Week one of the Affordable Care Act’s State Health Insurance Exchanges

Credit: Ōmono via Flickr under Creative Commons

On Tuesday morning (10/1) the state health insurance exchanges, an integral part of the much vaunted, but highly divisive Affordable Care Act opened for businesses. The date officially marked the start of the ACA’s open enrollment period for 2014, which will continue through until March 31, 2014.

Just as a refresher for those who don’t know, the state health insurance exchanges are where residents in each state are able to purchase subsidized health insurance plans that meet the Affordable Care Act’s standards for coverage and affordability. The October 1st launch of the exchanges was highly anticipated on both sides of the debate over health care reform.

So how did everything go?

Much to the chagrin of the Obama administration, things did not go as smoothly as all the authorities had assured us it would. Day one was plagued by chronic server problems at every state’s exchange, which kept a lot of people from being able to register for coverage.

For example in New York from our office in Rockland County, the New York State of Health exchange was inaccessible for the entire day on Monday. All that was displayed when visiting the website was a cryptic server error message.

New York State like all the other states experiencing similar problems clearly got the message and scaled things up as quickly as they could. By Tuesday for us the New York site was accessible, but we had some problems when trying to make an account and then log in to see the prices of the different health plans.

We also received some anecdotal reports of people in other states successfully getting onto their state’s exchange page, then getting nearly all the way through creating a profile but at the very end getting kicked back to the beginning of the process because of a server error.

However despite all these problems, the public’s reaction to the exchanges appears to be largely positive. Of course it hasn’t even been an entire week so we can’t know if this first phase of a long love affair with the exchanges or just a phase. Much of this week’s traffic is likely due to digital window shoppers trying see what the fuss is about without buying anything. Digital “tire kickers” so to speak.

Digital Complexity

It’s also worth pondering for a moment just how complex the technical system for purchasing health insurance at your state’s exchange is. The system has to build a profile for you and vet your information nearly simultaneously across several different equally complex government computer systems.

In total it needs to verify your information with the Social Security Administration, the Internal Revenue Service, Department of Labor and Homeland Security in real time as you complete the application. Not to mention that the system is also double verifying your identity using Experian’s credit reporting services.

With so many things to do and all at the same time, it’s no wonder there were server problems!