Since it launched last week, the state's new health insurance exchange has been used by 326 Marylanders to enroll in plans, while thousands of others created accounts to start shopping, despite persistent technical problems.
A new report released Monday outlining the performance of Maryland Health Connection in its first six days showed steady interest from Marylanders looking for health insurance. But the report also acknowledged that the state must continue to improve the system to make it more accessible.
The website logged more than 174,000 unique visitors and more than 10,500 people telephoned its call center. About 13,500 created accounts that allow them to browse, compare and buy health plans. The initial count doesn't include paper applications, which are being processed.
"Through every channel we have had tremendous interest, and our challenge and goal is to meet that interest," said Maryland Health Secretary Dr. Joshua Sharfstein. "We are doing everything we can around the clock to improve the system so people can be successful in what they want to do."
Consumers are supposed to be able to visit Maryland Health Connection, create an individual account and browse a variety of health insurance plans before buying one, much as they would book an airline flight. The exchange was created as part of the national health reform to provide a place for Maryland's 800,000 uninsured to find health coverage.
The website crashed almost immediately after it launched Oct. 1 to begin taking applications. Technical problems inhibited people from creating accounts. Those who managed to create an account ran into frozen screens, error messages and other issues.
It's unclear how much those problems might have hindered enrollment. Officials had expected many people to window shop and buy later.
State officials warned before its start that there could be glitches with the system because it was such a complex launch. They blamed the problems on the high volume of people trying to access the exchange, but some analysts have said it appears the system wasn't built with enough capacity to handle the demand. Some suggested that requiring people to create accounts to access the exchange also might have overburdened the system.
Technicians in Maryland have since added server capacity, made technical adjustments and improved the ability for employees in the call center to help those interested in enrolling, the report said. There are plans for a software upgrade in the near future.
Improvements will continue. During upgrades, users won't be able to access certain parts of the site. The site also will be taken down every night in October between 11 p.m. and 5 a.m. to fix problems.
Because Maryland's exchange has been open for so little time, it's tough to assess how well it's doing compared with other states or even within its borders, said Brad Herring, a Johns Hopkins University health economist who has been following the health law's implementation.
"If there are 800,000 uninsured in Maryland, then these numbers, at least in terms of applications and enrollment, seem pretty low," said Herring, an associate professor of health economics at Hopkins' Bloomberg School of Public Health. "But on the other hand, it's really early and certainly there have been a lot of visitors" to the site.
Herring said most people would want to gather information at first about premiums and deductibles, think about their options and return later to sign up, so the small number of enrollees is not surprising. Consumers have several months before the policies would kick in. Consumers have until March to enroll, but they must sign up by mid-December for coverage starting Jan. 1.
Also, Maryland requires consumers to create an account before seeing specific information on policies, so many may not be ready to enter the formal process, Herring said. Some also may have been deterred from logging on or creating an account because of news of the system's glitches.
On the other hand, he said, the number of visitors to the site may be inflated by those who have insurance but are curious about the offerings, such as researchers and journalists.
Others said it's not surprising there is more interest than enrollees at this point.
"The number of website visits, calls and created accounts all demonstrate significant public interest in obtaining coverage through the Maryland Health Connection," said Karen Davenport, director of health policy at the National Women's Law Center. "Women and their families looking into coverage through this marketplace need time to sort through the wide variety of health insurance options — Maryland Health Connection offers more than 80 health and dental plans — to work out what works for their budgets and anticipated health needs."
The state is taking constant feedback from consumers as they use the site.
Sharfstein declined to talk in detail about the system's problems.
"We are tracking [problems] and knocking them off as we are able to," he said. "We are certainly aware the technical issues need to be addressed. We expect the experience for users to get substantially better as we continue to address the issues."
Exchanges across the country have dealt with similar problems as millions of people went searching for insurance under the Affordable Care Act, the landmark legislation meant to spread access to health coverage to most uninsured Americans.
Community groups in Maryland helping to enroll people have turned to paper applications until kinks in the system are worked out.
Evergreen Health, a co-op started by former Baltimore Health Commissioner Dr. Peter Beilenson, has delayed signing up people using the website until next week because of problems with the exchange.
Sharfstein said people have plenty of time to enroll and he doesn't think the problems with the system will discourage people who need coverage.
"We think that there will be plenty of opportunity as the system moves forward for people to come back to it," he said.
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