"It was pretty horrible. It was stomachache horrible," said Karen Pollitz, senior fellow of the Kaiser Family Foundation, a health policy research group.
Pollitz noted that HealthCare.gov's crash came as millions of people who had been effectively priced out or locked out of the individual insurance market for years because of pre-existing health conditions or low incomes rushed to buy plans. The ACA not only barred insurance companies from discriminating against people with such conditions, it also provided often-generous federally funded subsidies to help low- and middle-income earners pay their premiums.
"It was frustrating," Pollitz said of the failure of HealthCare.gov to effectively serve those would-be enrollees as envisioned for two months, as the site's error and "busy" messages became running visual jokes on Twitter.
There were worries, Jost said, "that the whole thing would collapse."
There also was serious speculation that because of the extreme difficulty signing up for ACA plans, they would be overwhelmed by less-healthy enrollees, whose use of health services would drain money from the plans, and in turn lead to much-higher premiums for those plans in future years, a so-called death spiral.
As the political fallout grew, Obama placed management expert Jeff Zients in charge of the repair effort, which moved to get the site functioning properly for the "vast majority of users" by the end of November.
Zients' whip cracking paid off, and the site started enrolling meaningful numbers of people in December, and then enrollment exploded in March and April, as the deadline for signing up for health coverage and avoiding a tax penalty approached.
By the close of enrollment in mid-April, more than 8 million people had selected an insurance plan on the government-run exchanges—a million more than original, precrash projections—with the bulk of those sign-ups coming on HealthCare.gov.
As the close of enrollment season approached, Sebelius, who had been the target of harsh criticism during the fall because of the exchange's performance, announced her resignation and was replaced by Sylvia Burwell. HealthCare.gov also received its own dedicated CEO, Kevin Counihan, who ran Connecticut's lauded Obamacare exchange.