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There’s a growing urgency to get more Americans signed up for health insurance as the end of March and the deadline for open enrollment draw closer.

By March 31, under the Affordable Care Act, U.S. residents will need to have health insurance or coverage through a government program such as Medicare or Medicaid — or face a potential penalty.

Government officials and health-care advocacy groups are trying to get the word out that there isn’t much time left to buy a plan, either through a government-run insurance marketplace or directly from a broker or insurance company selling plans outside of the exchanges.

More than 4.2 million people have signed up in plans through the national marketplace or state-run insurance exchanges, the Obama administration announced Tuesday. The administration is aiming for 6 million enrollees by the end of the month. In February, more than 940,000 people signed up, so nearly double that number would need to enroll to meet the target.

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Local enrollment numbers have been increasing, but are still falling short. More than 106,000 people have enrolled in plans through Washington Healthplanfinder, the state’s online exchange marketplace. But that’s fewer than the state’s Jan. 1 target of 130,000 participants.

Affordable Care Act supporters eager to increase the number of recruits have taken aim particularly at 18- to 34-year-olds, a population generally healthier and less expensive to insure than older people. Approximately one-quarter of those enrolled in the exchanges nationwide are young adults, and that fraction increased in January and February over earlier numbers.

In an attempt to woo the younger demographic, President Obama was the guest on Zach Galifianakis’ Internet talk-show parody, “Between Two Ferns.” The show was posted Tuesday on the website “Funny or Die.”

On the program, Galifianakis, a star of “The Hangover” movies, queried Obama on such weighty issues as pardoning turkeys, sending “ambassador” Dennis Rodman to North Korea and whether Hulk Hogan or Tonya Harding would represent the United States in Syria, and whether he would build his presidential library in Hawaii or his “home country of Kenya.”

The irreverent program gets many of its laughs from inappropriate, cringe-inducing questions, which Obama played off by mocking Galifianakis right back, taking stabs at “Hangover” sequels and the actor’s inability to shoot hoops.

Obama’s appearance on the subversively funny online show trumps Washington state’s recent launch of a youth-targeted ad campaign featuring faux rappers, though it’s hard to compete with the president, or “community organizer,” as Galifianakis cheekily identifies him.

Locally, state officials have tried to reach younger subscribers by promoting Healthplanfinder at roller-derby bouts and ice-hockey games. They’ve held contests to give away tickets to the Sasquatch Music Festival and run comical, mildly controversial ads with fake rap artists.

On “Between Two Ferns,” Galifianakis and Obama engaged in some humorous sparring before the president directed the conversation to the Affordable Care Act.

“Oh yeah, I’ve heard about that,” Galifianakis said. “That’s the thing that doesn’t work. Why would you get the guy who created the Zune to make your website?”

“ works great now,” Obama replied.

He went on to make his pitch for the health-insurance website, which has suffered from technical problems that initially made enrollment impossible. Obama zeroed in on young Americans, saying “they can get coverage all for what it costs you to pay your cellphone bill.”

He continued to tout the benefits of coverage, drawing some snide asides from Galifianakis. Unfazed, Obama charged on, saying “if they get that health insurance, it can really make a big difference.”

State health officials Tuesday echoed the president’s call to sign up, and do it now. Given that there are still some computer glitches and long waits to get help through the state’s toll-free call center, they’re urging people not delay.

“Finding the right plan for you and your family is a big decision,” exchange spokesman Michael Marchand said in a prepared statement, “so don’t leave it to the last minute.”

If the enrollment targets aren’t met, the immediate fallout will be political. Republicans will say it proves their point that Obama’s signature project never had the public’s support. Backers of the law will have to work harder to smooth out some of its problems and persuade Americans to take a second look.

Washington state aims to enroll 280,000 people by the end of 2014, which includes another opportunity to sign up in late fall for insurance effective in 2015. That goal needs to be met to cover the costs of operating Washington’s exchange.

Administration officials expect the pace to pick up as procrastinators are forced to act. There are no plans to extend the March 31 deadline, they emphasize.

With a few exceptions, those who don’t sign up face potentially significant penalties. The fee is calculated by the number of people in one’s household, or as a fraction of their income — whichever is larger.

This year, the penalty is $95 per adult and $47.50 per child, up to $285 per family, or 1 percent of the household income. The government plans to withhold the penalty from a person’s tax refund — should they qualify for one — in the following year.

“Given what we know about past enrollment patterns for health care,” said Department of Health and Human Services Secretary Kathleen Sebelius, “We expect that even more [people] will sign up as we approach the March 31 deadline.”

Lisa Stiffler, a freelance writer in Seattle, can be reached at

This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation. Material from

The Associated Press is included

in this report.

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