DOYLESTOWN, Pa. » Tilda Elias had reason to be optimistic when she opened the HealthCare.gov website Monday, ready to help her first client of the week find health insurance. Technicians had made fixes to the online insurance exchange over the weekend. Even more promising, her client, Giovanna Romano, had managed to complete an online application at home with no problems.
But after Romano logged in, the system made her reconfirm everything in her application, a process that dragged on for 40 minutes. Then came the screen message that tens of thousands of people shopping for insurance under President Barack Obama’s new health care law have come to hate: "Sorry, our system is temporarily down."
Defeated, Elias, a "navigator" who helps people sign up for coverage, scheduled another appointment with Romano, a busy home health worker who could not return until December.
"I’m not sure what happened here," Elias told her, shaking her head.
Despite weeks of work by a small army of software experts to salvage HealthCare.gov, navigators in states that depend on the federal insurance exchange say they still cannot get most of their clients through the online enrollment process.
Those navigators said they had seen improvements in the system since its disastrous rollout Oct. 1, particularly in the initial steps of the application process. But the closer people come to signing up for a plan, the more the system seems to freeze or fail, many navigators said.
Administration officials say technicians have made significant improvements to sections that allow consumers to apply for insurance and compare health plans, and Obama this week encouraged people to continue trying to use the exchange. But those officials acknowledge that parts of the system are still not performing as well as they had hoped. And in congressional testimony Tuesday, Henry Chao, the chief digital architect of the federal online marketplace said that 30 percent to 40 percent of the project was still being built.
At Community Action of Nebraska, a nonprofit group with a statewide network of navigators, Roger Furrer has witnessed the problems up close. Most applicants he worked this week could not get to the screen that shows their coverage options.
"That’s really problematic," he said, "because if people are wavering already, they won’t always come back and follow through."
Some navigators said it was hard not to feel discouraged, especially when their clients, locked out by the website, went home upset.
"We have people who understandably say, ‘Well what the heck am I doing here if you can’t enroll me?’" said Ted Trevorrow, a navigator in Philadelphia who has not been able to enroll a single person yet. "I always want to say, ‘That’s a really good question.’"
Their experience remains markedly different from that in most of the 14 states that built their own exchange websites, where people are managing to sign up in much larger numbers. The remaining 36 states depend on the federal exchange.
Clients who are wary of the health care law can be especially intolerant of the website’s problems, Trevorrow said.
"They’re incensed over the fact that the law would, as they see it, intrude on them to this degree and then not even perform," he said.
Filing paper applications, which the Obama administration is encouraging people to do if they cannot access HealthCare.gov, has not necessarily been better.
Laura Line of Resources for Human Development, a nonprofit group based in Philadelphia that has navigators working in 10 counties, said the group stopped using paper applications a few weeks ago because the federal government was so slow to process them.
Only seven people have actually picked a plan with the group’s help, Line said, including three who succeeded Wednesday, an exciting development for the group. It has helped an additional 60 complete online applications and 110 submit paper applications.
"We got concerned that people would not hear back in a timely fashion," Line said. "When you do the paper, you eventually have to get online to finish the process anyway."
Paula Garey, an enrollment specialist at the Family Practice & Counseling Network, a group of community clinics in Philadelphia and York, Pa., said she worried because none of her clients who sent in paper applications had heard anything from the federal government.
"No one knows what’s going on with the paper applications at this point," Garey said. "I guess there’s just a big pileup."
In all, about 2,200 people in Pennsylvania had enrolled in an exchange plan as of Nov. 2, according to a federal report. People need to be enrolled by Dec. 15 to have coverage starting Jan. 1.
Verna Brown-Tyner, another navigator with Resources for Human Development, said she did not feel defeated because she was giving people valuable information about how to get coverage that would eventually make a difference in their lives.
"We don’t feel that our job is in vain," she said.
Some navigators have rituals that they think might improve their access to the federal website. Trevorrow, who works for Resources for Human Development, makes sure to clear his computer’s browsing history, or cache, before trying to enroll someone. John Foley, a navigator with the Legal Aid Society of Palm Beach County in Florida, avoids enrolling people early in the week because he thinks that is when the site has more problems.
"You get used to the system and the rhythm and the quirks to it," Foley said. "Fridays are really good days."
Foley, who leads a team of seven navigators, said that although the federal website was still "not great," he had noticed improvement over the last week.
"We’re able to get people through," he said. But he added that he still sees "disturbing" problems. In one case, a man who qualified for a federal subsidy was quoted different prices for plans the second time he logged on to the site.
Still, of more than about a dozen navigators and other enrollment counselors interviewed, most said their clients could now create logins and at least start the application process, a marked improvement.
Several said they noticed significant progress late last week, when they were able to help clients get all the way to the point of browsing plans.
"It’s not happening every time," Furrer, in Nebraska, said, "but we’ve got some really excited navigators out there going, ‘It’s working!’"
On Friday, Trevorrow helped a client complete an online application in one sitting for the first time, he said, getting to the point where they could start shopping for plans.
"We were both as excited as we could be," he said.
But then they encountered a problem: The website said that his client was not eligible for a subsidy to help with her premium costs. Based on the income she had reported, Trevorrow was certain that she should, in fact, get a subsidy.
"It did bring an abrupt halt to the proceedings," he said. "However, we ended on an upbeat note. I told that consumer this was the farthest I’d ever gotten with an application, it’s the smoothest I’d ever seen the system run, and I was very optimistic that we could finish."
He told her to call the federal call center over the weekend to resolve the subsidy issue, then to meet with him again this week to hopefully finish enrolling.
"Every weekend," he said, "I’m hopeful that the next week is going to be substantially better."