After website troubles sparked a two-week extension, California officials wrapped up the first open enrollment for Obamacare coverage with nearly 1.3 million consumers signed up since October for the state-run exchange.
Sign-ups ahead of Tuesday's enrollment deadline appeared to run more smoothly than they did March 31, the previous cut-off date. The state's Covered California website was overwhelmed that day by a last-minute surge of applicants and it repeatedly crashed. In response, officials extended a grace period until Tuesday for anyone who had already started an application or ran into technical problems.
"We are seeing some periodic slowdowns on our enrollment website because of high volume today, but there have been no outages," exchange spokeswoman Anne Gonzales said Tuesday. "We are seeing people with a little patience getting online and completing the enrollment process."
Insurance agents said the state website was operating faster than it did two weeks ago. Some clinics in Los Angeles were booked with appointments Tuesday, but for the most part they weren't swamped by the long lines of applicants that formed March 31. The state said phone wait times were 30 minutes at their peak Tuesday, better than hour-long waits previously.
An updated enrollment tally is expected later this week. As of Thursday, Covered California said 70,000 people had finished enrolling since March 31 and overall it expects to exceed 1.3 million health plan customers. About 85% of consumers have paid their health insurance premiums thus far, according to the exchange. An additional 1.5 million residents have signed up for Medi-Cal, the state's version of Medicaid.
Turnout surpassed state projections and gave a big boost nationally to President Obama's signature health law. Californians account for about 17% of the 7.5 million people who have enrolled nationwide through online exchanges.
Many more people have purchased individual coverage outside the government marketplaces. Consumers only have to use the federal or state exchanges to receive premium subsidies based on their income.
Before enrollment began under the Affordable Care Act, both Obama and California officials boasted to consumers that getting health insurance would be as easy as shopping online for a plane ticket or buying a book on Amazon.com.
It proved far more difficult. In California, consumers complained about busy signals and long wait times when seeking help from the state's call centers. The exchange's online chat function failed regularly. There was a shortage of local enrollment counselors, and the state didn't start publicizing the availability of free, in-person help until recently.
"I think we oversold simplicity," said Frank Mecca, executive director of the County Welfare Directors Assn. of California. "We made it seem too easy. There were significant delays and issues with technology. That's inevitable when you roll out something so big, so fast."
Mike Perry, a partner at PerryUndem Research and Communication, a nonpartisan research firm in Bethesda, Md., interviewed more than 70 Californians in February who applied for exchange coverage for a report issued this week by the California HealthCare Foundation.
He said many of the consumers were surprised at the amount of documentation needed for enrollment after hearing so much about easy online sign-ups. Many people were also unaware that enrollment counselors and certified insurance agents were ready to assist them at no cost. People who qualified for Medi-Cal and then were left waiting for confirmation of coverage were among the most frustrated, Perry said.
"There was a sense it would be a more streamlined process," Perry said. "But these people really wanted affordable health insurance and they were willing to go through a lot to get it."
Covered California tried to remedy many of its customer-service woes in the final weeks by adding call-center employees and promoting local enrollment help in its advertising. It also revamped its marketing to Latinos, a key group that makes up about 60% of the state's uninsured population.
Those changes helped lift Latino enrollment after a dismal start during the fall. Latino sign-ups made up about 36% of March enrollment, compared with 18% of those in the first three months.
Exchange officials say they will learn from any missteps during this initial phase and apply them to the next open enrollment period starting in mid-November. One top priority for this fall is restoring the exchange's physician directory so consumers can check for specific doctors before choosing a health plan. Covered California pulled its provider list in February because it was riddled with errors.
Some enrollees have complained about an inability to find a doctor willing to take new patients or getting contradictory information from physician offices and their insurer.
"This enrollment period was hectic for everybody," said Sarah Soto-Taylor, Covered California's deputy director of community relations. "We will be taking a step back and looking at what we can do differently."
The end of open enrollment Tuesday doesn't close off every opportunity to get coverage now.
Medi-Cal continues to accept applicants all year. In addition, people who experience a "qualifying life event," such as moving to a new area or losing their health insurance at work, may be eligible for special enrollment in the state exchange.
The federal healthcare law requires most Americans to have health insurance starting this year or face a tax penalty. The fines start at $95 per adult or 1% of adjusted gross income, whichever is greater.