First thing on the morning of Oct. 1, Candice Verwey logged on to her computer to shop for health insurance from her dining room table.
That was how it was supposed to work under the Affordable Care Act: Go to healthcare.gov, enter your personal information, see if you qualify for a government subsidy and then select a plan that meets your budget and health needs.
Ten days later, Verwey was still stuck in an internet traffic jam that has slowed the rollout of the federal insurance marketplace, a cornerstone of the new health care law.
After spending an estimated 40 hours on the computer and telephone over the past 10 days, Verwey logged on yet again Thursday afternoon from her Southwest Roanoke home.
“Maybe it will work today,” she said, not sounding very hopeful. It did not, informing Verwey that her personal information does not match an online profile she had created – and received confirmation of – just a few days earlier.
“See?” Verwey said. “I can’t go anywhere. This is Day 10, and I can’t go anywhere.”
As people in Southwest Virginia and across the country experience similar delays and technical glitches, critics of President Barack Obama’s signature health care plan are calling it a disaster while supporters say there’s plenty of time to fix the technical problems during an enrollment period that lasts until mid-February.
Although it will be a while before things sort out, there’s no doubt the marketplace has had a bumpy ride since it went live.
Even people like Robin Davis, who received advance training on the system as a certified application counselor, were having problems helping people enroll.
“It’s been a big ball of frustration at this point,” said Davis, who by last Wednesday had not been able to sign up a single person who sought her assistance at New Horizons Healthcare in Northwest Roanoke.
“The website is up, it’s down, it’s up again,” she said.
Numbers unknown
So far, officials have declined to say how many people have obtained insurance through the marketplaces, which are being run by the federal government in 27 states – including Virginia – that decided not to create their own systems as part of the Affordable Care Act.
Also known as exchanges, the marketplaces offer a variety of private insurance plans. Government subsidies are available for people with incomes between the federal poverty guideline ($11,490 for an individual; $23,550 for a family of four) and up to four times that level.
In their first three days of operation, the federal marketplaces had more than 8 million different visitors, with as many as 250,000 on the site at the same time, officials have said.
The Obama administration has cast the unexpectedly high numbers in a positive light, saying they show the public is eager to sign up for affordable insurance.
But officials with the U.S. Department of Health and Human Services say it will be early November before they announce how many people have actually obtained plans through the system.
In an Oct. 8 letter to HHS Secretary Kathleen Sebelius, 15 Republican members of the House Energy and Commerce Committee asked that she release the enrollment numbers by Oct. 18.
“We haven’t seen any numbers, and one would have to guess that the reason for that is that the numbers are abysmally low,” said Rep. Morgan Griffith, R-Salem, whose signature appears on the letter.
Griffith dismissed the argument that glitches during the system’s opening days were caused by an onslaught of eager customers.
“That’s just horse hockey,” he said. “The bottom line is that people are checking on it because they’re scared to death. … Everybody has to buy this. It is a mandate from the federal government that you buy it, so you better be prepared.”
The insurance plans being sold on the marketplaces take effect Jan. 1, the same day the so-called individual mandate, which requires nearly all Americans to have health insurance or pay a tax penalty, kicks in.
Widespread reports of delays in enrollment on the marketplace show that “it’s not ready for prime time,” Griffith said.
“They may be ready for a middle school play, but they’re clearly not ready for prime time TV.”
Hysteria misplaced?
Washington and Lee University law professor Timothy Jost, an expert on the health care law who has testified about it before Congress, said pronouncements that the system has failed are both premature and overblown.
“If problems aren’t fixed in a month we will be in trouble, but I believe they will be,” Jost said in an email late last week.
On his Health Affairs Blog, Jost recently wrote about what he called “the misplaced hysteria” surrounding the opening date for the exchanges.
“The world will not stop if the exchanges are not fully functional on Oct. 1, 2013,” he wrote. “Indeed, there will be no serious practical, as opposed to political, consequences if their doors remain shut for a few days beyond that point.”
The launch of complex government programs, such as the expansion of Medicare drug benefits under the administration of President George W. Bush, have experienced similar problems that were later worked out, Jost said.
Careful plan foiled
That’s not much comfort to people like Verwey, who says she needs to get on the system now to make decisions before her current insurance expires on Nov. 4.
Having spent a career in management for insurance giants such as MetLife and Blue Cross and Blue Shield, Verwey knows more about the business than the average consumer.
Her plan had been to get a short-term policy to carry her through the rest of the year, then use the marketplace to compare rates and decide what to do after that.
Now retired, Verwey is living on her pension and other personal assets. Her income is pushing the $45,960 cutoff for a subsidy, and she wants to do some online window shopping before deciding whether to take that route or start drawing her Social Security benefits early, which would push her over the threshold for a discounted plan.
“I had this all planned out,” she said. “I would find out how much it would cost and then I would make a decision.”
But not long after Verwey logged onto healthcare.gov the morning of Oct. 1, it became clear that all of her planning was for naught.
The system was sluggish from the start.
“We have a lot of visitors on our site right now and we’re working to make your experience here better,” one of the frequent messages to users stated. “Please wait here until we send you to the login page. Thanks for your patience!”
Eventually, Verwey was able to create an account with a user name and password. But when the system timed out, she had problems logging back on.
“It came back and said: ‘We don’t know who you are,'” Verwey recalled.
At the suggestion of a customer representative she reached by phone, Verwey created another account. And when that didn’t work, another one.
By then, Verwey was using the password of “thisiscrazy!”
“It’s a good thing I have a relatively good sense of humor,” she said.
Despite her latest setback on Thursday afternoon, Verwey was determined to keep trying. But she wondered how many other people, with less patience and insurance acumen than she, might have given up already.
Having been involved with computer systems in the insurance industry, Verwey is skeptical of the explanation that high traffic alone is causing the problem. A more likely scenario, she believes, is fundamental programming mistakes.
That possibility was also raised in another letter to Sebelius last week from another Congressional committee.
Rep. Darrell Issa, R-Calif., chairman of the Committee on Oversight and Government Reform, wrote of concerns “that the system suffers from architectural problems that need design changes.”
Some progress noted
Despite all the delays, there has been some progress with the marketplace in Virginia.
Two insurance companies offering plans in the Roanoke and New River valleys, Aetna and Anthem Blue Cross and Blue Shield, have said they have successfully sold plans through the system in the past two weeks, but they declined to say how many. Two other carriers in the market could not be reached.
Although an estimated 624,000 Virginians will be eligible for subsidized insurance through the marketplace, not all of them are expected to take advantage of the system right away.
In his blog post, Jost said it will be at least 2016 before the success of the Affordable Care Act can be judged.
“Only then,” he wrote, “will we know whether the ACA has accomplished its goal of covering uninsured America.”