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Enrollments For Health Care Exchanges Trickle In, Slowly

The Obama administration's hopes ran high that millions would flock to enroll for health insurance on state and federal exchanges established under the Affordable Care Act.

Those exchanges went online Oct. 1. The administration projected that half a million individuals or families would enroll within 30 days, according to The Associated Press.

But three weeks in, the data suggest the actual number of enrollments is lagging far behind that number.

The promise of signing up for health insurance with point-and-click ease at and state exchange sites has not come to pass — at least not yet.

"This is a fiasco," says health policy analyst Bob Laszewski. He says the sites are plagued by glitches and problems with data transfer.

"Literally a handful of enrollments [are] coming through to the largest insurance companies every day," he says. "Just a handful, like maybe 10 or 20 or 30. So anecdotally, the enrollments are very, very, very low."

Laszewski says the inability to get through to a website is not the only issue. Insurance companies are getting bad information, too.

"It's not uncommon for, say, John Doe's enrollment to come through at 10 in the morning. And then at 10:30 something comes through that says John Doe's unenrolled ... and then enrolled and unenrolled again," he says.

The federal government is running exchanges for 36 states through, which has been plagued by technical problems. Health and Human Services hasn't disclosed enrollment figures. But the digital marketing company Millward Brown estimates that 83,000 people enrolled through the federal site in the first two weeks.

The 14 states that opted to run their own online marketplaces appear to be faring better, though not by much. Among those states, the estimate of total enrollees so far is about 46,000. Those numbers are complicated by the fact that there is no common definition of what "enrolled" means. In some states, you're not considered "enrolled" until you've paid.

Laszewski says these small numbers could threaten the economics for insurers.

"They're very worried about only sick people showing up for coverage, because only sick people are willing to go through the gauntlet," he says.

There are two ways of looking at this: One is that the new law is failing to meet expectations. But proponents of the law argue it's still early and that many of these problems can be overcome.

Things will improve, says Timothy Jost, a law professor at Washington and Lee University. He points to the prescription drug benefit known as Medicare Part D. The federal program launched in 2005 during the Bush administration and had its own technical difficulties.

"Once people were finally signed up, there were problems that they would go to the pharmacy and there was no record of them," Jost says. He expects similar problems here.

"So it will take awhile to get the kinks ironed out," he says. "But the important thing right now is to allow people to get signed up, and I think there's an awful lot of people who want to do that."

In fact, there are two states that are declaring their sign-up efforts a success. Carrie Banahan, executive director of Kentucky's Health Benefit Exchange, says more than 15,000 individuals have enrolled.

"We're thrilled with these numbers. We had no idea that there would be such a demand and an overwhelming response," she says.

Kentucky's site was so overwhelmed that administrators had to add servers to its system.

Washington state reports about 30,000 enrollees. Richard Onizuka, CEO of Washington's health exchange, says his state was prepared.

"We started early. We've been working on this for nearly 2 1/2 years," he says.

Still, even Washington's system crashed. It went down for 4 1/2 hours on the first day.

"It was nerve-racking. We did a lot of analysis and diagnosis," he says. "We were hoping it would get better the second day. It got a little bit better. ... We took it down the second night and it got better the third day."

Onizuka says with time, anxiety has gone down.

"I'm breathing a little easier," he says.

The federal government plans to release its first enrollment figures in mid-November.

Copyright 2023 NPR. To see more, visit

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.