The Affordable Care Act's health insurance exchanges opened amid logistical delays and a U.S. government shutdown. Some states delayed their exchange openings by hours or days to avoid overwhelming their websites and call centers. While the federal exchanges in 36 states opened as scheduled, states were encouraging people to wait before signing up to allow time to work out issues. The exchanges aim to provide medical coverage to most of the nation's 48 million uninsured, though the Obama administration is seeking 7 million signups in the initial enrollment period running through March.

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2. exchanges in 36 states opened at 8 a.m. Washington, D.C., time. There were indications
some states were delaying their startup times by hours and some services by days.
“Our message is, ‘You are welcome to come on Oct. 1 if that’s what you want to do, but
you might just want to wait,’” Jon Hager, the executive director of Nevada’s state-run
insurance exchange, said in a telephone interview.
The show will go on, even with a government shutdown, as President Barack
Obama seeks to fulfill the law’s promise of medical coverage for most of the nation’s 48
million uninsured. The budget fight may actually help by diverting attention away from
the rollout, said Sanjay Singh, chief executive officer of hCentive Inc., a Reston,
Virginia-based software company working on the exchanges.
“Because they haven’t had the time to really put the system through its paces, they are
happy to see a softer kind of launch, where the traffic will be small the first couple of
weeks,” Singh said in a telephone interview.
State Markets
Fourteen states are running their own markets, with the rest operated in whole or part by
the federal government.
Maryland pushed back the planned 8 a.m. opening of its online marketplace until noon,
according to a message on its website that said the exchange was “experiencing
connectivity issues.”
In Minnesota, which built its own exchange, residents can check prices and determine if
they qualify for subsidies on the new MNsure website. They won’t be able to sign up
until the afternoon at the earliest, after a final check to ensure the state can properly share
data with the federal government, said April Todd-Malmlov, MNsure’s executive
director, on a conference call with reporters.
Consumers won’t be able to get in-person help from so-called navigators or other groups
designated to assist in the registration process until tomorrow at the earliest, ToddMalmlov said. The 5,000 individuals preparing for those positions still need to complete
training and clear background checks, she said.

3. Evaluate Options
“Consumers will have plenty of time to evaluate their options,” Todd-Malmlov said. “We
are anticipating there will be a lot of interest in the site, but we don’t anticipate there will
be a lot of applications in the first few weeks.”
Health Exchanges: The Battle and Background
The federal government began its first partial closure in 17 years, idling as many as
800,000 workers, after Congress failed to agree on a spending bill for the fiscal year that
began today. Republicans, who control the U.S. House, had demanded a delay or
dismantling of the health law as part of the funding bill. Democrats, who make up the
majority of the Senate, refused to concede.
Democratic leaders who helped write the 2010 health law plan to go forward with a
celebration of the exchange openings at a news conference later today. The consumer
advocacy group Families USA also is organizing an event that will showcase people and
small-business owners benefiting from the health law.
Obama Meeting
The White House planned its own media blitz, with the president due to meet in the Oval
Office with people eligible to enroll in the exchanges. An interview with Vice President
Joe Biden was scheduled to air on 450 college radio stations, appealing to an audience of
young, healthy consumers considered crucial to the success of the new insurance markets.
“Shutdown or no shutdown, we’re ready to go,” Kathleen Sebelius, secretary of the U.S.
Department of Health and Human Services, told reporters at a briefing yesterday.
That’s because the health law relies primarily on mandatory spending, which can’t be
stopped by congressional inaction on the fiscal 2014 budget. It’s the budget category used
for benefits such as Medicare and Social Security.
The $1.4 trillion Affordable Care Act requires most Americans to obtain health insurance
starting next year or pay a fine. To make finding coverage easier, the law set up

4. government-run exchanges in each state where most consumers can buy plans from
insurance companies with the help of tax credits.
About two-thirds of uninsured people said they plan to buy medical coverage next year
rather than pay a fine, according to a Gallup poll published yesterday.
7 Million
The Obama administration is seeking to get about 7 million people to buy plans through
the exchanges in the open enrollment period that starts today and runs through March.
“It’s going to be judged on Oct. 2 as a failure by opponents of reform because 7 million
people haven’t signed up,” said Kevin Counihan, the director of Access Health
CT, Connecticut’s exchange. “The reality is nothing like this begins with great fanfare.”
Consumers don’t have to complete enrollment until Dec. 15 to guarantee coverage
starting in Jan. 1. They may be dissuaded from signing up this month because the first
premium payment to their insurer is due within 30 days of enrollment.
More than 900 businesses, community groups and other organizations have agreed to
voluntarily promote the law and help people sign up. Retailers Wal-Mart Stores Inc.
(WMT), CVS Caremark Corp. (CVS), Walgreen Co. (WAG) and Rite Aid Corp.
(RAD) plan to promote coverage in their pharmacies.
Wal-Mart Invites
Wal-Mart, the world’s largest retailer, has invited insurance company representatives to
about 3,500 stores starting in mid-October to promote their plans, said Dave Tovar, a
spokesman for the Bentonville, Arkansas-based company.
The government also announced a contract with the Blue Cross Blue Shield Association,
the umbrella organization for 37 state and local insurance companies, to sell health plans
in 30 states, including three that previously had only one carrier participating in their
exchanges.

5. People eligible for coverage can go to healthcare.gov to find their state’s insurance
exchange. Monthly prices for the lowest-tier of plans average $249 nationwide. People
with incomes less than about four times the poverty level will get discounts on their
premiums by way of tax credits. For a family of four, that means those with incomes of
less than about $94,000 qualify for the credits.
People with incomes under about 1.4 times the poverty level may be able to enroll in
expanded Medicaid programs for the poor in about half the states.
The Obama administration needs some breathing room, Sebelius said at the briefing with
reporters. She compared the exchanges to Apple Inc. (AAPL)’s new mobile operating
system, which the company upgraded days after its debut to correct a flaw.
“No one is calling on Apple to stop selling devices for a year or to get out of the
business,” she said. “It’s a reminder that we’re likely to have some glitches. We’ll fix
them and move on.”