Lt. Gov. Anthony G. Brown, who was tapped to oversee health care reform in Maryland, spoke for the first time Wednesday about the bumpy rollout of the effort's centerpiece, the marketplace for the uninsured. He said he was "not satisfied."
"The state stumbled out of the gate," he said at a meeting of the Maryland Health Care Reform Coordinating Council, an advisory panel that he co-chairs. It was the first meeting since the health care exchange was launched Oct. 1.
State officials have seen a deluge of complaints from uninsured or underinsured consumers who wanted to buy coverage on the exchange but said they could not register, browse plans or complete applications because of technical difficulties.
After the largely genial council meeting, Brown said he wouldn't dwell on mistakes in creating the system but would focus on fixing the problems before the enrollment deadlines. Dec. 18 is the deadline for those who want coverage to begin Jan. 1 and March is the deadline for the uninsured to enroll.
"I am certainly not satisfied," he said. "But we're not looking back right now. We have people working around the clock. By the time Jan. 1 rolls around, we want to make sure everyone who wants to enroll will have to opportunity to enroll."
Brown said he didn't know there would be problems with the system until opening day. He said the initial problem was a lack of capacity, as too many people tried to use the site at once. He also said the state's website had trouble tapping federal systems to verify the identities and information provided by consumers — the same problem plaguing the federal website that serves consumers in 36 states.
The state has about 800,000 uninsured and officials say just over 16,000 have completed applications online and been told whether they qualify for subsidies. More than 1,120 have enrolled in a plan. More have filled out paper applications with the help of "navigators" hired to aid consumers.
Few other state exchanges have released enrollment numbers, and federal officials said they would not release enrollment numbers until November.
During the hearing Wednesday, Rebecca Pearce, the Maryland exchange's executive director, echoed Brown's statements that technicians are working "day and night" to smooth the operation.
She did expand on one area that has been an issue in Maryland and other states: A high level of interest on the first day caught officials off guard. She said the system had been tested as if 5,000 people "were pushing buttons" on the website at the same time and far more than that tried to use the Maryland Health Connection site on Oct. 1.
The council, which includes state lawmakers and representatives from state agencies, has been charged with recommending ways to implement the federal law in Maryland.
Outside observers say they believe the Maryland and federal sites had trouble handling the traffic because of their registration requirements. Consumers need to get a password before browsing insurance plans and that made the systems work harder as they verified users' identities, said Jonathan Wu, co-founder of the consumer finance website ValuePenguin.com.
"For Maryland, that appears to be one of the bigger issues," he said. "You have to ask yourself if everyone wants to browse, why create a system that doesn't allow you to browse. …This seems like poor design decisions coupled with bad expectations about what people would be doing on Day 1."
Kentucky, by contrast, allowed anyone to see available plans and faced few glitches. The state, with about 600,000 uninsured, has enrolled more than 10,000 people in plans.
Maryland officials have said that registration is a security measure and also allows consumers to see exactly what they would pay for each plan. Officials have since added sample premiums that can be viewed online before registering, so those buying coverage could get an idea of what a plan might cost them.
The good news, Wu said, is there is a high level of interest. And, he said, "This will all get fixed in the next month or so."