By John Reichard, CQ HealthBeat Editor
October 3, 2013 -- Federal officials on the third day of insurance exchange operations faced a new emerging narrative in the battle for public perceptions of the launch—lots of shoppers, but not many buyers.
Department of Health and Human Services (HHS) officials countered, however, that the system is working. Americans across the country are starting to enroll in plans, they said. But they aren't divulging numbers, and it's unlikely they will do so for a while.
Insurance industry consultant Robert Laszewski said HHS is under the gun to smooth out the process of shopping for plans and enrolling in them online however before the young people critical to the success of the health law get turned off.
"They need to fix this before the general feeling about Obamacare is that it is an administrative screw-up," he said in an email.
Laszewski said he heard from one insurance executive that HHS should have done a "soft launch" of the healthcare.gov site serving states that don't have their own exchanges.
He said the lack of enrollments is purely because of technological glitches that could have been dealt with more effectively through a slower launch. "People can't get past the front door of the site," he said. "Carriers with dominant market share in a state are getting a handful of enrollees. I have directly heard reports of zero new customers to 10, or 20. A dominant player would almost certainly have received hundreds if not thousands of sign-ups by now."
But defenders of the HHS implementation effort say it takes time for people to make up their minds about which plan to select once they have the information they need. And they said the HHS site has been beefed up to handle more capacity through adding more servers, engineers, and improved system configurations.
An HHS official said wait times at the HHS call center have been cut in half, and that the average time it takes a consumer to get an answer to a question has been cut to two minutes in the past 24 hours.
"In the last two days, 7 million Americans have visited healthcare.gov to learn about their options," said HHS spokeswoman Joanne Peters. "Experts are working around the clock and were able to expand system capacity somewhat overnight, cutting by one-third the volume of people waiting to apply." According to HHS statistics, the 7 million figure refers to "unique visitors" and doesn't include multiple hits from individual visitors. "That is more than the number of people that visit Southwest Airlines in a month," said an HHS official.
"Everyone presumes this can get on track when the fixes are made," Laszewski said. But "the concern we have all had is that healthy people would hear it is a real bother—phone wait times, websites not working—and would be discouraged from signing up. We are off to the wrong kind of start which makes people worried about anti-selection all the more worried."
Anti-selection refers to having not enough young and healthy people sign up to offset the costs of unhealthy enrollees requiring costly treatments.
But the many visitors bodes well for big enrollment figures down the road, said Ron Pollack, executive director of Families USA. "It means that many millions of people are anxious to receive significant new help that will make health coverage affordable for families that previously found health insurance beyond their reach. This is a strong indication that enrollment success will ultimately occur in the weeks and months ahead."
Pollack emphasized that people, particularly those new to insurance, need time to make choices.
"Over the 182-day enrollment period that lasts through March 2014, it is highly likely that there will be an acceleration of enrollees with each passing week and month," Pollack said. "As more and more people learn about comparably situated families who are receiving help through the Affordable Care Act, this will inevitably result in ever-increasing numbers of families seeking to complete their enrollment."
One of the more well-developed state exchange efforts, that of Maryland, appears to be progressing after a startup marred by delays and difficulties creating individual accounts. "The story of the first three days is tremendous interest in Maryland Health Connection through every channel that we have," said Joshua Sharfstein, Maryland Secretary of Health and Mental Hygiene.
"We have more than 140,000 people coming to the web site," he said in an interview. "We have thousands of calls to the call center. Our navigator partners have been swamped at different events. People are filling out paper applications if they can't get on line at the moment. We've had hundreds of people show up at local departments of social service seeking coverage."
"It's day three. I don't think anyone anticipated a lot of enrollments on day three. But this is not a case of somebody having a party and people not coming. This is a case of somebody having a party and tons of people coming. What we now have to do is be prepared to meet the whole demand. That's really the challenge but it's the right challenge."
Maryland had an "unexpected bottleneck at account creation, which for us is the first step," Sharfstein added. "In Maryland we require identity verification through account creation. There was a patch applied last night that made a big difference to account creation. Our expectation is that things will continue to improve."