Officials behind previous local and state efforts to enroll uninsured individuals in health coverage say that such individuals often are reluctant to purchase coverage and that outreach efforts take longer than expected, which could foreshadow similar struggles for the health insurance exchanges under the Affordable Care Act.

In 2006, Palm Beach County, Fla., launched a program called Vita Health that offered subsidized coverage for low-income residents who could not afford private insurance but were ineligible for Medicaid. Although enrollees could purchase health plans for $52 per month — well below the cost of private coverage — the program signed up fewer than 500 people, about one-third less than was anticipated.

Officials of past efforts warn that the penalties might not be enough to overcome the challenge of convincing young, healthy adults to enroll in the exchanges, which is necessary to hold down premiums. Experts also note that outreach often takes longer than expected, warning that such efforts need to occur through trusted individuals in the community, rather than just television and radio advertising.

Complicating the Obama administration’s and states’ efforts to enroll individuals in the exchanges is the fact that few residents understand the ACA’s provisions and requirements, including that they might be eligible for insurance subsidies, according to several polls.