Health care exchanges working out kinks a week later

• Kentucky remains a health insurance sales standout with 6%2C000 enrollees
• There%27s still three to six months to sign up%2C depending on whether you want coverage Jan. 1
• Feds say wait times for HealthCare.gov have been cut in half

Katie Busch was ready to shop for insurance last Sunday on the online exchange the federal government set up for her home state of Pennsylvania. It took a week for her to even set up a user name.

All last week, she kept getting error messages. This Sunday, Busch was finally able to log in and start the application. The Pottstown, Pa., mother of two is looking for insurance only for herself, but when she got to the family section, hit save and continue, the system kept asking her if she wanted to add another person.

A week after the launch of the health insurance exchanges that are the centerpiece of the health care law, the federal and state-run sites are working out the bugs. Technical difficulties are keeping many people from enrolling or even from setting up accounts. Though consumers, including Busch, are frustrated, administration officials and state spokespeople say the sites were overwhelmed by demand, problems are being addressed, and there will be plenty of time for people to sign up once the bugs are worked out.

"The tremendous interest in access to affordable health coverage is very encouraging," says Joshua Sharfstein, Maryland's secretary of Health. "We're hearing through the call center and elsewhere that people are planning to stick with it until they are successful."

The first week the exchanges were up "saw both successes and glitches, which is consistent with what we expected," says Heather Howard, director of the State Health Reform Assistance Network, which provides technical assistance to 11 state exchanges. "This was a massive undertaking."

Comparisons with the error-ridden launch of the Medicare Part D website in January 2006 can go only so far, says Howard, who was New Jersey's commissioner of Health at the time. Back then, consumers had already enrolled in the plan, and website issues sometimes kept them from getting their medications. That's a far bigger deal than causing people to delay signing up for something they have three to six months to complete, depending on when they want coverage to start.

After all, she says, it's not like shoe shopping: "They're not going to go somewhere else. This period is really for people to explore."

At HealthCare.gov, which is handling insurance sales for 31 states, browsing has gotten a bit easier since last week. Wait times have been cut in half, says Department of Health and Human Services spokeswoman Joanne Peters. Still, logging in remains a challenge because of error messages such as those Busch got and "unknown user" responses.

"The work done to increase access to HealthCare.gov in light of the overwhelming demand is beginning to show results," Peters said. "But we won't stop until the doors to HealthCare.gov are wide open, and at the end of the six-month open enrollment, millions of Americans gain affordable coverage."

Traffic continues to be high, and the federal site will shut down again at 1 a.m. ET Tuesday to add more server capacity, move an "over-stressed" component from virtual machine technology to "powerful dedicated hardware" and to make more software changes. People have been able to enroll over the phone.

Around the state sites:

• Kentucky. The website for the state, which had more than 600,000 uninsured people in 2011, got 3.1 million page views the first week it was up. By Monday, more than 14,000 had completed applications, and almost 7,000 had enrolled in plans. An additional 155,000 people had checked to see if they were eligible for subsidies or for Medicaid. And 209 small businesses had started applications.

"All of these numbers are, obviously, more than we expected," said Jill MidKiff, spokeswoman for Kentucky's Health Cabinet. "We've heard a lot of good news stories about people who were really excited — many in their 40s and 50s who said they had never had insurance before."

• Maryland. This state-run site saw tremendous interest: 170,000 unique visitors to Maryland Health Connection by noon Monday. The call center received more than 10,000 calls, and 13,500 people created accounts. The site experienced problems early on, and officials added server capacity, made technical adjustments and planned to update the system software. "We are still in the ramp-up stage of this launch," the state reminded in a statement.

• Rhode Island. In the first three days, HealthSource RI was open, 26,039 Rhode Islanders visited the site, for a total of 30,416 website hits. And 580 people made it all the way through the process.

"There are still some issues with identification verification," said Dara Chadwick, spokeswoman for HealthSource RI. "That's a problem on the federal side, I'm being told."

About 3,000 people created accounts — or a user name and password — but not everyone was able to get further because of the verification issue. On Day 1, the state site crashed for a couple of hours because of the "enormous volume," but it came back up the same day.

• New Mexico. State officials are deferring to the federal exchange until implementing their own in 2015. They did set up a Small Business Health Options Program, or SHOP. By Monday, 486 employers had begun the application process to cover 890 people.

"This is much more than I was expecting to get," said Mike Nuñez, interim CEO for New Mexico Health Insurance Exchange. "We were hoping for 1,500 to 2,000 for the whole year."

New Mexico's system went live on Day 1 and remained in good shape for the rest of the week, Nuñez said. Next year, the same team will create the individual exchange.

• Washington. Officials expected 130,000 people to sign up in time to receive coverage by Jan. 1. Monday the state announced 9,452 people had enrolled in insurance or its Medicaid program. The state exchange received 160,000 unique visitors the first week and 800,000 hits, said Michael Marchand, director of communication for the Washington Health Benefit Exchange.

"I've heard, 'It sounded too good to be true.' But when I went online, I found out it was true,'" Marchand said. "It's going to change their lives."

Marchand, who handled public affairs for his region during the Medicare Part D roll out, said the "bumps in the road" for Part D were the same as for the exchange. The site, he said, is now running smoothly.

As for Busch, her husband has insurance through his company that is paid in part by the state Medicaid program because their two children are on the autism spectrum. They feared they could lose the state contribution if she was added to the plan. She's been without insurance since the birth of her second child two years ago and just learned she has a genetic syndrome that requires medical treatment. HealthCare.gov won't let her find what insurance coverage would cost her. She tried contacting the call center over the weekend but gave up because the hold time was too long.

"The whole thing is nothing but a headache," Busch says. "I swear the computer techs must be on shutdown, too. That's how frustrated I am with the whole thing."