Associated Press

Posted on April 21, 2014 at 12:00 PM

Updated today at 12:03 PM

SACRAMENTO, Calif. (AP) The federal health care overhaul is providing coverage for millions of Americans, but it has only chipped away at one of its core goals: to sharply reduce the number of people without insurance.

President Barack Obama announced last week that 8 million people have signed up for coverage through new insurance exchanges, but many barriers remain.

Questions of affordability, eligibility, immigrant access and the response from employers and state legislatures obstacles that existed before the Affordable Care Act took effect mean considerable work remains to make a larger dent in the uninsured population.

Some remain ineligible for Medicaid or government subsidies that lower monthly premiums because their incomes are too high. Others are eligible for the subsidies but say they can't afford their share of plans sold through government exchanges. Millions of immigrants living in the country illegally are without care, prohibited from gaining coverage under the federal law.

Some employers, meanwhile, have reduced staff hours to avoid a provision of the law that requires health coverage for employees who work 30 hours a week.

"I'm a nurse, but my employer doesn't offer health insurance," said Gwen Eliezer, 32, who lives an hour north of Ashville in rural northwestern North Carolina.

During open enrollment, Eliezer's 6-year-old son was able to qualify for Medicaid, but she continues to go without coverage.

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Despite optimism, obstacles remain for health care