SIOUX CITY | Bethany Jones came down with an upper respiratory infection two months ago. She battled the illness for more than a week before going to a doctor.

"It’s $100 just to walk in the door," said Jones, 30, of Ida Grove, Iowa, an unemployed mother of two. "With me not working, $100, that's a lot of money just to see him and say, 'You need antibiotics.'"

Jones is one of an estimated 264,000 uninsured Iowans who, starting Tuesday, can purchase subsidized private coverage through online-based insurance exchanges.

The exchanges are the result of the Affordable Care Act, which requires almost all Americans to have health insurance by Jan. 1 or face penalties. The act, also known as “Obamacare,” sparked a contentious political battle in Washington that created the threat of a government shutdown on Tuesday.

Despite the issues, the health exchanges went live at 9 a.m. local time Tuesday, with many questions remaining. 

Iowa has agreed to a partnership exchange with the federal government, which means that the website and the technical infrastructure will all be handled by federal authorities. The Nebraska and South Dakota insurance exchanges are being run by the federal government.

All are accessed at

Iowa also is moving forward with an insurance program for low-income people, called Iowa Health and Wellness Plan

Jones is eager to explore her options on the insurance marketplace. She said she was denied coverage through her husband’s provider. Her children have coverage through Hawk-I, the state insurance program for lower-income people.

"People who don't have insurance or struggle getting insurance because of pre-existing conditions now have that option to not get booted off a plan, to not get services,” Jones said. “It allows them to have access to health care that before they didn't have."

The threat of a partial government shutdown, driven by Republican opponents of increasing the federal role in health care, did not stop the roll-out. Like Social Security and Medicare, the program is shielded from budget battles.  

"Shutdown or no shutdown, we're ready to go," Health and Human Services Secretary Kathleen Sebelius said Monday.

While Iowa is not a state where political opponents of the law are trying to aggressively impede implementation, state officials said there is still work to be done to explain the law to the public. 

"It's really a massive undertaking to educate Iowans. I think we have a lot of work ahead to educate people about the options on the exchange," said state Sen. Joe Bolkcom, D-Iowa, who supports the law and has worked to inform his constituents about the new program.

Those shopping for benefits in Iowa will be able to choose from between at least two insurance carriers, both selling plans that offer a range of premiums, deductibles and co-pays. Some people using the exchange will qualify for subsidies to help cover the cost.

Projected premium costs are expected to be lower in Iowa than in many other states. Before tax credits that will provide an up-front discount for most buyers, the premium price for a mid-range benchmark plan will average $287 a month in Iowa, according to information released by the Obama administration earlier this week. That's lower than the national average of $328 monthly.

"I think compared to other rates we've seen, we shape up pretty competitively," said Iowa Insurance Commissioner Nick Gerhart.

Getting the word out to residents about the exchanges remains a challenge. Advocacy groups are working to fill in the information gaps in Iowa. Anthony Carroll, associated state director for advocacy for AARP Iowa, said he was doing events around the state, talking to people about the law.

"This isn't about promoting it. What we're trying to do is educate people," Carroll said. "There's a huge vacuum of people who want to know what the law means."

Looking ahead to Tuesday, Gerhart stressed that it was going to take some time for this process to work.

"People need to take their time. It's just the first day," Gerhart said.

The Associated Press contributed to this report.


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