As consumers rushed to sign up for insurance on the last day of open enrollment under the Affordable Care Act, Maryland's health exchange website slowed to a crawl and all circuits were busy at the call center.
That worsened a bottleneck of consumers who have tried for months to overcome glitches on the troubled website to be able to buy a private plan or sign up for Medicaid. Consumers had faced a fine for not meeting the Monday deadline to get health coverage, but thousands will still be able to sign up.
Maryland officials decided not to penalize those who at least started the process to enroll through the exchange but were stymied by glitches, and will allow them to enroll for several more weeks.
But some consumers couldn't even log on or reach anyone at the call center. They will be allowed to attest that they tried to enroll but couldn't by checking an online box, which officials plan to add to the exchange website, marylandhealthconnection.gov, on Tuesday.
"It's been a whirlwind day," Carolyn Quattrocki, interim exchange director, said Monday evening. "We're going to have a lot of people get through, and that's good news. We'll get many more through in the next month."
Exchange officials said heavy volume — not technical problems — burdened the system Monday.
The exchange enrolled a record 1,700 on Friday and has surpassed that number each day since, Quattrocki said, though exact figures for more recent days weren't available.
The website has been so glitch-prone that up to 11,000 applications were in limbo at one time. Exchange officials have sent out email blasts to thousands of people stuck in the system to offer help with enrolling, and have kept a list of those who had logged on and started the process but were unable to complete it.
Officials are expected to ditch the software and develop a whole new system before the next open enrollment in November. The board that oversees the system plans to vote Tuesday on a proposal to adopt the platform developed by Deloitte Consulting LLC and used in Connecticut.
In the meantime, so-called navigators, those who have been tapped to help consumers enroll in health care, say they expect to continue to be busy for weeks.
"The next big step is after today we'll start making all of these appointments for the people who have touched us that we couldn't help," said Sheila Mackertich, vice president of health reform initiatives at HeathCare Access Maryland, a navigator group.
The group said it was slammed Monday with hundreds of people, some of whom were waiting outside the downtown Baltimore office when it opened. Some said they had waited for the website to improve before trying to enroll, while others said they were rushing to meet the deadline, Mackertich said.
Each of the group's navigators can only handle six or seven applications a day. Many of those who showed up Monday will be added to the list to be enrolled later.
HeathCare Access Maryland encountered a similar line of people at an enrollment fair it hosted on Saturday, where more than 500 people sought coverage. Israel Labasttida, a restaurant worker in Prince George's County, and his wife, Annamaria, were among the last to be signed up for coverage on Saturday.
"She tried the website, and it kept breaking down," said Labasttida, who has largely been without insurance since moving from Mexico 20 years ago. "We looked for a fair and ended up driving all the way to Baltimore before the deadline. It took half a day."
Exchange officials couldn't say Monday when they expect to complete enrollment for everyone who couldn't get through the process, or how many will be left without coverage.
About 400,000 were uninsured in Maryland and qualified for coverage under the federal health law at the start of open enrollment Oct. 1.
As of March 22, nearly 270,000 people had obtained new insurance through public or private plans, though exchange officials can't say how many already had coverage. The bulk signed up for Medicaid, the federal-state program for the poor, which has no enrollment deadline.
Almost 49,300 people signed up for private insurance through the exchange, falling below a target of at least 75,000 set by analysts for the state. While that target was revised from about 150,000, state officials now say the overall number of people with new public or private policies is on track with their expectations.
An unknown number of people also have signed up for coverage directly though four private insurance companies. Consumers were allowed this option when problems with the exchange mounted.
One observer said Maryland's site woes may mean higher premiums next year.
Maryland and other states with dysfunctional websites will have a disproportionate number of sick people enrolled because they were the ones who "pushed through the gauntlet because they really needed insurance," said Robert Laszewski, president of Health Policy and Strategy Associates LLC, a health care consulting group.
Without more healthy people in the insurance pool, premiums will rise for Marylanders next year. Maryland should consider adding another 30- to 60-day open enrollment period once officials get their new exchange website up and running to "fix the risk pool," he said.
And while federal and state officials tout overall enrollment numbers, Laszewski said many people still have not paid their premiums, meaning they may not have coverage. Consumers didn't have to pay at enrollment, and were billed by insurers.
"It'll take a while to get all this straightened out," he said.
Some politicians continued Monday to use the troubles to attack their rivals.
Attorney General Douglas F. Gansler, a Democratic candidate for governor, and his running mate, Del. Jolene Ivey, proposed during a news conference to reach out to key groups to ensure they get coverage: children, Latino immigrants and those with chronic health conditions.
The pair criticized oversight by Lt. Gov. Anthony G. Brown, the state's point man on health care reform, and renewed their calls for a new system.
"The botched rollout of Maryland's exchange hurts the most vulnerable, those who Obamacare was supposed to benefit the most," said Ivey. "Too many in our state cannot afford to wait in line or on the phone for fear of missing work or losing wages."
Brown countered that Gansler was doing little more than "attacking Obamacare." The lieutenant governor also criticized Gansler for not attending all of the meetings of a health care reform council, of which he was a member.
Larry Hogan, a Republican candidate for governor, called Monday for a thorough cost-benefit analysis of all of the state's options before the exchange board votes on a new system. Other options include fixing the existing site, using the federal site or using another state's system.
On Monday, as the midnight deadline for enrollment approached, some said the site had improved.
Dr. Peter Beilenson, founder of Evergreen Health Co-op, one of four insurers on the exchange, said the last three days were the best in the six months since the website's launch.
While he doesn't think it will make up for the potential loss of frustrated consumers who abandoned efforts to enroll because of the glitches, he said he was happy to see more people get health care.
"It's kind of been a long time coming," he said.
Healthy Howard in Columbia, another navigator group, had stepped up its efforts. Officials said they helped 180 people by late afternoon Friday — more than twice as many people as it saw in an entire day a few weeks ago. The group anticipated many people would wait until the last day and brought in more staff Monday.
Workers enrolled some and put others with technical problems in the queue to assist later.
"It's definitely busy," said Eric Masten, a spokesman for the group. "We expected and planned for a surge."