Jayne O'Donnell , USA TODAY
There was no shortage of confusion about the Affordable Care Act even before its mandated insurance marketplaces opened - barely - on Oct. 1.
Now there's so much attention paid to what's wrong with the federal website, it's hard to know what's working and what isn't.
Here's a look at the problems that have surfaced since the launch of the federal exchange, the likelihood of real fixes soon and what to do in the meantime if you're in the market for insurance under the state or federal exchanges.
Q: What's actually wrong with HealthCare.gov, the site handling 36 states' ACA insurance sales?
A. It's complicated. Consumers are having considerable trouble logging onto the site and are receiving error messages, pages that go blank or frozen screens. Jeffrey Zients, the administration's new point person on the site's fixes, said Friday that 90% of people can create an account, but just three in 10 can create an application. In its review of the site last week, the applications management company Compuware APM found users in the West and Midwest had some of the slowest load times and faulted the government for not testing the site adequately, something contractors and regulators acknowledged in a hearing on the Hill.
Q: What do you do if you want to shop for insurance?
A: There are plenty of shopping alternatives and plenty of time. The deadline to sign up for insurance if you want coverage that starts Jan. 1 is Dec. 15. The deadline to sign up so you avoid a penalty at tax time in 2015 is March 31, 2014. Don't know where to begin? Call one of the navigators listed for your state or the call center listed on HealthCare.gov. (That much works!) You can find out your eligibility for subsidies, tax credits or Medicaid by using Kaiser Family Foundation's subsidy calculator, which isn't reporting any technical difficulties. Once you know how much financial help you can get, you can begin comparing plans in your state. If you can't get into your state's exchange or HealthCare.gov, check out websites such as GoHealth.com or those of the insurers selling in your state to see what each plan offers and costs. Need more help? Ceci Connolly, managing director of PwC Health Research Institute, recommends using the extra time wisely to compare plans and gather all of your income information, Social Security numbers for family members and other financial documents.
The White House said Friday that it expects HealthCare.gov will be running smoothly by late November, which gives you plenty of time to shop and will reduce the risk of those impulse buys that get riskier this time of year. Besides, when everyone else is poring over Best Buy's website on Thanksgiving or waiting in line at Walmart on Black Friday, you can have HealthCare.gov to yourself.
Q: Is it even possible to enroll for one of the new Affordable Care Act plans online?
A: It can be done, but it may depend on where you live, when you log on and a few other more confounding factors. Plus you'll need a fair amount of patience. If you are in one of the states running their own exchanges, many of the kinks should be worked out by now. But glitches are still being reported in several state exchanges, too. If you lack patience or time, you can try the old-fashioned way - an actual paper application. That makes more sense than trying to apply over the phone, as the person on the other end is going to have to use the same system that's frustrating you.
Q: Seeing the state and federal government haven't met their deadlines, consumers won't have to meet theirs, right?
A: Despite pressure from some members of Congress, including Democrats, the administration is holding firm on the deadline to sign up. Though politicians and others may want extensions, insurance companies probably won't argue for delays. They've got enough uncertainty ahead of them in 2014 when it comes to all the new people they'll be insuring, Connolly says. Delaying the Dec. 15 date by much would make it difficult for insurers to get their new customers in their systems and insurance cards in the mail, she says, and delaying the March 31 one would complicate their efforts to assess what kind of risk they're up against.
Q: If Medicaid wasn't expanded, what does that mean to people right below the federal poverty limit?
A: Although ACA expanded Medicaid to include people making up to 138% of the federal poverty limit (which is $15,856), a Supreme Court decision in June left it up to states to decide whether to do so. In states that don't expand Medicaid, those making less than 100% of the federal poverty limit may make too much for Medicaid and not enough for a tax credit or subsidies. The Kaiser Commission on Medicaid and the Uninsured says this "coverage gap" will include about 5 million poor Americans. Things are slowly changing. Last week, Ohio became the most recent state to expand Medicaid. A few other states are in discussions about expanding Medicaid. Arkansas, Connolly notes, has proposed a different approach that would allow people to take Medicaid money and shop with it on the federal exchange. The plan, if approved by federal regulators, could prompt other states to follow this novel path, which would pull more people out of the coverage gap.