Millions of Americans who lack health insurance have until 2 a.m. Monday to sign up for coverage through exchanges established under the 2010 Patient Protection and Affordable Care Act.
The deadline -- midnight Sunday in the Pacific time zone -- marks the end of the open-enrollment period for coverage for this year for people who buy coverage on their own, rather than through an employer.
Those who qualify for Arkansas' private-option Medicaid program can enroll at any time during the year but can change plans only during the open-enrollment period.
For others, sign-ups are limited to annual open-enrollment periods or after certain events, such as a marriage, divorce, the birth of a child or the loss of a job.
Among those who enrolled Friday was Hope Findlay, a 25-year-old waitress at a Little Rock restaurant. She said she rarely visits a doctor and isn't happy about having to pay a $73 monthly premium.
But she learned last week that her income-tax refund will be reduced by about $71 because she went without coverage for much of last year.
She said she didn't want to pay a penalty again.
"I can either pay and not get a tax refund next year, and if I do get hurt or sick I'm screwed, or I can go ahead and pay for it, and if anything happens, at least I'm covered," she said.
HELP WITH PREMIUMS
Coverage under Arkansas' expanded Medicaid program, including through the private option, is available to adults with incomes of up to 138 percent of the poverty level: $16,105 for an individual, for instance, or $32,913 for a family of four.
Those who don't qualify for Medicaid may be eligible for federal tax-credit subsidies to help them buy coverage through the exchange, which is accessible through the federal enrollment portal, healthcare.gov.
The tax-credit subsidies are available to many people with incomes of less than 400 percent of the federal poverty level: for example, $45,960 for an individual or $94,200 for a family of four.
As of Feb. 6, 58,878 Arkansans who did not qualify for Medicaid had signed up for coverage through the exchange, up from 36,648 who the Arkansas Insurance Department reported were enrolled at start of the enrollment period on Nov. 15.
Of the Arkansans who had enrolled as of Jan. 30, 88 percent qualified for the tax-credit subsidies to help pay their premiums, according to the U.S. Department of Health and Human Services.
In addition, more than 223,000 Arkansans had been approved for coverage under the state's expanded Medicaid program as of Nov. 30, the most recent date for which figures were available Friday.
Nationally, 7.7 million Americans had enrolled through federally operated exchanges as of Feb. 6, federal officials said this week. An additional 2.4 million people had signed up through state-run exchanges as of Jan. 16, they said.
The Obama administration's goal is to have at least 9.1 million people enrolled and paying premiums at the end of this year.
Findlay had been covered under her mother's insurance policy but lost the coverage in March, when her mother lost her job at a company that administers health benefits.
On Friday at the First Presbyterian Church in Little Rock, an outreach worker from the University of Arkansas at Fayetteville's Partner's for Inclusive Communities helped Findlay use the federal enrollment portal, healthcare.gov, to sign up for a silver, or medium-level coverage plan offered by Arkansas Blue Cross and Blue Shield.
Federal tax-credit subsidies will cover all but $73 of the plan's $234 monthly premium, and other subsidies will reduce the plan's annual deductible to $500.
"It seems to be a pretty decent insurance plan," Findlay said.
Another outreach worker helped Findlay's mother apply for coverage under the private option.
PENALTY EMPHASIZED
In emails to consumers, federal officials have begun emphasizing the penalty during the final days of open enrollment.
A family or individual's penalty for failure to maintain coverage last year was the greater of $95 per uninsured adult, $47.50 per child, or 1 percent of a family's income that exceeds the tax filing threshold. The threshold is $10,150 for a single adult and $20,300 for a married couple who would file a joint return.
This year, the penalty is the greater of $325 per adult, $162.50 per child or 2 percent of household income above the tax filing threshold.
The penalty is capped at the national average annual premium for a bronze plan, designed to cover 60 percent of a typical patient's expenses. Last year, the cap was $2,448 per individual. The penalty is prorated based on the number of months the individual lacked coverage.
The penalty does not apply to those who would have to pay more than 8 percent of their income for insurance.
"While the penalty is a minimum of only $95 per adult without coverage in 2014," one message from the Obama administration says, "that fee rises to a minimum of $325 per adult without coverage in 2015, and to $695 per adult in 2016."
HELP WITH ENROLLMENT
Special language attached to the appropriation bills for the state Insurance, Human Services and Health departments prohibit those departments from promoting enrollment in the exchange or private option.
But other groups, using money from federal grants or private donations, will be offering one-on-one help at enrollment events today and Sunday.
The events today, listed at www.enrolleventsarkansas.com, are scheduled for 10 a.m. to 2 p.m. at the Laman Library at 2801 Orange St. in North Little Rock; 9 a.m.-3 p.m. at the Pocahontas Community Center, 300 Geneva Drive in Pocahantas; and from 9 a.m.-5 p.m. Saturday at the Arkansas Coalition of Marshallese, 109 Spring St., Suite 14, in Springdale.
In addition, ARcare, a community health center, will offer help from 8 a.m.-12 p.m. at its clinics in Augusta, Wynne, Jonesboro, Heber Springs, Conway and Lonoke.
On Sunday, the nonprofit Living Affected Corp. will help with enrollment from 9 a.m. to 9 p.m. at the First Presbyterian Church of Argenta at 201 E. Fourth St. in North Little Rock.
The Insurance Department lists contact information for outreach workers and insurance agents on its website at ahc.arkansas.gov.
At Laman Library, "we expect a big crowd," said David Wright, co-director of Partners for Inclusive Communities' Navigator Project.
"It's just human nature to wait until the last minute," he said.
Information for this article was contributed by Robert Pear and Abby Goodnough of The New York Times.