WASHINGTON — A surge of interest and last-minute technical glitches marked the final day of enrollment in health insurance through federal and state websites Monday, as a target once thought out of reach — 7 million enrollees — was on the verge of being reached.
Late Monday, a government official told USA TODAY that the administration is on track to sign up 7 million people by the midnight deadline. The official spoke on condition of anonymity because officials were not authorized to speak before the enrollees were all counted.
It is likely to be weeks before there is a final, official tally of how many people signed up for insurance under President Obama's signature Affordable Care Act as the administration has said will continue to work with late arriving applicants to get them covered.
Last week, Obama said 6 million people had enrolled in health insurance, and the number of sign-ups continued to rise over the weekend and into Monday.
The 7 million target was approached despite a series of glitches that struck Monday.
The federal HealthCare.gov website went down early Monday for four hours for what Health and Human Services Department officials called routine maintenance. Outages and intermittent delays hampered customers throughout the day, as more than 2 million people visited the site and more than 1 million had called the call centers by 8 p.m.
At one time, HHS spokeswoman Joanne Peters said, more than 125,000 people were using the site simultaneously. Officials with the federal and state exchanges said those who tried but couldn't complete the enrollment process would be allowed to finish this week and still be considered to have met the deadline. Users of the federal site just need to show they made a "good faith" effort to enroll to get an extension.
"We have been completely overwhelmed," said Liz Lee, community impact director for United Way, from her office in Cocoa, Fla. "We got to the point where we were booked up solid two weeks ago."
In Connecticut, customers who were unable to get through to the state site were asked to call a toll-free number and leave their contact information so they could complete their enrollment this week, said Kevin Counihan, CEO of the state's insurance exchange.
Despite the problems Monday, White House reaction was positive, said Jay Carney, Obama's press secretary.
"There has been a remarkable story since the dark days of October and November, which has resulted in a situation where here on the last day of enrollment we're looking at a number substantially larger than 6 million people enrolled," Carney said.
Monday's surge and delays mirrored those on Oct. 1, the first day the exchanges were open. Then the federal site couldn't handle the initial crush of interest and crashed often until a "tech surge" of Silicon Valley experts worked virtually around the clock to fix the site by Nov. 30. Since then, enrollment has risen.
The site's problems led the Congressional Budget Office, which last year estimated that 7 million people would use the exchanges to buy health insurance, to cut the estimate to 6 million last month. A decline in enrollments in February led some analysts to wonder if that goal would be met, a fear dispelled by last week's announcement.
"I daresay that there are few people in this room, including some of the folks who work in the White House, who would have predicted that we would get to that number," Carney said Monday.
The late enrollment success has not slowed the opponents of the Affordable Care Act, who unsuccessfully tried to kill it in Congress, hoped the Supreme Court would rule it unconstitutional in 2012 and passed more than 50 bills in Republican-led House to repeal it. Led by House Speaker John Boehner, R-Ohio, they have accused Obama of manipulating enrollment figures and hiding the number of people who have actually paid their premiums.
"The president's health care law continues to wreak havoc on American families, small businesses and our economy, and as I've said many times, the problem was never just about the website — it's the whole law," Boehner said in a statement. "We will also continue our work to replace this fundamentally-flawed law with patient-centered solutions focused on lowering health care costs and protecting jobs."
HHS Secretary Kathleen Sebelius said Monday that at least 80% of those who have enrolled have paid their first premiums, while California officials have placed that figure at 85%. On Monday, California reported that 1.2 million people have signed up for health insurance in the nation's most populous state.
"We are being swamped with huge interest, which is slowing down our system," said Peter Lee, executive director of California's exchange.
Health insurer Aetna has received premiums for about 80% of their newly enrolled members, said spokeswoman Susan Millerick. Cigna spokesman Joseph Mondy also estimated about 80% of people have paid their premiums.
"The welcome letters we send when we get their enrollment files processed are clear that the benefits do not begin until we receive payment," says Millerick. An incentive to pay: Consumers don't get their ID cards and detailed documents until after the payments are processed.
While the deadline passed Monday, insurance officials said the industry has plenty of work to do.
"We anticipate problems for many in the next couple of months," said Jessica Waltman, senior vice president of government affairs at the National Association of Health Underwriters, which represents insurance agents and brokers.
The big concern is the number of people who agents can't confirm actually have accounts and can establish they were actually in the queue. "It's very nerve-racking," Waltman said.
HOW MANY ENROLLED?
CBO's initial 7 million estimate was based on the number of people it believed would enroll this year. Other analysts said at least that many people were necessary to buy health insurance and balance out the risk pools for various health insurers. A system skewed toward older and less healthy people meant potentially higher premiums for everyone in the system.
Just like automobile and homeowner's insurance depends on the majority of people paying premiums but not making claims, so too does health insurance. The system, analysts said, relies on younger and healthier people paying into the system but not using many health services, in effect subsidizing the costs of those who do.
So far, federal records released in mid-March show, about 27% of those enrolling in insurance are younger than 35.
Insurers need "broad participation among the young and healthy," said Robert Zirkelbach, spokesman for the insurer trade group, America's Health Insurance Plans. Still, he notes, "age is not definitive." What's important is that insurers have a large number of relatively healthy to offset the sicker, and often older patients who have higher treatment costs.
"We know from the experience of several states in the '90s that tried insurance market reforms, it was incredibly disruptive, there were fewer cost savings for consumers and the number of uninsured didn't go down when there wasn't broad participation through an individual mandate for people to buy insurance," Zirkelbach said.
Still, "mix is what's most important," said Zirkelbach. "Having a balanced risk pool — young and healthy versus older and sicker — is more important than the total number of people that participate."
The open enrollment period was for more than just those buying insurance on the private market. The law allowed states to expand access to Medicaid, the federal-state program for low-income Americans, to those making up to 138% of the federal poverty level.
The federal government will pay for that expansion for four years. After that, the federal share would drop to 90% and the states would have to pay the remaining 10%. But the Supreme Court decision that upheld the law in June 2012 also allowed states to choose to not expand, and about half of the states have not decided to.
So far, however, at least 4.7 million Americans have enrolled in Medicaid, either through the expanded program or by learning they qualified for the regular system.
That's particularly true in Kentucky, where Democratic Gov. Steve Beshear has enthusiastically embraced the law and Medicaid expansion. Officials there said Monday that more than 350,000 Kentuckians have either signed up for Medicaid and private health insurance since Oct. 1.
For some, the wait and frustration proved to be worth it.
Darryl Manlove of Wilmington, Del., had meant to enroll before the deadline, but like millions of his fellow Americans, never got around to it.
The website was jammed when he met with marketplace guide Allison Russell of Brandywine Women's Health Associates, but she got him through on the phone, and Manlove found out he could get a silver insurance plan with a 94% discount.
Contributing: Beth Miller of The News-Journal of Wilmington, Del.; Chris Kenning, The Courier-Journal of Louisville and Chuck McClung of Florida Today.