New marketplaces meant to steer millions of uninsured Americans to health insurance under President Barack Obama's signature health-care law open for business today.
After a weekslong scramble by state and federal officials to iron out technical wrinkles and position thousands of outreach workers, the marketplaces are set to launch, warts and all, giving the public a first taste of the health law's core provisions.
Consumers can shop in the online marketplaces, called exchanges, comparing monthly prices, deductibles and other details of health plans, and buy coverage. Many moderate and low-income customers will receive federal subsidies to help pay for coverage.
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An estimated seven million people will sign up for individual coverage in the exchanges through 2014, according to the Congressional Budget Office. An additional two million people are expected to gain coverage in small-business exchanges.
Health and Human Services Secretary Kathleen Sebelius said Monday that her agency is confident the exchanges would work correctly as consumers begin to arrive. Administration officials have acknowledged the potential for hiccups in the exchanges' functions during the first days and weeks, however.
The federal government is running exchanges in 36 states. Several states, including Oregon and Colorado, that are running their own exchanges have said some features won't be available Tuesday. In addition to the online marketplaces, consumers can enroll by filling out paper applications, or contacting insurance agents and nonprofit workers who have signed on to help guide people to coverage.
Pieces of a puzzle that stretched from Washington, D.C., where officials worked to hammer out last-minute details of the exchanges, to neighborhoods around the country where residents waited for a chance to sign up, were coming together in the final hours before the launch on Tuesday.
"It is a huge undertaking," says Mark McClellan, a former director of the federal Medicare agency who oversaw the launch of a new drug benefit for seniors in 2005.
Contractors and government information-technology experts worked through the nights in recent weeks to fix problems with the exchange's technological backbone, such as a bug that causes the software to inaccurately determine whether people are eligible for subsidies.
Some camped out at hotels in Herndon, Va., to be close to the contractor finishing the work. People familiar with the situation said problems persisted late Monday, but it was unclear whether the issues would limit consumers' ability to enroll in coverage.
On the exchanges, many consumers will get a first clear look at the prices available to them to buy coverage. Administration officials contend it has pushed down premiums and made coverage more affordable—thanks in part to the subsidies. Meanwhile, critics say the law is boosting costs.
Today, consumers can begin to decide for themselves, if all goes well in the rollout.
Kelly Fristoe, a broker from Wichita Falls, Texas, had already scheduled more than two dozen appointments this week for people eager to shop for policies. "I've got people who are so anxious about what is this going to cost them, what do the plans look like," Mr. Fristoe said.
Officials and independent analysts expect most incoming enrollees to sign up late this year, in November and December, because coverage through the exchanges won't go into effect until Jan. 1 at the earliest. Consumers can enroll as late as Dec. 15 to gain coverage that begins Jan. 1, and open enrollment stretches through March.
Political detractors of the law are sure to use a poor turnout or any major glitches that emerge today to argue that the law isn't yet ready and should be delayed.
And insurers worry initial hitches could be a turnoff for their potential customers. If would-be enrollees can't initially sign up for technical reasons, they might lose interest and decline to try again later.
But administration allies stressed that early enrollment successes are a less important metric of success for the law than whether the administration's outreach campaign meets its goal for enrolling seven million people through next year.
"It's going to be a long, hard slog," says Joel Ario, a managing director of the consulting arm of law firm Manatt, Phelps & Phillips. Mr. Ario led the federal government's exchange-building effort for its first year.
—Timothy W. Martin contributed to this article. Write to Christopher Weaver at christopher.weaver@wsj.com
