The widely anticipated rollout of California's online health insurance exchange witnessed sluggish access and spotty problems Tuesday, but that didn't stop state officials from labeling it "a historic day'' that will begin to allow millions of Californians to access quality health care for the first time.
For many, the array of plans and prices offered under Obamacare proved to be a welcome surprise, but others experienced sticker shock from significantly higher costs.
Peter Lee, executive director of Covered California, was optimistic during news conferences around the state to announce the formal launching of the exchange.
"Welcome to affordable care. Welcome to security. Welcome to peace of mind,'' Lee told a crowd of a few dozen gathered at a restaurant in San Francisco's Embarcadero, the Bay Bridge in the background.
"We're going to make sure that Californians get the care that they deserve,'' Lee said. "Gone now are the days when you are asked about your allergies, your asthma. ... Gone now are the days you are denied health care. We now have a new world. This is a historic day.''
On the first day of a six-month open enrollment period, the state's website received one million page views in the first hour, followed by 800,000 page views every hour after, according to Covered California staff.
The computer system that was designed to accommodate 2,000 concurrent users was getting 3,000, officials said, while the exchange's two operative call centers in the state received nearly 9,000 calls by noon.
But there were problems. Users reported "horrendously slow'' response times, with Web pages sometimes never loading.
"One should plan on reading a great book while attempting to use the website; check for a possible website response between chapters,'' suggested user Mark Gaubatz. Others said they couldn't get past the "START HERE'' button on the coveredca.com site.
A Kaiser physician who lives and works in Santa Clara County punched in his zip code only to be misinformed that no Kaiser plan apparently existed in the county. And key information that was expected to be posted, including the list of doctors and hospitals that each insurance plan provides, as well as a list of certified enrollment counselors and certified insurance agents to help users understand the program, was missing. The information was expected to be posted online Wednesday.
"We're pleased with the extreme interest that's been shown, but we want to improve the user experience,'' said Larry Hicks, a Covered California spokesman. "We have some work to do.''
Some of the problems mimicked those around the country, where a combination of high demand and technical glitches seemed to overwhelm other online systems early in the day. But California's exchange didn't crash.
Yet even as Obamacare was met with relief by those who say they will benefit from the new law, there were cries of outrage from those who say their health insurance rates are skyrocketing.
Sherry Houston, a director of a San Jose nonprofit, said her insurance policy is increasing from about $286 a month to $600 a month, while her husband's will rise from $300 to $987 a month, according to a letter they received from their insurance carriers in the mail Monday.
"Our premiums have been reasonable in the scheme of things, but now they are unreasonable,'' said Houston, adding that her family does not qualify for assistance on any level. "It's the middle class that bears the biggest burden for those who cannot, do not or will not pay their own insurance."
Rich Olson, a principal at Cooper Preuit Engineers in San Jose, said he got the same sticker shock when he opened his mail Monday. He said his high-deductible Health Savings Account plan that has cost $775 a month for his family of four will now cost $1,346, a 73 percent increase.
While he'd checked the online prices as well, he said the lowest price Bronze plan there would reduce his current $6,500 deductible to $4,500, but would ultimately provide less coverage.
"I expected a little bit of a rise, but I didn't think I would be hammered this high," he said. "Those of us who can pay for insurance are going to pay for the ones who can't."
Covered California's Hicks said some plans will see a price hike, most likely because of the increase in number of services being offered and the new guaranteed coverage.
Adults with pre-existing conditions, for example, cannot by denied coverage or charged more. And all new health insurance plans will come with 10 essential benefits that include outpatient and emergency services, hospitalization, maternity and newborn care, mental health care and prescription drugs, among other benefits.
Other factors could also explain the higher rates for some.
Today, many health insurance policies cover 50 percent of the cost of care. But under Obamacare's new four-tier system, the lowest price a person pays is 60 percent in the Bronze plan, with the insurance provider picking up the 40 percent.
Marian Mulkey, director of health reform and public programs at the California Healthcare Foundation, a Oakland-based think tank, also said that because no one can be denied coverage under the new law, the pool of people eligible for insurance includes a larger number of sicker people, so the rates will be higher because of that.
"Everybody is in a bigger risk pool,'' Mulkey said. "And it's more expensive on average because the sick as well as the healthy are in the risk pool. And there is some cross subsidy.''
Moreover, she said, while older people today may pay five times as much as young adults, the new law restricts their costs to three times as much, which impacts younger people who will have to pay higher prices.
Consumers on Tuesday were able to access information intended to help them determine their eligibility for subsidized health care and Medi-Cal. They also were for the first time able to shop, compare and enroll in coverage that takes effect Jan. 1.
David Bernard of Santa Cruz said he accessed the site easily, and though he did not stay on it longer than 10 minutes, he could see that his premiums could end up being less.
Bernard, 53, who co-owns a branding development agency, said the family policy he buys includes his wife and two teenagers.
"I've wanted something like this for years,'' he said of the information on the website. "The amazing thing for me was how quickly you can look at your possible options and find a better deal.''
Covered California officials estimate that during the initial open-enrollment period, which ends March 31, they will enroll 500,000 to 700,000 Californians who are eligible for subsidies to make their care more affordable.
Lee said 4 million Californians will get some kind of financial support through the exchange, while at least 1.4 million will become eligible for expanded Medi-Cal, the state's medical program for the poor.
In Concord, at one of the state's two operational call centers statewide, a hum permeated the large building as service agents walked prospective enrollees through the process.
"It's been a very busy morning so far. There's been a lot of calls from individuals and families wanting to enroll," said Angela Bullock-Hayes, Concord call center site manager.
At 8:46 a.m., Covered California tweeted that it had enrolled its first person.
Not even the government shutdown could affect the debut of exchanges nationwide. As Lee noted during an early morning news conference in Sacramento, "We're not delaying anything. While Washington is talking about shutting down, we're talking about starting up."
The shutdown will have no immediate effect on the insurance marketplaces because they operate with money that isn't subject to the annual budget wrangling in Washington.
By Tuesday afternoon, at least 2.8 million people had visited the healthcare.gov website, said Medicare administrator Marilyn Tavenner, whose office is overseeing the rollout of the Affordable Care Act. The website had seven times the number of simultaneous users ever recorded on the medicare.gov site.
In Obama's home state, dozens of people who came to a Champaign, Ill., public health office to sign up for coverage found computer screens around the room flashing an error message: "System is unavailable."
Robert Booz, a vice president and analyst at Gartner Inc., an information technology research and advisory company, said the technical delays and glitches were "destined to be."
"This is a huge undertaking, it was a very short time frame relatively speaking for a major system implementation" Booz said -- a situation in which, all politics aside, a tremendously complex system had to be developed on the fly. "It had all the earmarks of trouble coming."
Imagine if going to the store to buy something required quickly syncing your online bank application, the store's application and a travel agent's application -- and then imagine tens of thousands of people trying to access that combination all at the very same moment, he said.
"That's exactly the kind of complexity were dealing with in the exchanges," he said.
And it'll only get more complex through the second quarter of next year, he predicted, as more enrollees enter the system and start making -- or missing -- their payments.
"It's the gift that keeps on giving," he said.
The Associated Press contributed to this report. Contact Tracy Seipel at email@example.com or 408 275-0140.