By Abby Goodnough
The New York Times
Rocky King, the executive director of Oregon's new health insurance exchange, has done everything in his power to tamp down expectations for its opening Tuesday.
He rejected the idea of a flashy downtown news conference that morning. He postponed a series of ads meant to drive customers to its website, coveroregon.com. In fact, King is not even allowing people to sign up for health coverage online without assistance at first; they will have to go through an insurance agent or a community group until at least mid-October.
Tuesday is the long-awaited kickoff for President Barack Obama's signature health care law, when millions of Americans can start signing up for new insurance options. Yet across the country, officials are issuing warnings that despite fevered efforts, their new insurance exchanges - online markets where people can shop for health plans and see if they qualify for federal subsidies - will not be fully operational for weeks or even months.
Last week, the District of Columbia's exchange announced that it would not immediately be able to determine online whether people qualify for Medicaid, which about half the states are expanding under the law, or for a federal subsidy to help cover the cost of private coverage. In Colorado, for the first month, people who want to know if they are eligible for a subsidy will have to call a customer-service line.
In Nevada, home to a large Hispanic population, a Spanish- language version of the exchange website will not be ready until mid- November. And in Maryland, small businesses will not be able to buy insurance for their employees through the state exchange until January. Federally run exchanges are having similar problems.
Now many of the 16 directors of state-run exchanges are describing October as a "soft launch" period, when Americans can start exploring their coverage options - but on websites that may be incomplete, vulnerable to glitches, and perhaps not ready for a full onslaught of customers.
"I have no idea what this thing's going to look like on Oct. 1," King said one afternoon last week as dozens of tense-looking programmers on laptops, scattered through the exchange offices outside Portland, rushed to finish testing and fix problems. "We could crash and burn and have to close it down."
The outcome could hardly be more important for Obama. With Republicans threatening to shut down the government unless Democrats agree to delay the law for a year, even small problems with the exchanges could be powerful fodder for the law's opponents.
Although the exchanges have been able to tap billions of federal startup dollars and hire companies like Accenture, Oracle and Xerox to help with the work, their task has been highly complex and their time frame tight.
The Web portals for the exchanges have to be able to share information in real time with insurance companies, state agencies and the federal government, which has built a "data hub" through which it can verify the income and citizenship of people applying for subsidies or Medicaid. Each portal has to undergo rigorous testing to ensure, for example, that data will flow properly, that the portal is secure and that it can handle heavy volume. Much of the testing is still going on.
Any insurance coverage acquired through the exchanges will not take effect until Jan. 1, when the health care law will start requiring most Americans to have insurance or to pay a tax penalty.