Pressure mounts to fix health insurance exchanges (with graphics)

The pressure is on for the federal

government and states running their own health insurance exchanges to

get the systems up

and running after overloaded websites and jammed phone lines

frustrated consumers for a second day as they tried to sign up

for coverage using the new marketplaces.

In some ways, the delays that persisted

Wednesday were good news for President Barack Obama and supporters of

his signature

domestic policy achievement because the holdups showed what

appeared to be exceptionally high interest in the overhauled insurance

system. But if the glitches aren't fixed quickly, they could

dampen enthusiasm for the law at the same time Republicans are

using it as a rallying cry to keep most of the federal government

closed.

"It was worse today than it was yesterday," Denise Rathman of Des Moines said after she tried for a second day to log onto

the Iowa site.

Rathman has insurance through Dec. 31 but said she is eager to sign up for a policy because of her psoriatic arthritis, which

has caused her to be denied insurance in the past.

David Berge, a pastor with two young children in Shoreview, Minn., tried unsuccessfully at least 10 times to create an online

account on the state-run site MNsure. His high-deductible plan expires at the end of the year.

"I'm anxious to see what the insurance is going to look like for my family at the beginning of the year," Berge said. "That's

a big unknown right now. I want to figure that out as soon as possible so we can begin planning."

In California, home to 15 percent of the

nation's uninsured, officials pulled the enrollment portion of the

Covered California

site down overnight for emergency upgrades. It was restored

midmorning Wednesday, and 7,770 people had started applications

by then, spokesman Roy Kennedy said.

California is one of a handful of mostly

Democratic states that opted to set up their own exchanges rather than

let the federal

government do it for them. In the 36 states being operated by the

federal Department of Health and Human Services, consumer

patience was still being tested.

Agency spokeswoman Joanne Peters said many Americans successfully enrolled on the first day, but she declined to put a number

on it. She said the delays were due to "overwhelming interest" and high volume.

It's not as if nobody warned them. Just three months ago, the congressional Government Accountability Office said a smooth

and timely rollout could not be guaranteed because the online system was still getting finishing touches and had not been

fully tested.

The Obama administration shrugged off the evaluation.

The bumpy debut has the hallmarks of a

technology project that may have rushed to meet the Oct. 1 deadline,

said Bill Curtis,

chief scientist at CAST, a software quality analysis firm, and

director of the Consortium for IT Software Quality, which develops

standards.

"When you are in a rush, you typically make a lot of mistakes and you don't have time to test them all out," he said.

High volume can also expose software flaws

that were not detected in testing, Curtis said, like the recurring

problem consumers

encountered trying to set up accounts on the federal site.

Drop-down menus that were supposed to provide security questions

did not work.

The department issued survival tips for

aggravated consumers after 4.7 million unique visitors logged in to the

healthcare.gov

website on Tuesday. As new health insurance markets went live

around the country, the federal call center also received 190,000

calls.

In suburban Cleveland, Sharon Schorr finally gave up on the federal exchange website after eight hours of failed clicks.

"It almost reminded me of going online and trying to buy Springsteen tickets," said Schorr, a self-employed accountant who

works for her husband's recruiting firm in Orange, Ohio.

Others simply resorted to old-fashioned pen and paper.

Luis Veloz, a college student in Dallas, was

so eager to have insurance that he had already mailed in a paper

application

by Tuesday night. He is hoping to avoid racking up major bills

like his parents, who incurred $250,000 in debt when his father

had a heart attack.

"It's an exciting moment because my family has never had preventative care," Veloz said.

Workers at the Florida Association of Community Health Centers printed out applications ahead of time.

"We don't care about the politics. This is about people so we were trying to make it easy for the patients," President and

CEO Andy Behrman said.

Connecticut Gov. Dannel P. Malloy, a

Democrat, said the law also known as Obamacare was working well because

his state embraced

the health reform law early on instead of fighting it. The state

received 373 applications for coverage by the end of Tuesday.

"Because we took the time and effort to be ready, to handle the calls, to have our ducks in a row if you will, we are in far

better shape than those states and governors that have turned their back on this historic program and historic offering,"

Malloy said.

The Obama administration hopes to sign up 7

million people during the first year. Using an expansion of Medicaid or

government-subsidized

plans, the White House would eventually like to cover at least

half of the nearly 50 million Americans who are uninsured.

Many states expect people to sign up closer

to the Dec. 15 deadline to enroll for coverage starting Jan. 1. Most

customers

will need to pay the first month's premium when they do, which

could lead them to put off choosing, said Bob Dickes, director

of sales and marketing for the nonprofit insurer Oregon's Health

CO-OP.

"I expect people to shop and see what's out there," Dickes said.

Customers have until the end of March to sign up to avoid tax penalties.

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.

Interactive Graphics