Obamacare: What will Affordable Care Act legacy be?
20 December 2013 Last updated at 23:11 GMT
The overhaul of the US healthcare system proposed by Barack Obama continues to cause logistical and political problems for the president.
Americans are obliged to take out health insurance or face a fine if they fail to sign up but the scheme has been beset by website glitches.
The BBC's Mark Mardell visited Mississippi, one of the country's poorest states, to find out how people are faring now the programme is under way.