Health Insurance Marketplaces Open for Business

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Updated: 10/14 3:55 am

Online health insurance Marketplaces offering coverage to uninsured Americans opened Tuesday in all 50 states to reports of widespread computer glitches that government officials scrambled to fix throughout the day.

The long-anticipated launch was heralded by President Obama as a first-time opportunity for more than 41 million uninsured Americans to get reasonably priced health insurance. Administration officials downplayed the problems in the opening hours. They said getting to the federally operated Marketplaces, located at Healthcare.gov, was either a slow or impossible process because computer systems were overwhelmed.

Marilyn Tavenner, the administrator for the Centers for Medicare & Medicaid Services, said that 2.8 million people visited healthcare.gov between midnight Monday and Tuesday afternoon.

She would not provide any details on how many enrolled Tuesday, but said "we can confirm that people have enrolled." She said the administration is working on "a schedule" of when the information on enrollment will be released.

Tavenner said at a press conference that the widely reported problem with security questions was fixed. But one reporter said she had just tried healthcare.gov and still couldn’t get through. Tavenner said that fixes were working their way through the system.

In a briefing with reporters, Obama said: “There have been times this morning where the site has been running more slowly than it normally will because more than 1 million people visited healthcare.gov before 7 in the morning. We are going to speed things up in the next few hours to handle all this demand that exceeds anything that we expected.”

The Marketplaces, also called Exchanges, are a cornerstone of the Affordable Care Act. They're supposed to allow people to go onto a computer and shop for health insurance policies. Federal tax credits will be available, depending upon income.

Open enrollment will last until March 31, 2014. New benefits take effect on Jan. 1, 2014, for those who sign up by Dec. 15, 2013.

Opening-Day Complications

For days, Obama administration officials tried to set expectations low and cautioned that there may be technology problems on opening day.

Indeed, WebMD readers reported that when they attempted to access Healthcare.gov, the starting point for the federally operated Marketplaces, they received the error message “Your account could not be created at this time. The system is unavailable.” The Marketplaces are operated by the federal government or in partnership with state governments in 36 states.

In the other 14 states and in the District of Columbia, which are running their own versions of the insurance Marketplace, there were different reports of complications. Maryland’s Marketplace crashed and a message said it was not opening until noon, while Minnesota said its Exchange wouldn’t open until later in the afternoon.

In Vermont, not only was the computer system slow, but also the site won’t accept premium payments until November. In Washington, D.C., the Exchange can’t yet calculate available subsidies for consumers, while in New York, volume was so high, consumers encountered error messages. In Ohio, the online Marketplace crashed repeatedly. Rocky King, executive director of Oregon's online Exchange, said they were holding back some features of the web site for a week or so to make sure it was operating properly.

In California, Jordan Zavaleta, 26, had what seemed like a typical experience trying to explore his options. The aspiring actor says he thinks his state's online Marketplace “must be flooded with people trying to sign up” because the site was moving very slowly.

Health Reform and the Government Shutdown

Opponents of the law seized on its problems as evidence that the administration has bungled the launch.

“The reality is that [Democrats] passed a law that said that there would be [health insurance] Exchanges up and running by Oct. 1, and they aren’t running,” said Douglas Holtz-Eakin, president of American Action Forum, a center-right policy think tank based in Washington, D.C.

Meanwhile, Congress reached an impasse on funding the federal government over the launch of the Marketplaces, and at midnight Monday, the federal government shut down non-essential services. The shutdown doesn’t directly affect the rollout of the Marketplaces because funding for the Affordable Care Act falls under “mandatory” spending that isn’t affected by the current budget debate.

Whether the problems will affect long-term enrollment in the Exchanges isn’t clear. Groups hired by various Marketplaces to help people with enrollment, called “navigator” organizations, said they weren’t very busy with calls, even though there seemed to be lots of interest on web sites.

Lin Jenkins, a consumer assistance supervisor  at Avita, a full-service hospital in Crawford County, Ohio, said at 1 p.m. Tuesday that neither she nor her staff had fielded any phone calls, emails, or instant messages.

"I have seen nothing today, and my email address is the one online. I’m kind of surprised by that, since we were first up on the list. Whether it's because it's the first day and people are just kind of waiting, or they're confused because of the government shutdown, I'm not quite sure," Jenkins said.

Erin Loubier, director of public benefits at the Whitman-Walker Health, a navigator organization based in Washington ,D.C., said “many people just need to time to feel comfortable with it and get information about policies before they jump in a buy something.”

Premium Prices

When people were able to access the Marketplaces, there was detailed information about the premiums for insurance products. One of the keys to whether the Marketplaces will work is if there is affordable coverage. 

William Custer, director of the Center for Health Services Research at Georgia State University, said the premiums he has seen from Marketplaces across the country look “really affordable and are equal or less than what many people are paying now” for insurance on the individual market. 

Federal tax credits to pay for premiums are a big part of that. For example, Custer said a person under 30 who is making $24,000 a year will receive about $200 a month in federal subsidies to pay for coverage.

Still, the price for insurance for many young people may be more than they are willing to pay. Custer said policies for those under 30 who are healthy are about 10% to 15% more expensive than what they can buy in individual insurance markets currently, but they will receive more benefits than are offered in most policies.

Holtz-Eakin thinks those higher prices will be a problem for getting healthy people to buy insurance. “The prices are bad news for the young and healthy,” he said.

Kathleen Doheny and Julie Edgar contributed reporting.

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