CHICAGO (AP) - Online insurance marketplaces at the heart of President Barack Obama's health care overhaul struggled to handle the volume of consumers on Tuesday, the first day of a six-month open enrollment period.
Federal officials said they were working to address the website problems as quickly as possible. Callers to the federal call center also reported long wait times.
"We have built a dynamic system and are prepared to make adjustments as needed and improve the consumer experience," said U.S. Health and Human Services spokeswoman Joanne Peters on Tuesday morning.
State-operated sites also experienced glitches as they rolled out their exchanges. Maryland's marketplace displayed a message saying "We open at 12:00 noon on October 1st." The Minnesota site too was not expected to be live before Tuesday afternoon.
Exchange officials in Colorado said their website wouldn't be fully functional for the first month, although consumers will be able to call for help applying for government subsidies during that time.
The nationwide rollout comes after months of buildup in which the marketplaces have been both praised and vilified.
Illustrating the heated political disagreements over the law, the opening of the exchanges comes the same day as the shutdown of the federal government, led by congressional Republicans who want to block the health insurance reforms altogether.
The shutdown will have no immediate effect on the insurance marketplaces that are the backbone of the law, because they operate with money that isn't subject to the annual budget wrangling in Washington.
The marketplaces represent a turning point in the nation's approach to health care, the biggest expansion in coverage in nearly 50 years.
The Obama administration hopes to sign up 7 million people during the first year and aims to eventually sign up at least half of the nearly 50 million uninsured Americans through an expansion of Medicaid or government-subsidized plans.
But if people become frustrated with the glitches in the computer-based enrollment process and turn away from the program, the prospects for Obama's signature domestic policy achievement could dim.
"The promise of the law is that no one will go bankrupt because of medical bills," said Neera Tanden, president of the Center for American Progress, which helped work for passage of the law. "It won't happen in the first day or the first year. But when the law is fully operational, it will provide an economic benefit to roughly 30 million Americans."
Tanden cautioned against rushing to judge the marketplace's success on its first-day performance. Numerous observers had predicted bugs and setbacks. Trained outreach workers in many states are having trouble getting the certification they need to start helping people to enroll.
Many states are predicting that people will initially test the online application system but actually sign up closer to Dec. 15, which is the deadline for coverage to start Jan. 1. Customers have until the end of March to sign up in order to avoid tax penalties.
Looming as one of the biggest challenges to the law's success is the ability of insurers to persuade young and healthy people to buy insurance to balance the costs of covering the older and the sick.
"You've got to launch this thing right the first time," said Robert Laszewski, a consultant who worked 20 years in the insurance industry. "If you don't, financially you will never recover."
Under the law, health insurance companies can no longer deny coverage to someone with a pre-existing medical condition and cannot impose lifetime caps on coverage. They also must cover a list of essential services, ranging from mental health treatment to maternity services.
Another obstacle: Nearly three-fourths of people under 65 who lack insurance are unaware the marketplaces open Tuesday, according to a Kaiser Family Foundation survey released over the weekend.
Spending money to raise that awareness with ad campaigns has varied vastly, with some Republican-led states doing little or nothing to promote the insurance exchanges. Missouri Lt. Gov. Peter Kinder, a Republican, even recently urged residents not to sign up for coverage.
In Florida, Republican Gov. Rick Scott and key lawmakers have pushed back against implementing parts of the law. The Florida Department of Health recently ordered county health departments to prohibit so-called navigators from signing people up for health insurance at those facilities.
But other states are doing more, such as Kentucky, the only Southern state running its own marketplace. Kentucky Gov. Steve Beshear, a Democrat, was an early supporter of the health law.
The state kicked off an $11 million advertising campaign in June, with ads on TV, radio, Internet and newspapers. It'll expand Tuesday and continue through the first three months of next year.
"Frankly, we can't implement the Affordable Care Act fast enough," Beshear said.
Associated Press writers Kelli Kennedy in Miami; David Lieb in Jefferson City, Mo.; Kristen Wyatt in Denver; and Roger Alford in Frankfort, Ky., contributed to this report.
AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson
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