( Des Moines, IA – Only one quarter of Iowans without health insurance have opted to get coverage since the introduction of Obamacare, despite millions of dollars in federal spending encouraging them to sign up.

Approximately 230,000 of the 305,000 Iowans who were uninsured prior to the implementation of Obamacare remain uninsured, according to an analysis actuarial firm Milliman prepared for the Iowa Department of Human Services.

The analysis by Milliman did not attempt to assess the effectiveness of the various state and federal government efforts to persuade the uninsured to sign up.

The Centers for Medicare and Medicaid Services was primarily responsible for the outreach to Iowa’s uninsured, but was unable to provide Iowa Watchdog with an account of what the agency did and how much it spent in the state.

Using $2.5 million in federal grant money, the Iowa Insurance Division, the state agency that oversees all insurance matters, conducted its own outreach and education activities to supplement the federal effort.

The Associated Press estimated the federal government spent approximately $684 million nationwide to promote Obamacare in 2013.

In spite of that spending, a nationwide survey of the uninsured by the Henry J. Kaiser Family Foundation conducted one month before the March 2014 deadline to sign up for Obamacare found that 75 percent knew only “a little” or “nothing at all” about how the new health care system worked.

Instead of providing details on its activities, CMS provided a general statement:

“Our comprehensive outreach and education effort around the launch of the Health Insurance Marketplace used targeted television and radio advertising, social media, as well as leveraging partnerships and our grassroots work in our regional offices to inform Americans about the new opportunity to enroll, many for the very first time, in quality affordable health care coverage.”

The federal effort in Iowa focused on advertising, largely in the Des Moines metro area, according to Tom Alger, communications director of the Iowa Insurance Division.

“It was a population-centric approach, with saturation in the market they felt would get the biggest return for their spending,” Alger said. “But in Iowa, there’s a real difference between inside and outside the metro area.”

Jeremy Horpedahl, one of the few economists to study the impact of Obamacare in Iowa, said the urban outreach strategy passed by the multitudes eligible for health care exchange subsidies who live in low income rural areas of Iowa.

“Des Moines media doesn’t necessarily penetrate the rest of the state,” Horpedahl, an assistant professor of economics at Buena Vista Univesity, stated.

Alger said the IID efforts were intended to cover areas largely untouched by the federal outreach.

“Instead of making it a one-size fits all approach, we worked across the state. We held public meetings in 21 communities, working with stakeholders who had access to underserved communities. There were also 40 webinars for those who couldn’t attend the meetings. And we had a little money in budget for advertising, which was used in places other than Des Moines.”

The Iowa Department of Human Services was also involved in attempting to sign up the uninsured. IDHS public information officer Amy Lorentzen McCoy was unable to provide Iowa Watchdog with the amount IDHS spent on those activities.

“We held approximately 100 educational events and town hall meetings across the state for stakeholders, community groups, providers and the general public,” McCoy said.

The Insurance Division will be reaching out to the uninsured again later this year. “We’re looking at plans for further work during the next open enrollment period,” Alger said

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