In the three years since the Affordable Care Act was signed into law, the Republicans gained control of the House, the Supreme Court weighed in, and President Obama secured a second term.

The president’s health-care law has been through a contentious existence, but as the federal government has been shut down, in part, to delay the act’s implementation, today marks the beginning of open enrollment, which officials expect will be a long process.

“I think it will be a staged response because lot of people are still not well-informed and not aware of what the options will be,” said Peter Damiano, the director of the University of Iowa Public Policy Center. 

Starting today and going throughout the next six months, uninsured Iowans will be able to find out information and sign up for insurance under Iowa’s health-insurance exchange, operated under a partnership between the state and federal government.

Damiano said there’s a possibility a very informed group will respond immediately, while others may take more time.

“There might be a group [today] who are informed, and excited about the opportunity and will try to sign up right away,” he said. “There might also be an another group who is not really comfortable with what [the law] is about and may need a lot of assistance and take more time and effort to be able to get them to sign up.”

The Iowa Insurance Division will aid the federal government’s outreach effort to promote and answer questions about the new law, including repurposing a previous $2.5 million grant of which $680,000 will be used for various forms of advertising.

The Department of Health and Human Services has enlisted the support of the Visiting Nurse Services of Iowa, Planned Parenthood of the Heartland, and Genesis Health System to be “navigators” and to assist with enrollment.

State officials further emphasized that prospective enrollees will not be affected by the current negotiations with the federal government over the Iowa Health and Wellness Plan, which lawmakers approved in May to use federal money offered for Medicaid expansion to cover low-income Iowans. The state needs a federal waiver to use Medicaid money.

One local Democrat agreed lots of education and work will be necessary to help Iowans apply for the law, but emphasized even coverage bought now does not go into effect until January. Sen. Joe Bolkcom, D-Iowa City, said even the notion Iowans and Americans can sign up for coverage today marks a significant moment.

“I’m extremely excited about the opening about the health exchanges, because for a very long time people have fought to make sure every American has access to healthcare,” he said.

Rep. Chip Baltimore, R-Boone, said he has heard of various problems with the exchange and is “crossing his fingers” there will be no issues with the rollout.

“I am befuddled by the decision to implement this, given all problems,” he said. “If the exchanges in the Affordable Care Act were a health-insurance company, it would fail, because it cannot provide the basic services it was designed to create.”

According to a report released last week by the Department of Health and Human Services, Iowa’s expected $287 premium is lower than the $328 national average.