WASHINGTON - The opening of state- and federal-run insurance marketplaces Tuesday saw a combination of huge interest and balky technology that led to a series of glitches, delays and even crashes that marred the first hours of the centerpiece of President Obama's health law.
Some of the delays were due to high volume. About 2.8 million people visited the federal website HealthCare.gov since midnight, said Marilyn Tavenner, director of the Centers for Medicare and Medicaid Services. The site is handling exchanges for 34 states that defaulted to the federal government for at least the first year.
"We certainly had a high volume creating accounts this morning," said Tavenner, adding the site improved as the day continued. "We added capacity and we made some adjustments." The agency did not release the number of Americans who actually bought insurance.
The exchanges are the critical part of the Affordable Care Act's requirement that uninsured Americans buy health insurance. The open-enrollment period for insurance customers will last until March 31, 2014.
Obama noted the glitches in an afternoon conference, saying they are expected with "every new law, every new product sign up." The administration will fix the problems, he said, and there were signs in the afternoon that many of the early problems were being addressed.
The government shutdown that started Tuesday at midnight brought unexpected publicity to the new exchanges, adding more volume to the site, said Jay Angoff, former head of insurance implementation at the Department of Health and Human Services.
"We're at three months before coverage starts, and I'm not worried that people won't be able to get in," he said. "They have 60 days to see what works and what doesn't."
Still, potential insurance customers around the country expressed frustration about the early problems. John Sanders of Kaukauna, Wisc., said he signed up on the exchange website three weeks ago but hit snags Tuesday.
Sanders called the system's launch "reckless at best. I will not accept the 'heavy traffic' argument. What else would be expected on the national launch date?"
The problems faced by customers Tuesday echoed those that confronted Medicare beneficiaries when they joined the program's prescription drug coverage plan in January 2006. Then, patients said they were overcharged or couldn't get their medications. Medicare Part D is now one of the health program's most popular benefits, and it has been expanded by the Affordable Care Act.
In some ways, Tuesday's pain also resembled those faced by shoppers on the busy online shopping day the Monday after Thanksgiving known as Cyber Monday or like the launch of a new retail site.
State and federal governments had no idea what to expect in terms of traffic, said retail technology expert Peggy Pulliam. She says retailers will stress or "load test" their sites simulating a surge of traffic ahead of big shopping days.
"If any simulation they ran for the stress test didn't reflect actual user behavior on that site today, they may have not found the vulnerabilities." says Pulliam, vice president of services for retail technology company Micros. "It's harder to load test a brand new system because you don't know how people are going to browse and shop the site."
Federal site an early bottleneck
Many problems centered on HealthCare.gov, the portal through which many Americans will go to sites geared to their states.
Consumers around the country frequently got messages telling them to come back later or endured long delays in connecting to the sites.
Bruce Brian, a self-employed real state broker from Greenwood, Ind., said he tried logging into HealthCare.gov and got a computer message: "Your account couldn't be created at this time. The system is unavailable."
"You would just think that with all this time they've had to get it set up and ready to go, they would have been a better premiere," Brian said.
Other potential customers, such as Nicole Argall of Appleton, Wisc., were more relaxed. She called the initial difficulties minor given the benefits of having the new coverage.
"I had some trouble with the security question portion, but I'll try again later or tomorrow," Argall said. "My husband and I are both self-employed and we've had issues with pre-existing conditions and being rejected in the past. I think a lot of people with employee-sponsored insurance don't understand that there are lots of people like us that make a good living, but are self-employed."
The surge in interest in the site is one reason for the problems, said Joel Ario, formerly the director of the Office of Health Insurance Exchanges at the Department of Health and Human Services and now a managing director at Manatt Health Solutions.
"This day has gotten a lot more attention than anyone anticipated," Ario said. "I'm not eligible for the exchange, but I've been on the site. There are going to be reporters. I've seen a lot of people come across my screen saying, 'Check out this state.'"
"It's a surprisingly high number to me," Ario said of the millions of hits reported so far. "I think it all goes to that notion that this is supposed to be a six-month gradual process."
Anne Filipic, president of the non profit group Enroll America, said many people are undeterred, citing navigators' use of paper applications to get around federal website outages in Florida.
"We have always honestly expected that as this got up and running there would be glitches," says Filipic, whose group is using a grass roots strategy to get uninsured Americans to sign up. "What's most important is that people have a place to turn to when they have questions. Even when people are frustrated they remain enthusiastic and interested."
That would describe the Rev. Donald Morton. Just as he vowed he would be, the pastor of Perfected Life Church in Wilmington, Del., was first in line Tuesday this morning at Brandywine Women's Health Association to enroll in the exchange.
For hours, however, Morton and other eager enrollees and their guides got hung up somewhere in the "create an account" process or saw a message that said: "Please wait. We have a lot of visitors on our site right now and we're working to make your experience here better. Please wait here until we send you to the login page. Thanks for your patience!"
Morton said he and others have been waiting a long time for health care. A little longer wouldn't hurt.
"I'm one of the most vulnerable," Morton said, "a black male with a pre-existing condition."
Lisa Oglesby, who directs Brandywine's team of certified marketplace guides, said it probably was a good sign that the system was overwhelmed. It shows the pent-up demand for such coverage, she said.
Around the country
Early reviews from various states were mixed. For example:
• Arkansas. In the morning, Arkansas' online exchange was moving at a crawl due to heavy traffic. Mountain Home, Ark., insurance agent Joey Crump said a number of people approached him seeking help with insurance needs but he was not been able to get on. "It' been frustrating," Crump said.
• California. Applications for the Covered California exchange were slowed by website delays and glitches all morning on the main website. Screens were showing blank on apply.coveredca.com. Error messages showed up, but applications did not. Call center lines were ringing busy and wait times of more than 30 minutes were being reported.
Rachel Mansfield, a 30-year-old self-employed esthetician in La Quinta, jumped on the website right at midnight Tuesday to sign up for a new coverage plan. The website kept crashing, she said, so she ended up downloading the application and printing it 10 hours later. But even the frustration that she saw as inevitable couldn't stop her excitement. She went on Twitter to share:" It feels so good to be signing up today. Healthcare coverage that doesn't discriminate-finally!!!"
• Connecticut. Jason Madrak, the spokesman for the state's exchange, said there were initial bugs but the exchange had 11,000 visitors and its first customer at 9:30 a.m. and 24 by noon.
"We're off to the races," Madrak said.
• Florida. Florida Blue Cross and Blue Shield added five bricks-and-mortar sales centers, bringing the statewide total to 16, and doubled the size of its direct sales force. This was done in large part to acquaint people with the company's health exchange products, and to assist those ready to purchase, said Jon Urbanek, its Jacksonville-based senior vice president .
"We're getting better traffic than we expected. And, our expectations were high," Urbanek said.
He added that company company call centers were getting more than double the normal daily call volumes, and that demand was particularly brisk at sales centers in the east coast cities of Miami, Orlando and Jacksonville.
In Estero, in southwest Florida, Florida Blue Center Director Meredith Viskovic estimated morning visitor traffic was up by 3% to 4% percent in the morning, but had tapered off by mid-afternoon.
"Callers were asking about subsidies, and whether they should wait a day or two to come in," Viskovic said.
People who arrived "came in ready to purchase a plan," but Viskovic couldn't estimate what percentage actually did. The government health exchange website "at times, was overwhelmed," Viskovic said.
• Iowa. Problems there went beyond the exchange. Visiting Nurse Services and Planned Parenthood of the Heartland both received federal grants to hire "navigators," who are to help consumers figure out their options on the new online system. Both agencies say they're working to hire and train navigators, and should have them available within a few weeks.
• Kentucky. The state''s Kynect website, which opened after midnight Tuesday, had 24,000 visitors and had processed nearly 1,000 applications by 9:30 a.m. - more than officials expected. But then the registration function went down, keeping many from applying for insurance or seeing personalized rates for various plans. State technicians worked feverishly to fix bugs, but the delay frustrated thousands who went online or came to sign-up events such as one at Jefferson Community & Technical College in Louisville.
Vanessa Anglin, 61, said she'd waited for months after losing her job and her insurance, and had to make appointment with an application counselor for next week. "It's frustrating," said Kelli Cauley, a Kynector, or in-person assistor, who was on campus to help people sign up.
The heavy demand in Kentucky reflected how many of the state's 640,000 uninsured were clamoring for access to affordable coverage, said Bill Wagner, executive director of Louisville's Family Health Centers, which serve many of the city's neighborhoods with high concentrations of uninsured residents. "When we opened this morning, we had people standing outside waiting to make an application," he said. The state's health exchange call center had taken more than 2,500 calls by early afternoon, officials said.
• Maryland. Dr. Joshua Sharfstein, the state's secretary of health, said the state delayed its opening by four hours to work on some connectivity issues with the agency's partner organizations. But when its exchange opened at noon, an "unexpected bottleneck" made it impossible for people to create accounts. At one point, more than 1,000 people were trying to do so, he says. Maryland Health Benefit Exchange spokeswoman Danielle Davis said about 90,000 people visited the site and crashed it.
"It's really as a result of the tremendous interest," Sharfstein said of the glitch. "But our system should be able to handle that."
• Michigan. After the signup website stopped functioning, long lines formed early in the day at Dearborn-based Access, a non-profit social service agency that is helping people navigate the new law. Rick Murdock, of the Michigan Association of Health Plans that represents Michigan insurers, said technical glitches aren't unexpected and "will take care of itself."
Just after the Detroit-based Thea Bowman Community Health Center opened today at 8 a.m., a patient in for a regular check-up at 9:30 asked about his options on the marketplace, triggering a call from his doctor to Jamie Jackson. Jackson is one of four community health guides for Advantage Health Centers, which operates several clinics that provide free and low-cost care to the homeless and poor. Jackson said she wasn't surprised at the call and she was able to discuss options for the patient. Despite plenty of news about federal health reform and the stalemate in Congress, consumers are still working out the details for themselves, she said. "I don't necessarily think that people will be clamoring to sign up today," Jackson said, "but I do think that the questions will start today."
• Mississippi. At 9 a.m., HealthCare.gov would not show Mississippi's exchange. Instead, it displayed a message saying visitors would be directed to the login site as soon as traffic allowed. After several minutes, a message appeared saying the system was down. Several attempts to log in yielded the same result.
• New Jersey. Scott Hartung of Shore Benefits Brokerage in Allenhurst, N.J., said the phone was ringing off the hook, and described the first day that residents could sign up for healthcare plans as "frenetic pandemonium."
• New Mexico. The state's SHOP site for small businesses enrolled 29 businesses within the first 45 minutes the exchange was open. By noon, they had more than 100 businesses, said Mike Nuñez, interim CEO for New Mexico Health Insurance Exchange.
"I'm just really excited," he said. The first few employers were rural , and that's icing on the cake for us to know that we're reaching out to rural employers."
But the rest of the day proved more difficult as people had long waiting times to the federal call center and federal exchange.
• New York. Traffic apparently overwhelmed its website in the morning. Reports on Twitter cited 2 million visitors in the first 90 minutes that nystateofhealth.ny.gov was open for business. A spokesman at the Department of Health at 8:30 a.m. said the site was working fine, but already there were delays, locked screens and error messages. By mid-morning, the site was much slower. While the home page came up on Internet Explorer, Firefox and Chrome web browsers, server error messages were common when clicking on the individual and small business links.
Reporters trying to ask questions about the website were equally out of luck Tuesday. The Chicago-based Department of Health and Human Services staff bounced back emails stating they were furloughed and unable to answer press inquiries due to the federal government shutdown.
HHS Secretary Kathleen Sebelius said 52% of her staff is working despite the federal shutdown that started at midnight Tuesday.
Those who don't get through today can still rest easy. If you want coverage to start Jan. 1, you need to enroll by Dec. 15. Otherwise, enrollment for 2014 remains open through March.
Contributing: Brian Eason, The Clarion Ledger; Matthew Daneman, Rochester Democrat & Chronicle; Kevin Pieper, The Baxter (Ark.) Bulletin; Jens Manuel Krogstad, Des Moines Register; Nick Penzenstadler. The Post-Crescent (Appleton, Wisc.); Jess Rollins, Springfield (Mo.) News-Leader; Jean Mikle, Asbury Park Press; Chris Kenning, Louisville Courier-Journal; Robin Erb and J.C. Reindl, Detroit Free Press; Beth Miller, The News Journal; Victoria Pelham, The (Palm Springs, Calif.) Desert Sun; Laura Ruane, The News-Press (Fort Myers, Fla.).