Broadlawns Medical Center has been serving low-income residents of Des Moines, Iowa, and the surrounding countryside for decades. Now there's a twist in Broadlawns' mission as a public hospital: helping people sign up for insurance under the Affordable Care Act.
On a recent Saturday morning, Jerrine Sanford traveled half an hour from the small town of Runnells to get her insurance questions answered at a hospital-run event.
Sanford, 47, is out of work because of a back injury. She's worried about the law's requirement that everyone have health insurance or pay a penalty.
She has been covered through IowaCare, which provides some services to people who haven't been eligible for Medicaid. But as Iowa expands Medicaid to include people who previously weren't covered, IowaCare is ending.
Sanford wants to know about her options. "Where our doctors are going to be, enrollment fees, if it covers dental coverage, eye coverage and hospitalization," she says.
With more than 200,000 Iowans lacking health insurance, there are lots of people asking questions like Sanford's but not many people available to answer them.
Iowa Insurance Commissioner Nick Gerhart says the state got about $600,000 in federal funding to pay for navigators, who help people understand their options and sign up for coverage. That's not much considering the task at hand. "You have to hire staff, train staff, hold events," he says. "I mean, that's expensive."
Right now, Iowa has only about a dozen full-time navigators and a few part-timers. "When you think that some of the navigators are going to be working in 60-plus counties, that's a heavy lift for just a few people, quite frankly," he says.
One of the organizations spreading the word is Planned Parenthood of the Heartland, which received a $217,000 navigator grant. Kyle Carlson, the group's director of legal and public policy, says it's trying to cover a broad swath of southern Iowa. The goal is to sign up 2,000 people through five navigators, which he calls ambitious.
But at least people in those counties have someone to help. In 27 of Iowa's 99 counties there aren't any navigators at all.
In those areas, people with questions have some options. They can turn to insurance agents or certified application counselors like Joe Heitritter.
Heitritter, director of outreach at Greater Sioux Community Health Center, which serves four rural counties in northwest Iowa, has been visiting local Head Start programs, churches and food banks, looking for people who need help. And he's getting some really basic questions.
"There are a lot of people we're seeing who've been uninsured for a lot of years," he says. "Just understanding what health insurance is, what premiums and deductibles are may be new to some people."
Heitritter says he and his colleagues have helped several clients narrow down their options, but he doesn't know of any who've finished the sign-up process yet.
Even with the resources of a hospital like Broadlawns, it's not easy.
Jerrine Sanford leaves her meeting with a financial counselor with a whole new set of questions. She'd hoped to qualify for Iowa's new health plan for low-income patients.
But she's been told her husband's disability payments may disqualify her. Sanford says she's tried to shop for other plans on the federal insurance marketplace. But like others, she's struggled to get the website to work. With her current coverage expiring at the end of the year, she's hoping to have some answers soon.
This story is part of a reporting partnership between NPR and Kaiser Health News. Sarah McCammon is a reporter for Iowa Public Broadcasting.