A bumpy first day for new insurance marketplaces

by Carla K. Johnson
Doug Carmichael, worksite coordinator for Marketplace Nebraska, a health insurance broker under the new Affordable Care Act, explains to citizens the health insurance enrollment process and the options available to them at a seminar at the Willa Cather Omaha Public Library in Omaha, Neb., Tuesday, Oct. 1, 2013. (AP Photo/Nati Harnik)

For millions of Americans trying to log in, the online insurance marketplaces that are the center of President Barack Obama's health care overhaul began with a stalled website, an error message or a menu that didn't work.

The years-long battle over the biggest expansion in in nearly five decades culminated in a shutdown of the that also began Tuesday. The rollout of the new program will do much to define Obama's legacy.

But the debut of the new insurance marketplaces might have been a victim of the law's own success. The initial sign-up day appeared to draw heavy interest that suggested pent-up demand for just the kind of coverage now being offered.

Officials in President Barack Obama's administration said they are pleased with the strong consumer interest, but on a day of glitches they refused to say how many people actually succeeded in signing up for coverage.

By Tuesday afternoon, at least 2.8 million people had visited the healthcare.gov , said Medicare administrator Marilyn Tavenner, whose office is overseeing the introduction of the Affordable Care Act. The website had seven times the number of simultaneous users ever recorded on the medicare.gov site.

But at most only a handful of people had been able to successfully enroll online through the federal website in that time period, according to two industry officials with knowledge of the situation. The officials spoke on condition of anonymity because they were not authorized to speak about the issue publicly. The number of those enrolled is expected grow as technicians tackle and resolve glitches.

Obama called it a "historic day" for uninsured Americans. He said the opportunity is life-changing for those who could not get access to care before Tuesday's launch of the exchanges.

The president accused Republicans of making the concept of keeping people uninsured "the centerpiece of their agenda."

Republicans vehemently oppose the law, especially a mandate that all Americans have health care insurance or face . The law provides subsidies to help lower-income people pay for the plans.

The marketplaces represent a turning point in the U.S. approach to health care. The Obama administration hopes to sign up 7 million people during the first year and aims to eventually sign up at least half of the nearly 50 million uninsured Americans through an expansion of Medicaid, the government-funded program that provides for poorer Americans, or through government-subsidized plans.

Among those who signed up for a policy on Tuesday was Tennessee State University student Sam Rutherford, 31, who lost several organs as a result of a sledding accident some 15 years ago.

"I've been virtually uninsurable since that time," he said.

Ashley Hentze, left, of Lakeland, Fla., signs up for the Affordable Care Act with Enroll America, a private, non-profit organization running a grassroots campaign to encourage people to sign up for health care, Tuesday, Oct. 1, 2013 After months of build-up, Florida residents can start shopping for health insurance on government-run online marketplaces as the key component of the Affordable Care Act goes live. (AP Photo/Chris O'Meara)

In 36 states where the federal government is running the marketplaces, a snag involving security questions on users' accounts cropped up repeatedly, preventing many from completing their enrollment.

Brett Graham, a consultant advising states, called the security questions glitch "a real show-stopper."

"If you can't set up an account ... you can't enroll," said Graham, of Leavitt Partners, a consulting firm run by former Health and Human Services Secretary Michael Leavitt, who rolled out the Medicare prescription drug benefit for the elderly under former President George W. Bush.

In some states, trained health care guides resorted to old-school means of signing people up: paper or telephone.

Katie League, an outreach and enrollment manager at Health Care for the Homeless in Baltimore, used paper applications to register people when the website developed problems. She said she wasn't surprised by the opening delay and took it in stride.

The technical trouble couldn't dampen the relief Hussein Daoud felt for himself, his wife and their six children.

Louis Peters fills out papers at the Henry J. Austin Health Center, in Trenton, N.J., Tuesday, Oct. 1, 2013, to sign-up for new plans through a health insurance exchange. The exchanges are being launched in every state Tuesday as a key part of President Barack Obama's health insurance overhaul. Some uninsured New Jersey residents can begin signing up for new plans through a health insurance exchange. The exchanges are being launched in every state Tuesday as a key part of President Barack Obama's health insurance overhaul. (AP Photo/Mel Evans)

The 51-year-old Detroit man came to apply for insurance at the Dearborn-based nonprofit organization ACCESS. With the help of counselors, he learned that his annual income of $14,500 made him eligible for Medicaid, and he likely won't have to pay for a plan that covers his family.

"This is the first time I asked for anything from the government, and I'm really glad that the government can help my family," said Hussein, who lost his supervisory job at a dollar store when it closed a few years ago. He now sells used cars and can't afford coverage.

Minnesota got its site running after a delay of several hours. Rhode Island's site recovered after a temporary crash. A spokesman for the New York Department of Health blamed difficulties on the 2 million visits to the website in the first 90 minutes after its launch. Exchange officials in Colorado said their website would not be fully functional for the first month, although consumers will be able to get help applying for government subsidies during that time.

Connecticut seemed to be a bright spot. Access Health CT sent out a tweet shortly before noon Tuesday, confirming the marketplace logged 10,000 visitors in the first three hours of operation and 22 enrollments.

Alex Gonzalez, left, a volunteer with Enroll America, a private, non-profit organization running a grassroots campaign to encourage people to sign up for health care offered by the Affordable Care Act, trains volunteers who work the phones to inform residents of their health care options, Tuesday, Oct. 1, 2013, in Tampa, Fla. After months of build-up, Florida residents can start shopping for health insurance on government-run online marketplaces as the key component of the Affordable Care Act goes live. (AP Photo/Chris O'Meara)

California, home to 15 percent of the nation's uninsured, reported delays online and on the phone because of heavy volume.

In Portsmouth, New Hampshire, Deborah Lielasus tried to sign up for coverage but got only as far as creating an account before the website stopped working. She said she expected problems.

Lielasus, a 54-year-old self-employed grant writer with a pre-existing health condition, expects her costs to decrease significantly once she is able to enroll for coverage. .

As excited as she was to sign up, she said, her anticipation was tempered by dismay over the shutdown that was led by congressional Republicans who want to block the reforms.

"I'm really happy that this is happening, that this is being launched ... I feel like it's a child caught in the middle of a really bad divorce," Lielasus said.

Carol Stuewe, left, a volunteer counselor with Insure Central Texas explains health insurance options to Eric Sosa and Nancy Maldonado, Tuesday, Oct. 1, 2013, in Austin, Texas. Texas hospitals, clinics and charities are gearing up to help uninsured Texans enroll in health care exchanges after Gov. Rick Perry declared the state government would do as little as possible to help implement the Affordable Care Act. (AP Photo/Eric Gay)

The shutdown will have no immediate effect on the insurance marketplaces, which are the backbone of the law, because they operate with money that isn't subject to the annual budget wrangling in Washington.

Many states predicted that an initial surge of interest would test the online system, but they expect most people to sign up closer to Dec. 15, which is the deadline for coverage to start Jan. 1. Customers have until the end of March to sign up in order to avoid tax penalties.

Under the law, health insurance companies can no longer deny coverage to someone with a pre-existing medical condition and cannot impose lifetime caps on coverage. They also must cover a list of essential services, ranging from mental health treatment to maternity care.

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