A paediatric emergency room suite is shown in the Ryder Trauma Center at Jackson Memorial Hospital in Miami
By David Morgan and Caroline Humer
(Reuters) - Technical glitches and heavy internet traffic slowed Tuesday's launch of new online insurance exchanges at the heart of President Barack Obama's healthcare reform, showcasing the challenge of covering millions of uninsured Americans.
The opening itself represented a victory for Obama's signature domestic policy achievement after years of attack from Republican foes and delays in building the technology infrastructure to support sites in 50 U.S. states. It defied a partial federal government shutdown precipitated by Republican efforts to delay the law's implementation.
"As long as I'm president I won't give in to reckless demands by some in the Republican Party to deny affordable health insurance to millions of hard-working Americans," Obama said in the White House Rose Garden after his meeting with people who stand to benefit from the healthcare overhaul.
The Patient Protection and Affordable Care Act, commonly known as Obamacare, will provide subsidized health insurance based on income through the state exchanges and expand Medicaid coverage for the poor from January 1, representing the most ambitious U.S. social program since Medicare plans for the elderly launched in the 1960s.
Reuters checks in at least 47 states throughout the day turned up frequent error messages or traffic overload notices, particularly for 36 sites run by the federal government. One frequently observed glitch involved a page asking the user to answer security questions that either went blank or would not accept new data. Kansas officials urged residents to wait a few weeks for the "bugs" to be worked out before enrolling.
The Department of Health and Human Services said 2.8 million people visited the federal HealthCare.gov since midnight, with 81,000 reaching out to call centers and 60,000 requesting live chats. The department did not provide details on the source of the traffic or the number of visitors who applied for health insurance, but said it was working to speed up the site.
"We think we're off to a good start," said Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, which oversees the new exchange.
The performance of state-run exchanges was mixed, with users in Connecticut, Rhode Island and California able to create profiles. Kentucky said it had processed more than 1,000 insurance applications, while Colorado said 1,300 user accounts had been created. Maryland delayed its launch by hours. When it went live, access stalled for some users.
Chris Carlin, a 25-year-old student and part-time worker from the Los Angeles area, said he was unable to access health plan details on the California exchange, but would keep trying.
"This is a huge deal for me," he said. "I haven't had health insurance since high school - that's been 7 years."
Anna and Dennis Franks, a Utah couple in their 60s, drove about 40 miles from their home in Ogden with friends to attend a marketplace launch event in Salt Lake City. The couple was unable to compare health plans or enroll online, but they were undeterred. "We'll wait for all the hoopla to settle down," Dennis Franks said.
Jonna Bady and Antonio Hill, a couple in their 20s, made an appointment to enroll on Tuesday in Chicago, and expected to qualify for Medicaid. The website was down when they arrived.
Asked why she came on the first day of open enrollment, Bady said: "It's important. I know other people are going to come. I want to get in early."
For full coverage on the Obamacare launch, see: http://www.reuters.com/subjects/healthcare
To participate in a survey about your experience signing onto an exchange, please click on: https://www.surveymonkey.com/s/ReutersExchanges.
The administration had predicted hitches that could last during the first few weeks of enrollment, which runs through the end of March. Even before Tuesday's launch, officials last week announced delays for federal exchanges geared toward Spanish speakers and small businesses.
"It's very significant for the political campaign but not for the enrollment campaign," said Jon Kingsdale, the former head of the Massachusetts state health exchange, which opened in 2006 and became the model for Obamacare.
Kingsdale said that if the problems persist until November, "that is really a big problem."
The snags have become a focus of the fight between Obama's Democratic Party and the Republican Party over whether the 2010 Affordable Care Act will succeed. Republicans have blamed its requirements for pushing up the cost of health insurance for business and individuals.
"These exchanges are going live today with too many unanswered questions and too many unsolved problems," Orrin Hatch, a Republican senator from Utah said in a speech on the Senate floor. "The Obama administration should have acknowledged the ample warning signs of problems in the exchanges and heeded the many calls for delay."
It was not clear if the problems signaled overwhelming interest in signing up for insurance, a lack of capacity or connectivity for state or federal systems, or even some kind of intrusion by Obamacare's opponents. New York, for example, reported 7.5 million visitors, hobbling its site for hours. An estimated 2.5 million New Yorkers are uninsured.
"The level of functionality they're offering today is worse than we might have anticipated. I expected a level where you could at least get to the point of shopping," said Austin Bordelon, an analyst with healthcare consulting group Leavitt Partners, who monitored federal and state marketplaces through the day. "But really, you just can't get through the door."
The marketplaces require health plans to provide a broad range of essential benefits that were not necessarily part of individual policies in the past, including mental health services, birth control and preventive care.
The coverage is linked to other insurance market reforms and new consumer safeguards, including a ban on discrimination based on gender or pre-existing health problems.
For a graphic on the new plans, see: http://link.reuters.com/dyj43v
The new law also includes a mandate that healthy people get health insurance or pay a fine - major bone of contention with Republicans.
"I pay for car insurance. I can pay for health insurance," said Carlin, the young Californian looking to sign up.
(Additional reporting by Lewis Krauskopf, Sharon Begley, Curits Skinner and Bill Berkrot in New York; Deena Beasley in Los Angeles, Julie Steenhuysen in Chicago, Jennifer Dobner in Salt Lake City, and Carey; Editing by Michele Gershberg, Grant McCool and Tim Dobbyn)