Obamacare begins with fits and starts

McClatchy Washington BureauOctober 1, 2013 

— The nationwide launch of the new online health insurance marketplaces got off to a rocky start on Tuesday.

Websites malfunctioned and crashed in some states and stalled in others because of a combination of technical problems and the millions of people who overwhelmed the systems trying to get their first glimpse of the new coverage offerings.

The 36 states that use federal systems to run their marketplaces had online enrollment problems early and often as slow, clunky website navigation caused long delays for online users shortly after 8 a.m., when the six-month open enrollment period for 2014 coverage began.

The three dozen states include 27 federally run marketplaces; seven jointly run by the federal government and the states; and New Mexico and Idaho, which each operates a state-run marketplace that uses the federal computer system.

Because all 36 use the same computer system, they all experienced virtually the same types of problems, like on-screen dropdown menus that wouldn’t work properly. The malfunctions prevented users from creating individual marketplace accounts, which halted their online enrollment efforts for hours in states like Missouri, Illinois, Florida, Michigan and Virginia.

In Kansas City, Mo., Leonard Hopkins was unable to find coverage for his daughter after spending 90 minutes on the state’s federally run marketplace website.

“I have tried calling the help center and got an automated system which couldn’t help,” he said in an email. “Tried using the ‘chat’ service and was told they would connect with someone who could help when available. Waited 10 minutes and then was disconnected.”

Even the 17 states that run their own marketplaces experienced similar breakdowns. Hawaii’s system crashed. Online enrollment in Maryland was halted shortly after 8 a.m. due to “bottlenecking” caused by 300,000 page visits by 87,000 unique visitors by midafternoon, said Carolyn Quattrocki, executive director of the governor’s office of health care reform.

Federal Department of Health and Human Services officials said the problems resulted from a high volume of web users and technical glitches.

“We, likewise, received word that some users were having difficulty creating accounts,” Marilyn Tavenner, administrator of the federal Centers for Medicare and Medicaid Services, said in a telephone briefing Tuesday afternoon. “So we did two things: We added capacity and we made some adjustments to the system to handle that. And I think you’ll find it much improved today.”

The problems didn’t come as a surprise. Health and Human Services Secretary Kathleen Sebelius warned on Monday that technical issues would arise in the marketplace rollouts. But the extent of the problems caught many by surprise and left agency officials forced to play defense.

“This work represents more than three years of policy and operations coming together. This has never been done before and this is a historic moment,” Chiquita Brooks-LaSure, deputy director of the federal Center for Consumer Information and Insurance Oversight, said in the telephone briefing. “If you look at what we have just experienced in the last 15 hours, the first that we have actually been open, we have seen more simultaneous users to our website than we have ever seen on Medicare.gov. We think that’s a tremendous beginning to this program and we are off to a good start.”

More than 2.8 million people on Tuesday visited the federal marketplace website, healthcare.gov, which serves as a main entry point to the 36 state marketplaces.

That’s three times the site traffic they experienced after the site was redesigned in June and seven times “more users on the marketplace website today than have ever been on the Medicare.gov website at any given time.” Tavenner said.

As more web users were diverted to the federal call centers, similar delays ensued as callers jammed the federal phone lines. To allow people to see the health plan offerings, federal officials posted the documents to the websites so people could compare and review rates without going through the enrollment process.

Officials hope to have the problems resolved on Wednesday. It’s unclear how the problems affected enrollment. Federal officials would not disclose the number of people who enrolled into coverage in the 36 states.

In Kentucky, where 640,000 people are uninsured, 1,000 applications were processed and more than 24,000 people had browsed the state’s marketplace website before 9:30 a.m.

“The surge of early applications demonstrates the pent-up demand for quality health coverage,” said Gwenda Bond, a spokeswoman for Kentucky’s Cabinet for Health and Family Services.

Freelance writer Andrew Shaffer of Lexington, Ky., beat the crowd by visiting the website at 12:01 a.m. Tuesday and signing up for coverage by 1:30 a.m. Shaffer got several error messages and was even kicked off the site once. But, he said, “I was just so excited to sign up, I had to keep going.”

Shaffer’s plan will cost $350 a month, which is $100 less than he had been paying for coverage. Figuring his income was too high, he decided not to apply for premium tax credits, the federal subsidies that help low- and middle-income people pay for coverage.

Kathryn Jarvis Gray, a self-employed home care worker from Flemingsburg, Ky. wasn’t as lucky. The system had crashed when she tried to log on at 9 a.m. The marketplace call center told her it would be two to four hours before the site was back up again, so she said she’d try again later.

Gray and her husband, Gary, a welder, both need coverage but said the extra cost would be a hardship.

“We are just regular people; we live paycheck to paycheck,” she said. “It will be hard to make another payment” for health insurance, she said. But she knows coverage is important.

In Fort Worth, Texas, Flora Brewer and Adri Smith couldn’t log in to their federally run state marketplace.

“I tried repeatedly, but the whole system is just overwhelmed,” said Brewer, who runs a Fort Worth real estate company and currently has an insurance policy that she continued after leaving her previous employer. “I’ve been involved with the implementation of new software systems and this is not unusual.”

Smith had already created a user account but forgot her password.

Jeannette Conley, an unemployed resident of Morrisville, N.C., didn’t use the online marketplace but was stymied by the complexity of plan offerings she perused at a Blue Cross and Blue Shield storefront in Morrisville.

“It’s overwhelming,” Conley said. “The variables make it difficult to make a decision because it’s hard to line up everything that you need so that it’s cost effective and you get the doctors you want and the prescriptions you need.”

In Charlotte, N.C., three enrollment assistance workers known as “navigators” only had three appointments on Tuesday at Legal Services of Southern Piedmont.

“We’re trying to do a slower rollout and make sure that we really understand the process and are giving the best possible assistance to the consumers,” said Legal Services attorney Madison Hardee.

In Florida, the Broward Community and Family Health Center in Pompano Beach had lines of people reaching the door, each seeking in-person assistance to sign up for coverage.

“I see this as a vote. The people are telling their legislators that they want Obamacare,” said Andrew Behrman, president of the Florida Association of Community Health Centers, which represents 47 federally qualified health centers in Florida.

Blue Cross is one of just two insurers offering subsidized policies in North Carolina, a state that elected not to expand Medicaid or to participate in setting up an insurance marketplace for its residents.

Contributing to this story were Dave Helling of The Kansas City Star; John Murawski of the News & Observer in Raleigh, N.C.; Jim Fuquay of the Fort Worth Star-Telegram; Mary Meehan of the Lexington Herald-Leader; Evan S. Benn and Kathleen McGrory of the Miami Herald; Zachary Kyle of the Idaho Statesman, and Karen Garloch of the Charlotte Observer.

Email: tpugh@mcclatchydc.com; Twitter: @TonyPughDC

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