Republican governors and legislatures in about two dozen states are refusing cooperation with the roll-out of the health overhaul, but some local governments are trying to fill the gap, working with nonprofit organizations, hospitals and churches leading the outreach.

As Texas residents encountered difficulties with the website for a second day, those trained to assist with the process said callers are simply asking for a nearby location where they can complete the process the old-fashioned way: in person and on paper.

For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital the most expensive setting for those covering the cost.