DES MOINES, Iowa — Only one quarter of Iowans without health insurance have opted to get coverage since the introduction of Obamacare, despite millions of dollars in federal spending encouraging them to sign up.

Approximately 230,000 of the 305,000 Iowans who were uninsured prior to the implementation of Obamacare remain uninsured, according to an analysis actuarial firm Milliman prepared for the Iowa Department of Human Services.

The analysis by Milliman did not attempt to assess the effectiveness of the various state and federal government efforts to persuade the uninsured to sign up.