Justine Covington receives a flu shot last week from Jeffrey Daniel at a clinic in Salt Lake City. Across the country, new online insurance marketplaces are scheduled to open for business today as part of the new federal health overhaul.
By Bill Toland Pittsburgh Post-Gazette
There's only one chance to make a first impression. So will the online health insurance exchanges, the tent pole to President Barack Obama's 2010 Affordable Care Act, work as advertised as they go live this morning?
Or will the various glitches, bugs and delays that have plagued the construction of the exchanges -- one of the largest information technology projects in modern times -- doom the launch?
"I think it's understandable [that with] something this big and complex, there may be some glitches to work through," said Bill England, state director for Enroll America, the Obama-aligned nonprofit whose goal is to persuade the uninsured to sign up for health coverage, as now required by federal law.
Residents turn out for Obamacare enrollment
The Hill House held an open enrollment event for residents interested in signing up for health insurance through the new Affordable Care Act. (Video by Andrew Rush; 10/1/2013)
Those potential glitches are "part of our messaging," Mr. England said Monday. "It begins on Oct. 1, and we reassure people that they have six months" to sign up for a plan.
"This is just the starting line. This is not the race."
For all the buildup to today's launch, Oct. 1 doesn't mark any sort of consumer deadline. Really, it's a curtain-raiser to what is essentially a six-month open enrollment period. The uninsured can spend the next six months shopping for plans online and calculating potential subsidies before pulling the trigger; those hoping for coverage by Jan. 1 must buy a policy by Dec. 15.
Still, many -- perhaps millions -- will test-drive the sites today, even if they don't buy a policy immediately. At that point, glitches could surface, along with the delays that have already been acknowledged:
• Several of the state-operated exchanges, including in Oregon, Colorado and the District of Columbia, have already said certain enrollment functions won't be ready for a few more weeks.
• The Web function that was supposed to allow small business to shop for and buy insurance for employees will have to wait until November to complete the sign-up process. That could affect 2 million potential enrollees.
• The Spanish-language side of the federally operated exchanges isn't ready either, according to The Associated Press. An estimated 10 million Latinos -- 4 million of whom speak Spanish exclusively or primarily -- are expected to be eligible for subsidized policies or Medicaid policies under the Affordable Care Act.
• The federal exchange site (healthcare.gov) is supposed to evaluate income and family size to determine if applicants are eligible for Medicaid coverage, rather than a private policy purchased through the exchanges. At that point, the exchange is supposed to transfer applications to a state's welfare department. But that functionality won't be available until November.
• Lastly, the software meant to determine whether shoppers get any tax subsidy wasn't returning accurate results, according to The Wall Street Journal.
The U.S. Department of Health and Human Services is overseeing all or part of the exchanges in 36 states, including Pennsylvania, which declined to build and operate its own exchange. The rest of the states have built their own websites.
Day one issues might be more than just a cosmetic issue for the Obama administration. Republicans, particularly those in the House, are rooting for the failure of the online exchanges in hopes that an early flop will give them ammunition in their attempt to delay, defund or otherwise derail the landmark health care law, whose key provision -- an "individual mandate" requiring most Americans to obtain health insurance or face a fine -- was upheld as constitutional by the U.S. Supreme Court last year.
But Mr. Obama's allies continued to sell the exchanges Monday and over the weekend. In an opinion piece that ran in several newspapers, Vice President Joe Biden criticized House Republicans who "are going to demonize [health care reform], run against it, do what they can to sabotage it," risking default or a government shutdown in opposition to the Affordable Care Act.
And HHS officials are urging patience and reminding potential shoppers that if the Web experience is unsatisfactory, they also can sign up by phone toll-free at 1-800-318-2596, or with an insurance agent.
The federal government says its phone centers will be heavily staffed and, on the Web side, "armies of information technology specialists tested and re-tested the complex interfaces and communication links needed to make the exchanges functional" over the weekend, according to Reuters news service.
The government and most analysts expect that the website and phone lines will be most heavily trafficked in November and December, after consumers have had a few months to comparison shop. About 7 million people are expected to obtain policies through the exchanges, while 8 million more could receive coverage through an enlarged Medicaid program.