State sabotage: overwhelming the system was part of the plan

Obamacare’s architects assumed that most states would opt to run their own marketplaces, with federal officials running only a few. The assumption proved wrong: Pretty much any state with a Republican governor or Republican legislative control said no, adding to the administrative burden on HHS. But 14 states plus the District of Columbia are managing their own markets. Mostly it’s places you would expect—progressive outposts like California, Washington, and New York—where Obama and his policies are most popular. But Kentucky, where a Democratic governor and group of dedicated officials have worked diligently to deliver the law’s benefits, is also on the list.

Some of these states are still having major problems: Hawaii, which relied on the same contractor as HHS, seems to be in the worst shape. But the websites in other states are now running and, while it's difficult to get a precise sense of how each one is operating, most appear to be functioning well. They may have more traditional glitches, like random error messages or delays in certain features. (California had to hold off introducing a tool that allows people to check provider networks online.) And most had trouble on the first day or two. But since that time they've been running more smoothly.

One of those states is Connecticut, where Kevin Counihan, chief executive of Connecticut’s health marketplace, told me last week that the system has been working well and consistently since Tuesday afternoon on October 1. "We were down from 12:30 until 2 that day, for a fix, but we’ve had no problems since. We are able to process applications through enrollment and we don’t have issues with wait time." 

As a result, Obamacare in these places seems to be working more or less like it's supposed to work. Consumers are getting opportunities they never had before—to shop for insurance plans, each one with clearly defined benefits that make true comparisons possible, and to receive substantial financial assistance that provides many with thousands of dollars a year in assistance. And, from the looks of things, people are taking advantage of it. The Advisory Board, which is tracking state figures, says that about 180,000 have completed applications for insurance and, of those, 50,000 have enrolled.

Those figures don't say much about whether Obamacare in these states will meet goals for enrollment. It's way, way too early to make that judgment. But the figures suggest that the technology in these places works. And people using the sites say the same thing. “The system is working well—we can’t complain,” Licelot Miguel, a navigator in New York, told Dwyer. (Miguel emphasized that she was speaking for herself, not on behalf of her organization.) The first day was tough, Miguel said: It seems some browsers weren’t working. But now the slowdowns tend to be human rather than technological, Miguel said, because people need 15 or 20 minutes to choose the right plan. “When you get through to the end, it’s like oooooh. People get excited.”