Sheila Lawless is the office manager at a small rheumatology practice in Wichita Falls, Texas, about two hours outside of Dallas. She makes sure everything in the office runs smoothly – scheduling patients, collecting payments, keeping the lights on. Recently she added another duty--incorporating the trickle of patients with insurance plans purchased on the new Affordable Care Act exchanges. Open enrollment doesn't end until March 31, but people who have already bought Obamacare plans are beginning to use them. "We had a spattering in January—maybe once a week. But I think we're averaging two to three a day now," says Lawless.