Edward Brown heard a radio ad recently and realized the clock was ticking: If he wanted health insurance, the Baltimore truck driver needed to find time to sign up before the end of March.
He found his way to the downtown offices of HealthCare Access Maryland, which employs "navigators" to help people sign up for coverage under the Affordable Care Act.
"It's comforting," said Brown, as navigator Athena Lynch typed in his information to create an account on the Maryland health exchange website. "For three years, I didn't have it. … What if I stepped on a nail or caught a cold or needed to go to the emergency room?"
Exchange officials in Maryland are trying to lure as many walk-ins like Brown as possible before the end of open enrollment through a barrage of methods. On Tuesday, the exchange board also approved a policy to allow anyone who tries to enroll by March 31 to be able to get coverage, even if they couldn't complete the process.
At one time, about 11,000 people had started an application but gotten stuck by technical problems in the exchange system. Anyone who tries the system and can't enroll will be able to call a hotline by March 31 to let the exchange know and they will get a call back to enroll them in coverage starting by May 1.
Along with the procrastinators and the uninformed, they could provide a significant bump in the number of new policies sold by the exchange. Under health care reform, people must have health insurance by March 31 or face penalties that begin at $95 or 1 percent of their income in the first year.
The next chance to enroll in health insurance won't begin until November.
"We're pushing on all fronts," said Carolyn Quattrocki, interim director of the Maryland Health Benefit Exchange. "We really want to make sure everyone knows the deadline is the 31st."
The exchange is running ads and employing social media, holding enrollment fairs, tapping churches and relying on navigator and advocacy groups to reach the uninsured.
The website's technical troubles may be complicating the efforts, but so is a general lack of information among the uninsured about the federal health law and the deadline to enroll, according to some national polls.
A Kaiser Health tracking poll found that among those uninsured nationwide in February, half still didn't understand how the 2010 law affected them. A quarter knew nothing at all about the online exchanges, which were supposed to provide one-stop shopping for insurance plans to the uninsured and underinsured.
A quarter also didn't know that the deadline to sign up and avoid penalties was March 31.
Another survey from Bankrate, a publisher of personal financial information, found a third of the uninsured planned to remain without coverage. About 41 percent of those people said insurance was too costly. About seven in 10 of all uninsured didn't know about the subsidies available to most enrollees.
In Maryland, some 800,000 were estimated to be uninsured, though about half are undocumented and not eligible for insurance coverage under the federal health law. About 40,000 people have signed up for private health plans — a figure that grew by an average of 2,200 people a week since January, when major fixes were installed on the website.
That tally still misses a lowered enrollment target set by analysts hired by the state. Enrollment in Medicaid, the expanded federal-state health insurance program for the poor, however, has exceeded the state goal. But in all, those enrolled in public and private plans, plus those moved automatically to Medicaid from a state program, puts the total number of people who have obtained health coverage at more than 234,000.
The state signed a contract with Weber Shandwick valued at close to $6 million to provide marketing and advertising services, though officials have not responded to requests for information under the state's public records law about how the money has been spent.
One insurer on the exchange, Evergreen Health Co-op, has raised money to do its own marketing and has also hosted town hall-style conference calls so consumers could dial in and ask questions.
But Dr. Peter Beilenson, a former city and Howard County health officer who founded and runs the co-op, said exchange ads don't help if the website is malfunctioning and consumers can't adequately compare prices and choose a plan.
That hindered his new cooperative insurance pool. He said Evergreen has signed up the bulk of its customers, mostly small businesses, directly and through brokers. After his direct appeals on TV, he said, 40 companies with 300 people signed on in one week.
"This is the last chance people will get," said Beilenson. "Health care should be a right, and we should all be encouraging people to sign up, especially since it's affordable for most people with subsidies."