Only 35 Mississippians have signed up for insurance at HealthCare.gov

Chris Miller, a chef at an Italian grill and pizzeria in Picayune, Miss., has spent years living in fear of anyone in his family of four facing a health crisis.

He is the sole provider for his family, and, after living without health insurance for nearly five years, he knows the consequences of anything going wrong.

"I worry about that every day," Miller told Al Jazeera. "All it takes is one accident and then you could be $20,000, $100,000 in debt, or more than that. You just never know." 

Miller said he and his wife are searching for health care, but couldn't even get onto the new federal health care exchange website.

The lack of Mississippians signing up for health insurance under the Affordable Care Act — as of Oct. 21, only 35 Mississippi residents have signed up, according to the state's insurance commissioner — is likely largely to blame on the glitch-ridden government website. The Obama administration has been embarrassed by the faulty roll-out of the site, which has led to criticism, from both Republicans and Democrats, of the web platform designed for President Barack Obama's signature health care reform bill.

On Saturday, Obama promised that the website was just weeks away from being fixed, and criticized Republicans for continuing to attack the law behind the site.

On Oct. 10, a poll showed that only 11 percent of those who tried to sign up for health insurance through the website were successful. Seventy-three percent of Americans who tried to register for health insurance reported experiencing problems.

But health-care advocates say there are also challenges to signing people up for health insurance that are specific to Mississippi.

Mississippi was the only state to appeal to the federal government to run its own insurance exchange — a request that was rejected. The federal government turned it down because of concerns the state wouldn't provide enough support for its own insurance exchange.

Jarvis Dortch of Mississippi's Health Advocacy Program said Mississippi is lagging in promoting the federal insurance marketplace for this reason.

"A lot of the advocacy groups, a lot of the provider groups did a lot of work preparing for a Mississippi-based exchange, so we've been behind other states to get the word out about the exchange," Dortch said.

The largely rural state also presents technical challenges, with some residents living without Internet access or computers.

Mississippi is the unhealthiest state in the country, according to the U.S. Department of Health and Human Services, and also has the third highest premiums in the nation for the new health care exchanges.

Hospitals and advocacy groups which received the money are training navigators to help patients sign up for coverage and mapping out state-wide outreach to bring computers to the people.

Miller, for his part, said he will try to sign up for coverage again — but is going to wait until the web site is more reliable.