To understand American history, Jon Lauck says you have to understand the Midwest's role in some critical events.
Despite the government shutdown, the insurance exchanges at the heart of the Affordable Care Act, or Obamacare, open for business today.
The insurance marketplaces, accessible online or — depending on the state — at clinics and via telephone, ask that people sign up for a plan by December 15th.
Those who won’t be going in to discuss their health insurance options in person will be going on HealthCare.gov to search for their options.
The vast online insurance marketplaces will allow participants to find the exchange offered in their state, check eligibility, sign up for coverage and calculate subsidies.
NPR’s Elise Hu joins us to explain the challenges to such a large technological undertaking.
MEGHNA CHAKRABARTI, HOST:
From NPR and WBUR Boston, I'm Meghna Chakrabarti.
ROBIN YOUNG, HOST:
I'm Robin Young. It's HERE AND NOW. Coming up, former Democratic Senator Tom Daschle on the last government shutdown 17 years ago.
CHAKRABARTI: But first...
VALERIE MYERS: Good morning, good morning, health care marketplace opens today. Live fearless with independence. Have a great day.
CHAKRABARTI: Health insurance representative Valerie Myers(ph) was up early today recruiting perspective customers at a Philadelphia transit station on this, the first day of business for those new insurance exchanges set up under the Affordable Care Act. So how is day one of business going? Let's check in with the HERE AND NOW contributors network. Elana Gordon is health and science reporter with WHYY in Philadelphia. Hi there, Elana.
ELANA GORDON: Hello.
CHAKRABARTI: So you were out this morning talking to people. What did you hear?
GORDON: I was. Well, people in their rush near Valerie Myers, a lot of people were familiar with Obamacare and, you know, had some semblance of what was going on, that there were these marketplaces, for the most part. But some people didn't really know much more than that. It was just kind of this vague notion.
So for example I talked to Nancy Barrett(ph), she was on her way to work, and learning more about it was something she really wanted to do, but she said it's been difficult.
NANCY BARRETT: This is not explained very well. The average person will never get it.
GORDON: And so you stopped by to find some information out for a friend?
BARRETT: For my daughter, actually. She gets no health care through her employer.
GORDON: I also talked with a lot of people who do have health coverage through their employers. So they weren't really thinking much about it one way or another. But there were some other people that didn't have insurance, weren't really sure what was going on.
I spoke with a guy who also just didn't have insurance but didn't really care to get any.
CHAKRABARTI: So an interesting variety of opinions on this first day, here. Now, those insurance marketplaces are available via the Internet, and depending on the state that you live in, in-person clinics and telephone hotlines, as well. So you visited one of those clinics, in particular in northern Philadelphia. What did you see?
GORDON: Well, it was actually pretty busy. There were people that had gotten there quite early in the morning to sign up. By the time got there, around 10 a.m., they'd already enrolled about 20 people. I say that, but at the same time all these marketplaces, the online sites are having some issues. So they weren't actually able to log on to sign up that way.
Instead the folks there had been anticipating problems, so they printed out the applications, and they were having people sign up via paper. Now the issue with that is that you have to send them in, and then you wait a couple weeks, and then you find out from there what you're eligible for.
CHAKRABARTI: Oh interesting, so sadly paperwork will always be with us, even in this new era of the Affordable Care Act, it seems. But tell us a little bit more about these clinics and what their particular interest is in this process.
GORDON: Well, clinics are kind of on the front lines of a lot of this outreach. Many have gotten funding to do some of that outreach, to have these trained counselors there to assist people with signing up. They're also in this position where they often are serving a lot of uninsured and underinsured people. So they want to see people get coverage to help get the care that they need.
But at the same time, it also works for them because the more that they see people who have coverage, then they're able to get reimbursed for that care. So there are actually several people who came in who didn't have insurance that were very excited to sign up. One of those people was Carmen Santiago(ph), who she has looked for coverage before.
CARMEN SANTIAGO: Because I had diabetes, the (unintelligible) goes up, and I got sick, and I wound up in the hospital. And this is why I'm going through all this because I haven't got any blood work or anything for at least maybe three or four years.
GORDON: And again she wasn't the only one. I spoke with Nicole Windbush(ph), who she has high blood pressure. She hurt her wrist a couple months ago, but she's a hair stylist, so that's complicated. It's made it hard for her to earn income and earn a living, so that's been a challenge for her.
CHAKRABARTI: OK, so Elana, interesting to hear how things are going on in the ground in Philadelphia. But what do you know about things in other states?
GORDON: Well, we're hearing about glitches, at least on this launch date everywhere, as I mentioned, with the clinic here using their paper applications. Now here in Pennsylvania, the federal government is running the marketplace. That's also the case for example in New Jersey. Delaware is running similarly, but there's a partnership with the federal government.
So they've had a little more funding. They've been a little more proactive as a whole of getting the message out about the marketplaces. But really today's the day, the starting day to see how people respond.
CHAKRABARTI: Well, Elana Gordon is health and science reporter for WHYY in Philadelphia. Elana, thank you so much.
GORDON: Thank you.
YOUNG: So as we're hearing, some glitches today. A government website down there in Pennsylvania, Philadelphia, and they prepared for it by printing forms ahead of time. Glitches were expected, as we're hearing, in these new insurance exchanges. Glitches occurred when other federal programs were launched.
And today the system is a complicated one in order to handle that's expected. Elise Hu is lead blogger for NPR's ALL TECH CONSIDERED. So Elise, nationwide how's the system doing?
ELISE HU, BYLINE: I think Elana was right, there have been glitches not only in Pennsylvania but all over the country. It of course is still way too early to render a judgment, but it's definitely been a mixed bag for folks trying to sign up or even just to window-shop. A handful of state exchanges are running smoothly, but the federal system, which is running all or part of the exchanges in 34 states, that's either throwing errors at the part where people are trying to set up accounts, or it's inaccessible even earlier in the process because of high traffic.
High traffic volume is what HHS is blaming on a lot of the technical problems.
YOUNG: Well, they're blaming the high traffic on the technical problems, but they also sound kind of excited. Tell us more about the traffic.
HU: Yeah, we're looking, they are saying that about one million people went on healthcare.gov this morning, that is the main federal site to sign up. In New York that traffic number is even higher. But getting on the site really isn't the main issue. When people are trying to set up marketplace accounts in order to learn more about what they might be eligible for, that's where the system is locking up.
YOUNG: Well, and just tell us, what's involved in setting up this huge online health care system?
HU: There's a lot involved. Now what makes it so hard is that it's an unprecedented system, and nothing like this exists anywhere in the world. So you have states building their own sites for exchanges, the federal government building sites for some states and the creation of this massive federal data hub. And that hub is what the computer systems talk to in order to fetch data about you from various places like the IRS to check your income, Homeland Security to check your citizenship status and decide also whether you're eligible for - or whether you're eligible and what subsidies or credits you might be able to qualify for.
So that's a lot of systems talking to one another. Some of them are very old, and, you know, technology generations can change very quickly. And so you have some systems that are maybe 10, 15 generations ago when it comes to technology time.
YOUNG: Well, and we know that this all varies state to state, but you spoke to a health care consultant and former Medicaid officer at HHS who said the state exchanges are actually working better?
HU: Yeah, that's right. He says the states are doing better because some of them started earlier, or they had something similar. They had enrollment experience, for instance with Medicaid, at the state level. And so just having a little bit more run time has helped and then just experience in this, some sort of enrollment experience has been helpful.
So we're seeing some states work really well, others not so well, but again it's still fairly early in the process.
YOUNG: Well, it's funny you say that because we did a segment earlier in the year, a lot of questions about Medicaid and maybe fraud in the welfare program. And we spoke to a tech expert at that time who said we had - it's not the people, it's the system, even with Medicaid. So maybe health care being added to Medicaid will improve some of these technical systems in some states.
That's Elise Hu, lead blogger for NPR's ALL TECH CONSIDERED with the technical side of today's launch of the marketplaces. Elise, thank you.
HU: Thank you. Transcript provided by NPR, Copyright NPR.