Buying health insurance in Nebraska will change starting in October as part of Affordable Care Act. The new law seeks to reduce the state’s uninsured population through an exchange where people can comparison-shop for insurance. Federal officials also are urging states to expand their Medicaid programs, which provide health care to the poor and disabled. Open enrollment begins Oct. 1 for the exchanges, which are expected to be fully operational by Jan. 1, 2014.

Here are answers to a few common questions about the process:

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How many people are uninsured in Nebraska?

At least 217,000 Nebraskans don’t have health insurance. A July report by the University of Nebraska shows that population has surged by 67 percent over the last decade. It’s not clear how many would buy insurance through the exchange, but the outreach efforts to draw more people to the exchange could take a few years.

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How many people in Nebraska are covered by Medicaid, and how many would be covered if it’s expanded?

Roughly 237,000 Nebraskans— about 13 percent of the population — are eligible for Medicaid, according to a December report by the state Department of Health and Human Services. Expanding Medicaid would extend benefits to an estimated 54,000 low-income residents.

Republican Gov. Dave Heineman has said he opposes the Medicaid expansion, but some Republican and Democratic lawmakers in the officially nonpartisan Legislature are pushing to extend coverage to more residents. The federal government would pay the full cost of the new Medicaid recipients for three years, after which time the contribution would ratchet down to 90 percent.

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How will the exchange be set up?

The exchange is designed to serve as a marketplace to help consumers comparison-shop for health insurance and show whether they qualify for income-based federal subsidies. Nebraska has opted to let the federal government design Nebraska’s exchange with input from state officials. The exchanges mostly will serve individuals who buy insurance on their own and small businesses with up to 100 employees.

Heineman said he preferred a federal exchange because it would ultimately cost state taxpayers less. The Department of Insurance estimates that a federal insurance exchange would cost the state $176.6 million between 2013 and 2020, while a state-based exchange would cost $646.6 million. The state-based option would have cost Nebraska more because of the administrative and technology set-up and maintenance costs, according to the governor’s office.

Supporters of the state-based options argued that it would have given local officials greater control, but Heineman said both options were heavily regulated by the federal government.