The Obama administration has made headway against an online bottleneck that jammed enrollment for the president's healthcare reform, but new technical problems greeted users on Monday, showing how difficult it will be to get consumers registered in time for insurance coverage to start January 1.
Three weeks after the launch of new health insurance plans under Obamacare, users were able to create accounts for themselves and begin the process of enrolling through the Healthcare.gov insurance marketplace, according to people aiding the sign-up effort.
But further into the process, error messages and other difficulties were apparent, leading to fresh frustrations for health insurers and nonprofit groups who want to help millions of uninsured Americans sign up for benefits as promised under President Barack Obama's signature healthcare law.
"We have seen progress every day," said Nasim Zahran of Miami's Borinquen Medical Health Care Centers, where hundreds of people are waiting to enroll in coverage.
"Today was the first day that we got all the way to the last screen. But then an error screen popped up saying the site would be down for 72 hours," Zahran said.
Healthcare.gov saw 14.6 million unique visits in its first 10 days, a larger-than-expected public response that raised hopes Obamacare would meet with strong enough demand in its first year.
But the site's limited ability to enroll consumers is becoming an increasing focus of Obamacare's Republican foes, who say the government was not ready to implement the law and should have delayed it.
Experts say the administration has until mid-November to iron out the problems or risk jeopardizing its goal of signing up 7 million people in the first year of the Obamacare marketplaces. The number includes 2.7 million healthy young adults whose participation will help offset the higher cost of insuring sicker and older beneficiaries.
Underscoring the high stakes nature of the issue, former White House spokesman Robert Gibbs told cable-television channel MSNBC on Monday that heads should roll: "I hope they're working day and night to get this done. And when they get it fixed, I hope they fire some people that were in charge of making sure that this thing was supposed to work."
Republican Senator Pat Roberts of Kansas has already called on U.S. Health and Human Services Secretary Kathleen Sebelius to resign. But analysts say that would be unlikely anytime soon. Such a high-level departure could complicate the already fragile roll-out and raise the prospect of stormy Senate confirmation proceedings for a replacement.
At town hall meetings originally intended to drive people to enroll, Blue Cross and Blue Shield of Kansas is telling consumers not to rush to purchase health coverage through Healthcare.gov, given that the enrollment period runs through March 31.
"What we are encouraging our folks in Kansas to do is give it a few weeks and let the bugs work their way out of the system," said Mary Beth Chambers, spokeswoman for the health insurer.
Virginia-based insurer Optima Health reported receiving their first applications for insurance filed through Healthcare.gov in the last few days.
"We, ourselves, have been testing and we're seeing the same difficulties that folks have been telling us on the phone," said spokesman Bobby Pearson.
Cigna said it has been able to sign up people through the federal exchange, without providing further details.
Other major insurers that have helped test the federal system for months, say the problems were long in the making.
"We were pretty nervous as we got further along. We helped them build blueprints on how to put the system together, and as they started missing deadlines, we were pretty convinced that it was going to be a difficult launch," Aetna Chief Executive Mark Bertolini said in an interview with cable business channel CNBC.
FOLLOWING THE STATES
The administration faces growing criticism for designing Healthcare.gov with a series of gates that require visitors to set up accounts and verify their identities before getting actual information on available insurance plans and their own eligibility for federal subsidies.
"I really don't think that anybody knows how difficult it's going to be to get Healthcare.gov fully functioning," said Jon Kingsdale, a widely respected expert on market exchanges, who oversaw the first such operation in Massachusetts.
"With users stuck in the first couple of gates, they haven't really been able to test downstream gates," he added. "There are literally hundreds of insurers. Each of them has to get this right in their interchange of information with the exchange for the exchange enrollment to become effective. We're not even there yet."
Over the weekend, Healthcare.gov alerted consumers to a new tool that makes it easier to view sample insurance premiums in their area and estimate their subsidy without creating accounts.
"This is perhaps a way to distract visitors or hold them over while (the administration) continues to fortify the web design on the back end," said Austin Bordelon, an analyst for Leavitt Partners, a Utah-based consulting group that is tracking the healthcare exchanges.
The change is more in line with the approach of states like Connecticut and California that successfully launched their own healthcare exchanges.
"States have figured out how to do it. It's a harder lift for the federal government with the volume it has, but it's not different in kind," said Joel Ario, who oversaw the early plans for the state exchanges at the U.S. Department of Health and Human Services (HHS) until his departure in 2011.
"Maybe they need to hire the contractors from the states that have figured this out," he said in a discussion posted to the journal Health Affairs' blog.