At the offices of Healthy Howard Inc. in Columbia, about 25 people had gathered at 8 a.m. to get help enrolling in insurance plans. All had insurance through a program for low-income people operated by the group. That program will end in January and enrollees will have to get plans through the exchange. Its clients likely will qualify for the expanded Medicaid or private plans with subsidies.

The staff quickly switched gears after the site didn't work. They began signing people up with paper applications and asking people to come back later in the week.

Roseline Mushi of Laurel was ready to enroll at Healthy Howard, but rescheduled to come in later this week. The 55-year-old found herself without insurance in 2010 when she lost her job as a nursing assistant. She then got coverage through Healthy Howard for $50 a month. Since getting the coverage, she has improved her diet with the use of a health coach, lost weight and stopped taking medicine for high blood pressure.

"I wanted to come here early and take this opportunity to get health insurance," she said. "I know what it's like to be without health insurance. People die because they don't have health insurance."

Manuel Dias Ribeiro and his wife Givanilda Dias Ribeiro filled out a paper application for insurance at Healthy Howard. The pair remember several years ago when they didn't have insurance and got a bill for $140,000 for a surgery their young daughter underwent. They eventually got a charity to pay it, but said they never want that feeling again.

The state expects about 150,000 of the 800,000 uninsured Marylanders to buy insurance from the exchange in the first year. Another 100,000 are expected to gain coverage through an expansion of Medicaid.

Maryland Health Connection operates much like a travel or other online shopping websites and allows people to search 45 plans offered by six insurers. People also can buy insurance by phone or visit enrollment offices throughout the state.

Sharfstein said a call center experienced problems Tuesday with people being able to hear workers, but that the problem was fixed. About 1,000 people had called by late Tuesday afternoon.

State health officials said they expect many will window shop on the first day and might not purchase plans until closer to the end of the enrollment period in March.

Melanie Jackson, a restaurant server from Columbia, wants to compare prices before buying on the exchange. She wants to see how much it will cost for insurance from her employer if she were to take on full-time hours.

"I need to do some homework before I decide," said the 47-year-old with four kids.

In Bel Air in Harford County, the non-profit Seedco set up an table on Main Street to pass out information on health reform. Many who stopped already had insurance.

Others weren't quite sure how Maryland Health Connection might help them, but were eager to know more. Adam Robicheaux, a 22-year-old Bel Air resident, came from his job at the Sunny Day Café across the street to learn more because "you need insurance to do certain things in life."

Robicheaux is insured through a state program called Primary Adult Care, members of which will be shifted to more comprehensive coverage through the state's Medicaid program. He wasn't aware of that change, but said he wanted to find affordable insurance with good coverage after having taken a few trips to the hospital in recent years.

Seedco navigators collected Robicheaux's information to further discuss his insurance options later.

"I don't want to get stuck with a bunch of bills if I get stuck in the hospital," Robicheaux said.

Reuters contributed to this report.


Marylanders can call the state's call center at 855-642-8572 or 1-855-642-8573 for TTY service. The website for the health care exchange is