Health care law enrollment period launches with glitchy websites and long waits
The marketplaces represent a turning point in the nation's approach to health care, the biggest expansion in coverage in nearly 50 years.
The Obama administration hopes to sign up 7 million people during the first year and aims to eventually sign up at least half of the nearly 50 million uninsured Americans through an expansion of Medicaid or government-subsidized plans.
But if people become frustrated with the glitches in the computer-based enrollment process and turn away from the program, the prospects for Obama's signature domestic policy achievement could dim.
"You've got to launch this thing right the first time," said Robert Laszewski, a consultant who worked 20 years in the insurance industry. "If you don't, financially you will never recover."
Neera Tanden, president of the Center for American Progress, which helped work for passage of the law, cautioned against rushing to judge the marketplace's success on its first-day performance. Numerous observers had predicted bugs and setbacks. Trained outreach workers in many states are having trouble getting the certification they need to start helping people to enroll.
Many states predicted that an initial surge of interest would test the online system, but they expect most people to sign up closer to Dec. 15, which is the deadline for coverage to start Jan. 1. Customers have until the end of March to sign up in order to avoid tax penalties.
Looming as one of the biggest challenges to the law's success is persuading young, healthy people to buy insurance to balance the costs of covering older, sicker Americans.
Under the law, health insurance companies can no longer deny coverage to someone with a pre-existing medical condition and cannot impose lifetime caps on coverage. They also must cover a list of essential services, ranging from mental health treatment to maternity care.
Another obstacle: Nearly three-fourths of people under 65 who lack insurance are unaware that the marketplaces open Tuesday, according to a Kaiser Family Foundation survey released over the weekend.
Spending money to raise that awareness with ad campaigns has varied vastly, with some Republican-led states doing little or nothing to promote the insurance exchanges. Missouri Lt. Gov. Peter Kinder, a Republican, even recently urged residents not to sign up for coverage.
In Florida, Republican Gov. Rick Scott and key lawmakers have pushed back against implementing parts of the law. The Florida Department of Health recently ordered county health departments to prohibit so-called navigators from signing people up for health insurance at those facilities.
But other states are doing more, such as Kentucky, the only Southern state running its own marketplace. Kentucky Gov. Steve Beshear, a Democrat, was an early supporter of the health law.
The state kicked off an $11 million advertising campaign in June, with ads on TV, radio, Internet and newspapers. It will expand Tuesday and continue through the first three months of next year.
"Frankly, we can't implement the Affordable Care Act fast enough," Beshear said.
Associated Press writers Kelli Kennedy in Miami; David Lieb in Jefferson City, Mo.; Kristen Wyatt in Denver; Kathy Matheson in Philadelphia; Erika Niedowski in Providence; Holly Ramer in Portsmouth, N.H.; Ricardo Alonso-Zaldivar in Washington; Carolyn Thompson in Buffalo, N.Y; Susan Haigh in Hartford, Conn.; and Roger Alford in Frankfort, Ky., contributed to this report. AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson .
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