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HOUSTON (AP) — In San Antonio, a line of last-minute health care consumers stretched a quarter of the way around the Alamodome. In Houston, the search was on for interpreters to help people enroll for insurance.

Those trained to assist with the rush in Dallas prepared to work well past 11 p.m. And in the Rio Grande Valley, an organizer scurried between stacks of library books trying to help a half-dozen people get health care.

This is what the final day of open enrollment in President Barack Obama's health insurance marketplace looked like in Texas — the state with the highest rate of uninsured in the nation and one of the most crucial to the program's overall success.

"Texans sometimes have a little bit of a Southern sensibility, so it takes these deadlines to get them to get their enrollment completed," said Mimi Garcia, Texas' director for Enroll America.

But the obstacles abounded Monday as people rushed to either complete their enrollment or at least begin, guaranteeing they could then continue in the coming weeks under an Obama administration extension. The website worked sporadically, an 800 number was slower than usual, and it took hours to get an interpreter and a counselor on the phone simultaneously at a center in Houston that helps refugees.

"With everybody showing up the last day it's a little bit rough," said Bob Reed, vice president of patient services at Parkland Hospital in Dallas. By 2 p.m. Monday, the hospital and its outlying clinics had already seen more people than they had been averaging daily, he said.

For Texas, where one in four people are uninsured, enrollment is crucial, and the state has lagged behind others that face similar obstacles, including powerful politicians that have vocally opposed the program. By March 1, about 295,000 Texans had enrolled, less than half the 629,000 that the Centers for Medicare and Medicaid Services had projected would enroll by the deadline.

Azeb Yusuf, 45, a program coordinator at the Somali Bantu Community of Greater Houston, has been working since March 8 with a City of Houston navigator to enroll refugees.

By 8:30 a.m. Monday, more than a half-dozen people from Ethiopia, Nepal, Eritrea, Somalia, Iraq, Iran and other war-torn areas waited inside a small room to see the navigator. Many had visited before. On this last day, they took a day off from work, hoping to meet the deadline.

Besides enrollment assistance, they also needed help from interpreters who speak languages such as Amharic and Tigrigna, the latter spoken in Eritrea. Yusuf said it can take hours for an interpreter and an Affordable Care Act counselor to help on the phone simultaneously, and sometimes one drops off the line. She said a client was on hold for so long last week that the interpreter fell asleep.

"And he started snoring," Yusuf added, laughing.

As more people streamed in, Yusuf instructed them on how to start enrolling on their smartphones.

Misrak Tessema, a 31-year-old mother of two who moved to Houston from Addis Ababa, Ethiopia, three years ago, took the day off from her cable assembly job to enroll. Clutching her paperwork, she said she had tried to enroll several times.

"We've been coming back and forth and back and forth to get an appointment. It was just so overwhelming with the waiting period and I wasn't able to get off from work," Tessema said.

At a nearby City of Houston-run multicultural center, Juana and Alberto Lopez, both 50, sat nervously with a city-hired application counselor waiting to learn whether they qualified for a subsidy. Their 20-year-old daughter, Juanita, was with them.

Alberto Lopez, unemployed and on disability since he became ill with cirrhosis, might qualify for Medicaid, Juanita Lopez said, explaining that her 3-month-old daughter also has Medicaid.

With her 13-year-old sister also at home, Juanita Lopez doesn't believe the family could pay more than $50 a month for insurance. At the moment their income is about $1,200 a month between her mother's wages as a housekeeper and her father's disability. Most of that goes to a monthly rent of $1,000, she said.

But Monday was the first time they tried to apply.

"We weren't sure if we had to do it or not," Juanita Lopez said. "The whole process was so confusing."

At another city-run multicultural center in Houston, Francisco Montano, a 62-year-old who does odd jobs, waited with his wife, Edith, 58. Montano scoffs at the $50 low-premium plan with the $12,500 deductible they have been offered and questions why he should pay for insurance, considering the companies "have all the money in the world."

"I first need to know what Obama is trying to impose and whether it's better for me," Montano said. "If it's better for me to pay a penalty than I'd rather give my money to the government than to the insurance."

Associated Press writer Christopher Sherman contributed to this report from McAllen, Texas.


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