month ago the names of 44 groups that will provide in-person counseling assistance.
Using Affordable Care Act grant dollars, the state handed out $27 million to those groups.
Many of those groups have said they will reach into western Illinois, including Rock Island County. Casa Guanajuato, for example, is part of that effort.
In Iowa, the picture is different.
The state was not eligible for the money Illinois got because its exchange, while a partnership with the federal government, is structured differently.
In December, Gov. Terry Branstad notified the Obama administration that it would partner with the federal government on an exchange with oversight of plan management. That doesn't include in-person enrollment assistance.
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As a result, the federal government will oversee that.
The state is involved in some outreach efforts. It was notified last month that it received approval to reuse part of a previous Affordable Care Act grant, including $2.5 million, for consumer education and outreach.
The state already has had a booth at the state fair. It also plans other outreach efforts.
"We're going to do a variety of sessions with consumer stakeholder organizations," said Jennifer Steenblock, Affordable Care Act project director for the Iowa Department of Human Services.
An Obama administration official said it is working closely with the state of Iowa and stakeholder groups.
"We've seen pretty robust interest," said Nanette Foster Reilly, senior official for the Centers for Medicare and Medicaid Services.
She said the federal government also will be conducting meetings and there are other partners who will be reaching out to their constituencies, too.
"I'm confident the consumers in Iowa will have the opportunity to enroll," she said.
One concern among local organizations is that the start of enrollment is a month away and some were only recently notified they had won grant money, including with the navigator program.
Training hasn't been completed yet, and some organizations are still in the hiring stage.
Others say they see no sign of overall coordination.
"The challenge is they’ve had (three) years to get this ready and they’re waiting until the last minute," Woods said.
Plan information isn't available yet on the Iowa or Illinois exchanges, either.
Federal officials say agreements with plan providers are expected to be completed by mid-month, and top administration officials have pledged to be ready when enrollment starts.
On a conference call with reporters last month, U.S. Health and Human Services Secretary Kathleen Sebelius declared, "We'll be ready on Oct. 1."