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In Washington state, nearly 25,000 residents have signed up for coverage in the exchange's first two weeks, whereas in Oregon, no one has been able to enroll through its website, although low-income residents have been able to sign up for Medicaid without the site.
Health centers expand thanks to federal grants, but increased competition could hurt smaller facilities.
Texas community groups are relying on promotoras - health counselors, often women, who offer one-on-one counseling about coverage options in Spanish-speaking communities.
Once consumers are primed to enroll, the hand-off to counselors has been rocky. Many counselors are still attending training or are awaiting background checks and state-issued licenses; some just need a computer log-in.
The health law provides for subsidized coverage for basic and preventive services for kids, and some states are requiring that they be included in every policy.
Brad Stevens, 54, learned the hard way that being uninsured was risky as accidents and illness took a toll. Soon, he'll qualify for California's expanded Medicaid program.
Pardit Pri, 29, is among the 5 million uninsured people in California. Insurance would give her peace of mind, but she worries whether she can afford it.
One South Texas health center had 50 people show up to enroll Tuesday, many could prove what they make, but not a single one had an email address required to sign up online.
There was a party atmosphere at Affordable Care Act events in California, where the law has been embraced, and in Virginia, where it has been resisted. But consumers will have very different experiences in the two states.
What you need to know about signing up for ACA marketplace coverage: There are new benefits, and what you pay depends on your age, your address and how much you earn.
They can expect to be bombarded by messages from both proponents and critics of the law.
A coalition of the city's health department, county clinics and groups like the Urban League and Enroll America is trying to get the word out to Houston's 800,000 uninsured residents about the Affordable Care Act's insurance marketplaces, which will open Oct. 1.
Survey of 2,000 Californians also finds that many undocumented immigrants mistakenly believe they will be covered.
In Missouri, a decidedly low-profile campaign stems from a voter referendum last year barring the governor from moving forward on an exchange. In Illinois, officials partnered with the federal government to build the marketplace. Nonetheless, neither exchange has given any cost information to consumers.
When consultants ran simulations of the exchanges that open for enrollment Oct. 1, they found that price was a major consideration. But so were hospital networks -- more so than retaining doctors.
The federal overhaul will help some immigrants who are not citizens gain insurance, but there are no provisions to help those who are in the country illegally.
The uninsured rate for 2012 dropped slightly from 15.7 percent to 15.4 percent, largely because of an increase in people enrolled in public insurance programs.
Nobody has a bigger financial stake in the success of Affordable Care Act insurance exchanges than hospitals. And few may work harder to sign up consumers than hospitals themselves.
Some enrollees will have to pay more for coverage in new exchanges, while others may lose out in states that do not expand Medicaid.
The health law created 24 nonprofit, insurance company startups that will compete with long established companies starting next month.
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