Americans got their first chance Tuesday to shop for health insurance using the online marketplaces that are at the center of President Barack Obama's health care overhaul, the divisive program that will do much to define the president's legacy.
The years-long battle over the biggest expansion in coverage in nearly five decades culminated in a shutdown of the federal government that also began Tuesday.
Government websites designed to sell the policies struggled to handle the surge of traffic, with many frustrated users reporting trouble setting up accounts.
State and federal agencies were working to fix the sites. There should be time to make improvements — the open-enrollment period lasts for six months.
Administration officials said they are pleased with the strong consumer interest, but on a day of glitches they refused to say how many people actually succeeded in signing up for coverage. They gave inconsistent answers on whether a common problem had been cleared up or was still being corrected.
By Tuesday afternoon, at least 2.8 million people had visited the healthcare.gov website, according to officials overseeing the rollout of the Affordable Care Act, also known as Obamacare. The website had seven times the number of simultaneous users ever recorded on the medicare.gov site.
Obama called it a "historic day" for uninsured Americans. He said the opportunity is life-changing for those who could not get access to health care before Tuesday's launch of the exchanges.
Obama accused Republicans of making the concept of keeping people uninsured "the centerpiece of their agenda."
Republicans vehemently oppose the law, especially a mandate that all Americans have health care insurance or face tax penalties. The law provides subsidies to help lower-income people pay for the plans.
The federal government's shutdown will have no immediate effect on the insurance marketplaces that are the backbone of the law, because they operate with money that isn't subject to the annual budget wrangling in Washington.
The marketplaces represent a turning point in the U.S. approach to health care. 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, the government-funded program that provides health care coverage for poorer Americans, or through government-subsidized plans.
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.
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.
Signs of trouble handling the volume of consumers emerged soon after the exchanges opened. For nearly every state using the federal exchange, users on Tuesday reached a page with a notification to please wait or a message that said:
"The System is down at the moment.
"We're working to resolve the issue as soon as possible. Please try again later."
If people become frustrated with the malfunctions in the computer-based enrollment process and turn away from the program, the prospects for Obama's signature domestic-policy achievement could dim.
Neera Tanden, president of the Center for American Progress, which helped work for passage of the law, cautioned against rushing to judge on 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.
In Texas, a federally funded network of "navigators" hired to help people enroll was off to a rocky start because of backtracking participants — including some cowed by the politics of the health law.
At least four regional government councils — covering more than 30 counties statewide — reversed course in the past two weeks and turned away funds that would train navigators in their areas. Local leaders described their hesitancy as a mix of uncertainty surrounding state rules and a fear of running afoul of Republican leaders.
Associated Press writers David Mercer in Champaign, Illinois; Kelli Kennedy in Miami; David Lieb in Jefferson City, Missouri; Kristen Wyatt in Denver; Kathy Matheson in Philadelphia; Erika Niedowski in Providence; Holly Ramer in Portsmouth, New Hampshire; Ricardo Alonso-Zaldivar in Washington; Carolyn Thompson in Buffalo, New York; Susan Haigh in Hartford, Connecticut; Juliet Williams in Sacramento; Oskar Garcia in Honolulu; Paul J. Weber in Austin; Steve Karnowski in Minneapolis; and Roger Alford in Frankfort, Kentucky, contributed to this report.
AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson
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