Marilyn Kruse couldn't get health insurance through her job as a substitute teacher in Jefferson County, Colo. Now she buys insurance through the state's health exchange. John Daley/Colorado Public Radio hide caption

itoggle caption John Daley/Colorado Public Radio

A Medicaid office employee works on reports at Montefiore Medical Center in New York in late 2014. New York expanded Medicaid eligibility under the Affordable Care Act and enrollment surged. Julie Jacobson/AP hide caption

itoggle caption Julie Jacobson/AP

Isaiah Roggow, a third-year medical student at the University of California, Riverside, examines patient Becky Ketchum during the school's free clinic. Rebecca Plevin/KPCC hide caption

itoggle caption Rebecca Plevin/KPCC

Outreach coordinator Sonny Weahkee (left) talks with a restaurant customer about health insurance for Native Americans in Shiprock, N.M., in early August. Heidi de Marco/Kaiser Health News hide caption

itoggle caption Heidi de Marco/Kaiser Health News

Valerie Davidson, Alaska's health and social services commissioner, drives her 1983 Chevy truck to pick up salmon for a dinner party for 50 people. Annie Fiedt/Alaska Public Media hide caption

itoggle caption Annie Fiedt/Alaska Public Media

Jo Ann Farwell, a retired social worker, has a brain tumor; she wanted to make sure her sons were clear about her end-of-life wishes. So, after talking with her doctor, she filled out a form that Oregon provides to ease those family conversations. Alan Sylvestre/Kristian Foden-Vencil/Oregon Public Broadcasting hide caption

itoggle caption Alan Sylvestre/Kristian Foden-Vencil/Oregon Public Broadcasting

Cris and Valerie Fiore hold one of their favorite pictures of their sons Anthony (with the dark hair) and Nick. Anthony died from a heroin overdose in May 2014 at the age of 24. Cris Fiore's eulogy described his son's death as a shock, but "not a surprise." Anthony had been addicted to heroin for years. Ben Allen/WITF hide caption

itoggle caption Ben Allen/WITF

Brenda Hummel and her 7-year-old daughter Andrea in their home near Des Moines, Iowa. Andrea was born with severe epilepsy and gets her health care through Medicaid. Clay Masters/Iowa Public Radio hide caption

itoggle caption Clay Masters/Iowa Public Radio

PCORI Executive Director Joe Selby says grants to medical societies are needed to get through to busy professionals who "may not answer our phone calls." Stephen Elliot/Courtesy of PCORI hide caption

itoggle caption Stephen Elliot/Courtesy of PCORI

Enrollment counselor Vue Yang (left) reviews health insurance options for Laura San Nicolas (center), accompanied by her daughter, Geena, 17, at Sacramento Covered in Sacramento, Calif., in February. Rich Pedroncelli/AP hide caption

itoggle caption Rich Pedroncelli/AP

At sign-up events like this one in Los Angeles in 2013, Covered California pledged "affordability" in health insurance as one of its main selling points. Lucy Nicholson/Reuters/Landov hide caption

itoggle caption Lucy Nicholson/Reuters/Landov

The IRS released preliminary figures that show about three-quarters of taxpayers indicated they had qualifying health insurance in 2014. Carolyn Kaster/AP hide caption

itoggle caption Carolyn Kaster/AP

Steve Heller has worked for Minnesota's John Henry Foster company for 15 years. He says he likes the greater choice of health plans he now has because of the private exchange. Mark Zdechlik/MPR hide caption

itoggle caption Mark Zdechlik/MPR

Dr. Annelys Hernandez (left) checks out Cynthia Louis (right) in Florida International University's Mobile Health Center in Miami on March 3, 2015. Courtesy of WLRN/Peter Andrew Bosch/Miami Herald hide caption

itoggle caption Courtesy of WLRN/Peter Andrew Bosch/Miami Herald