WASHINGTON - Enrollment for health insurance on state-run exchanges has been low in the first month, as officials in various states cite website glitches, a months-away deadline and even the government shutdown as reasons for the low numbers.
Officials from 13 of the 14 states with their own exchanges, said 757,000 have registered for the exchanges, but only 139,170 people have bought or enrolled in health insurance plans.
Health and Human Services Secretary Kathleen Sebelius said Wednesday the number of new insurance customers through the federal exchange, HealthCare.gov, will also be "quite low" when it is announced next week.
Alan Weil, executive director of the National Academy for State Health Policy, said it's too early to be looking at raw numbers and trying to determine what the market might look like on March 31, when enrollment ends. The exchanges opened Oct. 1, but people must enroll by Dec. 15 to have insurance on Jan. 1.
"It is pretty unusual for people to buy a product this far in advance of being able to use it," Weil said. "Mostly what you're looking for people who are seriously shopping, and I think we're definitely seeing that."
For example, in Colorado, 44,035 people have created accounts, but there have been 316,326 unique visitors to the state's exchange website. In Kentucky, 31,545 have enrolled, but 318,810 people have checked to see if they're eligible for subsidies or medicaid. In Vermont, 2,435 have chosen plans, but 107,000 people have visited the website. California has had more than 2.5 million unique visitors, and 227,002 have started applications.
When the Medicare Part D and Children's Health Insurance Program began last decade, it took "literally years" for people to understand the programs and decide to participate, Weil said.
The exchanges don't have that much time because budget predictions are based on 7 million people buying insurance in the first year.
At this point, Weil said officials need to be looking at trends: Are people looking to buy? And are people showing continuing interest?
"I think by those two standards, what I hear from the states is a pretty good story," he said. "The big problem is there's a rush to judgment. I do think the problem right now is that new programs even under the best of circumstances to take time to mature."
Joel Cantor, director of the Center for State Health Policy at Rutgers University, said people have not been signing up for Medicaid in New Jersey as quickly as expected. Though the state chose to expand Medicaid, residents must go through the federal exchange to learn of eligibility. And, he said, the government shutdown may have confused people about whether they could still sign up for Medicaid.
"If you were planning to go to the county office, people have thought Medicaid was closed," he said. "These sorts of things lead to confusion."
But news about HealthCare.gov may have discouraged people from even trying, he said.
"I do think the major impediment has been the dysfunction of the website and all the news surrounding the dysfunction," he said.
Ironically, the bad news about the website may have been good news in that a lot more people appear to know about the exchanges now, said Sara Collins, vice president for the Health Care Coverage and Access program at the Commonwealth Fund. After surveying 682 people, the Fund found a one-third jump up in awareness about the marketplace to 60% from July to September.
"That could be because of the huge amount of media attention that's been given to it," Collins said.
"It was a pretty healthy distribution," she said.
But some said they could not tell if they were eligible because of problems with the website, and 70% rated their experience there are poor.
"I think it's consistent with the reality of the website problems," Collins said of the survey. "It's consistent with being very hard to tell if you're eligible for subsidies. It's very encouraging that awareness went up, and encouraging that they're willing to come back."
Some of the states have had their own glitches to contend with. Maryland delayed its launch, as did Oregon, because of inaccurate eligibility messages for tax credits or Medicaid programs. Officials had hoped to have the website fully functional by the end of October. Instead, staffers have been trying to manually process 7,000 paper applications, but no one has yet enrolled in an insurance plan.
Idaho decided to go with a state-based marketplace in March, and they're still looking for a vendor to operate it. In the meantime, they're using the federal exchange.
Contributing: Saerom You, Statesman Journal of Salem, Ore.; Olga Hajishengallis; John Adams, Great Falls (Mont.) Tribune; Brian Duggan, Reno Gazette-Journal; Trevor Hughes, Fort Collins Coloradoan; Kirsti Marohn, St. Cloud (Minn.) Times; Antoinette Konz, The Courier-Journal; Matthew Daneman, Rochester (N.Y.) Democrat and Chronicle; Dan D'Ambrosio, The Burlington (Vt.) Free Press; Brian Shane, The (Salisbury, Md.) Daily Times.