Six weeks into the rollout of President Obama's new health care law, some of the online insurance exchanges run by states are continuing to have serious technological problems, often mirroring the issues plaguing the much larger federal exchange.
In Oregon, the computer system cannot accurately determine whether people qualify for federal subsidies or Medicaid, so the exchange has hired 400 temporary workers to process thousands of lengthy paper applications while the problem is fixed.
In Vermont, customers are unable to pay for the plans they choose because of technical problems. In Hawaii, the site was not available to customers until mid-October, and users continue to report problems. Maryland's exchange portal has had so many issues, including slowness and frequent error messages, that the exchange board decided last week to let insurers handle payments directly for now. It also delayed opening its small business marketplace until April.
"The complexity of the challenge has been clearly more than we anticipated," said Dr. Joshua M. Sharfstein, Maryland's health and mental hygiene secretary and the chairman of the state's exchange board. "We are really looking for significant improvement."
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In Colorado and the District of Columbia, exchange officials say they just repaired major problems. Until last week, Colorado residents who wanted to see if they qualified for a federal subsidy to buy insurance through the state's exchange had to go through a call center. Many customers have also complained that the application process is cumbersome, requiring them to apply for Medicaid and wait for a denial before finding out if they qualified for a subsidy.
Despite some of their own problems, several of the state-run exchanges, including those in Connecticut, New York and Washington State, are functioning much better than the federal exchange, with customers able to log in, register and enroll much faster than on HealthCare.gov.
New York, for instance, added server capacity after experiencing problems the first week and has remained largely free of trouble, with insurers saying they are working closely with officials to handle issues as they arise. About 47,000 people have enrolled, including about 24,000 who have selected a private insurance plan.
"The website is working reasonably well," said Lynne Scalzo, an executive at Excellus Blue Cross Blue Shield in Rochester, N.Y.
Still, enrollment numbers are lower six weeks after the opening of the online marketplaces than many analysts had projected, according to information collected by the Advisory Board Company and The New York Times.
While not every state has made its numbers public yet, including California, which is expected to announce enrollment numbers in the tens of thousands later this week, 10 states and the District of Columbia have provided preliminary estimates. All told, about 210,000 people have signed up, about 155,000 for Medicaid and 55,000 others for private insurance plans. Those numbers include people who have picked a plan but have not necessarily paid their first premium, which is not due for another month.
In addition, Oregon has signed up more than 70,000 people for the Medicaid expansion through a "fast-track" program that does not rely on the exchange. And Maryland will automatically enroll more than 80,000 newly eligible people in Medicaid in January.
"It's coming along," Patty Fontneau, chief executive of Colorado's exchange, said of her state's enrollment numbers for private plans, which stood at about 3,400 people as of Nov. 1. "Would I want there to be more? Sure."
But exchange officials and others emphasized there was a long way to go before much meaning could be read from enrollment numbers. "We are not even in the first inning of a nine-inning game," said Kevin Counihan, chief executive of Connecticut's exchange, Access Health CT. "For people to throw out all kinds of inferences on success or failure at this point, I think, is really, really naïve."
Even states whose websites are working well say they are hampered by a common problem: the federal website, particularly the data hub that checks every applicant's identity and eligibility. That hub has stopped working on several occasions, preventing applications in the states from being completed.
After two such breakdowns recently, officials with Connecticut's exchange, which has worked relatively smoothly, said they would hire an outside contractor to verify identities when the hub fails.
"We're just trying to make this as easy for the customer as possible," Mr. Counihan said.
Other state exchanges that work relatively well also have problems. In California, for instance, the exchange website has yet to offer a complete directory of doctors and hospitals in each new plan network. And some users are still complaining about problems and error messages.
State officials also say many residents have been confused by constant news about the dysfunctional federal exchange, wrongly assuming that state exchanges have also failed.
"It's very hard for the public to differentiate what they're seeing in the paper about Obamacare not working — to realize that's not our website," said Richard Sorian, a spokesman for the District of Columbia's exchange, DC Health Link.
Exchange officials, policy analysts and insurance executives caution against reading too much into the enrollment numbers, saying the rocky start of both the federal and many of the state websites has discouraged many individuals from even trying to sign up.
"The numbers are definitely low," said Andrew D. Hyman, an official at the Robert Wood Johnson Foundation, which is closely tracking the rollout of the marketplaces, "but I think things will turn around quickly once the process is more reliable."
But the uneven rollout, even among those states that run their own exchanges, underscores the challenge of creating a new way to buy insurance, one that primarily relies on a website where people can compare plans.
"The states that had good leadership, good design philosophy and were pragmatic about planning and development of their exchange ultimately are faring the best," said Dan Schuyler, a director at Leavitt Partners, which worked with several states on developing exchanges.
Insurers, exchange officials and policy analysts all warn that the experience in the first month or so of the program provides little, if any, indication of whether the new marketplaces are succeeding. "This is all new," said Michael Wise, the president of ConnecticCare, one of the three insurers offering plans on the state-based exchange. "It's hard to know what we should have expected."
Some insurers say the confusion over some of the websites, along with the political noise, may be dissuading some people from trying to enroll, even in states where the marketplaces are functioning well. Some, like WellPoint, whose Anthem Blue Cross plans are being sold in marketplaces in more than a dozen states, including California and Connecticut, said they were trying to time their sales efforts for when they think there could be the most response. The company has indicated it plans to spend tens of millions of dollars on marketing its plans.
"We will be calibrating our marketing execution and messaging with the pace of the overall exchange readiness — and tenor of consumer sentiment," said Patrick Blair, WellPoint's chief marketing officer, in a statement.