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make her eligible for a subsidy. That scene has played out many times since last fall.

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South Dakota enrollments on the federal health insurance exchange have reached 6,765, a number supporters of the program call disappointingly low, but not surprising.About 55 percent of the South Dakota signups on the Internet marketplace have been women. Young adults the so called invincibles who see no need for insurance have signed up at a greater rate in South Dakota than nationally. And most who are enrolling nine out of 10 are eligible for subsidies where the government uses tax money to help them pay their premiums.The numbers are a mixed review. The signups represent less than one tenth the 71,000 figure the state quotes as its uninsured population. Supporters say the program is offering enrollees unexpected bargains. But they also see gaps in understanding and a reluctance for people to accept the fact that the government now requires virtually all Americans to buy coverage."A lot of people tell me 'I don't ever get sick,' " said Kim Jones, an insurance navigator with the South Dakota Community Action Association in Brookings. "And it's a politically charged concept. I've had a number of people call me with very strong opinions of how this works."The number enrolling here is part of 4.2 million enrollments nationally as of the end of February. The six month enrollment period runs through March. Most Americans without insurance then, as the law is written, will be subject to a penalty next year of $95 or 1 percent of their income, whichever is greater.Jones and other backers of the health initiative hoped the enrollment numbers would be more than twice as high. She has been coordinating the officially designated navigators who assist people with questions about enrolling. Her observation after 260 outreach events across the state and massive amounts of publicity is that the program has not yet clicked in the public mindset."People don't know about it," she said.She's also finding many people falling into a gap where they do not qualify for Medicaid under state guidelines and do not make enough money to qualify for the tax subsidies on the insurance exchange. Many simply do not like the idea of the government requiring its citizens to buy insurance, as now is the case under the Affordable Care Act.Debra Muller, chief administrative officer for Avera insurance plans, said Avera has 4,845 signups as of Tuesday. Avera consistently has had more than 70 percent of the state's signups since the enrollment period opened in October."Are we happy? Yes, but we're also realizing there are tens of thousands of South Dakotans without insurance," Muller said.Ruth Krystopolski, president of the Sanford health plan, said Sanford has Converse Dainty Denim Blue had 1,150 individuals enroll through Tuesday. She said that's what she expected."I thought we'd have a little over 1,000 the first go round," Krystopolski said. "This is a multiyear process. It's going to take awhile for people to know the requirements and obligations and then engage in the market."She said Sanford is not concerned about Avera's lead in enrollments."We have different strategies in the market. Our goal was to make sure there were options for people in the community. We believe we've provided a product priced correctly," she said.The other signups are with a third carrier, Dakotacare, where a representative was not available Wednesday for comment.Most South Dakotans don't need to worry about the enrollment period because they already have insurance through Medicare, Medicaid, private plans or group coverage.Those without insurance have until the end of March to enroll to avoid a penalty on their income tax form in 2015. Whatever mode they choose, residents with household income at 100 percent to 400 percent of the federal poverty level are eligible for tax subsidies to help on their premiums. Those earning less than 100 percent of poverty $11,490 a year are not eligible for the subsidies.South Dakota's estimate of 71,000 uninsured comes from a Market Decisions survey in 2011. National agencies have said the number is higher."The best estimate is something around 90,000 South Dakotans are uninsured," said Mike Fierberg, spokesman for the Centers for Medicare and Medicaid Services in Denver. "That said, a high proportion are people that the law intended to insure through Medicaid. The plans really aren't feasible to them without the assistance."Forcing young, healthy and until now uninsured Americans to buy coverage has been a key goal of the enrollment process in order for that group to help pay the medical costs of older Americans with greater needs.Fierberg said 29 percent of the South Dakota enrollees are 18 to 34 years old, a rate slightly higher than the national average. Thirty two percent are 55 to 64 years old.Federal officials have no estimate on how many of the 6,765 enrollees in South Dakota had been previously Batman Converse High Tops Australia

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health care exchange signups low but not surprising

coverage gap those ineligible for Medicaid, but too poor to qualify for a subsidy is especially hard on women. Many come to agencies such as hers and go through an exhaustive process to determine needs and eligibility."It can take four hours," Jones said.One woman she tried to help was 60 years old, had worked 36 years and has farm rental income, but not enough to reach the $11,490 level that would Converse Trainers

uninsured. Those buying insurance for the first time potentially would be adding money to the insurance pool, as the law intends. But those enrolling on the exchange also could be people switching plans for lower rates, resulting in less money for the insurance pool.That 55 percent of the signups so far have been women might be a clue to the modern marketplace."Women tend to use health care services more than men," Krystopolski said.Jones, the navigator in Brookings, sees another situation, however.She said the Converse Mens Sneakers

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