But a key question in Iowa is whether all the people seeking coverage can get enrolled in plans, or on Medicaid, by the beginning of January. The enrollment process has been beset by glitches with the federal exchange website, which is being used by 36 states, including Iowa. Obama officials promised to improve the site by the end of November and it appears to be working better.
"It's going better. I don't know if I can say it's going well," said Iowa Insurance Commissioner Nick Gerhart.
According to data released by the federal government last week, about 25,000 state residents applied for coverage on the federal website in October and November. Of them, just 757 have enrolled in private health insurance plans and another 7,832 have been deemed eligible for Medicaid or another state program.
Gerhart stressed that uninsured people who want coverage to start at the beginning of January must remember that the deadline to sign up for private plans is Dec. 23. He recommended getting advice to help with the process.
"Talk to somebody who can help you. Talk to a navigator, talk to your agent," Gerhart said, adding that people need to think about what kind of coverage they require. "Is your doctor in the network, are the drugs you need?"
The health care law seeks to reduce the number of people without health insurance — estimated at roughly 300,000 in Iowa —both through an expansion of Medicaid and by requiring individuals who don't have employer-provided health insurance to purchase it. There will be federal subsidies available to help some people with their premium costs, and those who don't buy insurance will pay a penalty.
Cliff Gold, chief operating officer at CoOportunity Health, which is offering insurance plans for Iowa on the exchange, said they've seen enrollments skyrocket in early December, suggesting the process is speeding up.
"We're definitely seeing those enrollments going up," said Gold, noting that they had 344 enrollments in October and November and that the overall enrollment number climbed to 685 in the first week of December.
Those in the field said interest is growing as the end of the month draws near.
Betty Spratt, supervisor of financial counseling at Broadlawns Medical Center in Des Moines, said 12 staffers who help people with insurance applications have been inundated recently.
"We've been standing room only the last few weeks or so," said Spratt, who noted that the website is working better, though there are still problems sometimes. "I've been hearing more positive things from the counselors getting online."
People can continue to sign up on the exchange through March 31 and Medicaid enrollment is possible year-round.
Another major development for Iowa came last week, when Gov. Terry Branstad and federal authorities reached an agreement to allow the state to use additional Medicaid dollars to create a new program for low-income residents. Under the Iowa Health and Wellness Plan, some people will go on a new state-run health plan with benefits similar to those offered to state workers. Others will get private health plans on the exchange and the premiums will be paid for with federal dollars.
The state will start charging small monthly premiums to some participants in 2015. The premiums will be waived if people meet certain health goals, or in cases of hardship, and the out-of-pocket costs can't exceed 5 percent of their annual income. As part of the agreement with federal authorities the state can't deny coverage to the poorest participants if they don't pay the premiums, though they could try to collect any debts.
More than 50,000 Iowa residents are already signed up for the Iowa Health and Wellness plan, all of whom are currently on a different low-income health program set to expire at the end of the year. Thousands more have applied for state coverage and may be eligible.
