It’s a familiar experience for Mr. Myint. After starting Oct. 1, when the exchanges went live, his organization was aiming to sign up 5,800 people by the end of March 2014. It has a long way to go.

“We have yet to see an application from start to finish,” he says.

The current HHS navigator grants last for one year, ending next fall. Surveying the battlefield, Mr. Myint says: “I think there will be plenty of navigation left to do after this year.”

Other navigators in Durham agree with his assessment. Ricardo Correa, a navigator with the Lincoln Community Health Center, is determined to sign people up for health-care insurance one way or another. “We have to be very creative on how we reach the community,” he says. “We have to think outside the box.” At a meeting that includes Mr. Correa, Duke University officials, and other groups that received navigator grants, they discuss the feasibility of tucking brochures promoting the Affordable Care Act in water bills or sending them home with school children.