TAMPA — Kristen Nash fueled up with a frappuccino, grabbed a handful of fliers and bounded across the University of South Florida campus.
"Hey, you guys all have health care?" Nash, 23, asked a group of students walking past the library one recent afternoon.
"No," said one of them.
Nash got into step with her targets and started to launch her pitch for the Affordable Care Act, but the guy cut her off.
"We're all right," he said as he and his friends kept walking.
Just two weeks remain until the March 31 deadline to purchase health insurance through the federal marketplace. The website is now working smoothly. Generous subsidies are still available. Tax penalties still await those who qualify but don't get insurance.
And yet, the holdouts are as tough as ever to convince, as outreach workers like Nash, who works for the nonprofit Enroll America, are finding.
Some don't know they might get financial help paying for the new plans. Others still think that "Obamacare" is government health care, when in reality the insurance plans are offered by private companies.
And as always, some believe that young, healthy people — exactly the customers the plans want most — can put off insurance.
"There's still a lot of misinformation out there," said Melanie Hall, executive director of the Family Healthcare Foundation in Tampa, one of numerous organizations employing enrollment specialists known as navigators.
Even so, a new report shows the Sunshine State has relatively high enrollment figures despite a political climate often hostile to the law.
As of mid March, Florida has more sign-ups than any other state where the federal government is running the insurance marketplace, nearly 442,000. That's far outstripping the projections of a national health care consulting firm. Though Florida's sheer size accounts in part for its ranking, the state is also well ahead of Texas, which had 295,000 sign-ups.
Nationwide, 4.2 million have enrolled, suggesting the Obama administration will fall short of its revised 6 million goal for the first year of the program. In addition, adults under age 34 make up just about one-fourth of the enrollees, which may not be enough to offset the higher health costs of older people.
Florida has been a key battleground because nearly a quarter of the nonelderly population is uninsured, the second-highest rate in the nation.
"There were a couple of big states that really needed help, and Florida was one," said Eric Conrad, one of Enroll America's lead organizers.
Outreach groups have learned to adjust their approach, he said. For instance, Enroll America mostly stopped neighborhood canvassing when they realized it wasn't paying off. So they focused on running phone banks, teaming up with local organizations and showing up at special events, including this year's Gasparilla parade, where they distributed fliers on "Seven Reasons Pirates Should Get Covered." (No. 1 reason? Pre-existing conditions, such as peg legs, are now covered by all plans.)
Enrollment figures haven't been broken down to the city or county level. But in Tampa, Mayor Bob Buckhorn has gone further than his counterparts elsewhere, opening up city buildings to "super enrollment" events.
Lakeland resident Susan Upthegrove, 56, is one kind of person enrollment organizers events are hoping to find.
She was signing up for classes at Hillsborough Community College's Ybor campus two weeks ago when she happened upon an enrollment event.
Upthegrove, who is self-employed, hasn't had insurance in 20 years. She tried to check out the healthcare.gov site back in the fall, but its glitches meant she couldn't find out whether she qualified for subsidies.
"I guess there was initially some negativity surrounding the website," she said, "and I'm definitely a procrastinator."
Her chance meeting with an enrollment counselor paid off when she got a plan for just $2 a month after her subsidy.
How good is it? If she'd had such a plan last year, she noted, she wouldn't have owed $28,000 to Lakeland Regional Hospital, where she went to the emergency department, thinking she might be having a heart attack. After three nights, she left with a clean bill of health — and a big bill that will take years to pay off.
Back at USF, Nash — a graduate student who remains on her parents' insurance — kept pushing on. Some students ignored her; others made sarcastic comments. One skateboarder careened around her, saying: "Don't sign up! They need healthy people."
Finally, someone stopped and listened. Brittany Alers, 19, told Nash she hasn't had insurance since she aged out of Florida KidCare last year. "I'm kind of like, 'What am I going to do?' " she said she asked herself.
She took a flier from Nash and said she'd think about it.
Jodie Tillman can be reached at [email protected] or (813) 226-3374.