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"A lot of these people obviously don't have insurance, and enrolling in insurance is always a complicated process, anyway," said Purva Rawal, a senior manager at Avalere Health, a Washington-based advisory company.
Federal health officials have shown some regulatory leeway with states that have resisted the health care law, and they're working with private groups behind the scenes to make sure residents in those states understand the law, said Purva Rawal, a senior manager at Avalere, a Washington-based health consulting group.