SCOTT SIMON, HOST:
This is WEEKEND EDITION from NPR News. I'm Scott Simon. The new health insurance exchanges are now in their second week and it has been a rocky start almost everywhere. Just how rocky may depend on what state that you live in. Jenny Gold tells us about people called the navigators, people hired to help consumers enroll in coverage.
JENNY GOLD, BYLINE: The waiting room at a community clinic in Silver Spring, Maryland is filled with people waiting to see a doctor. Alexandra Dixon walks among the rows of chairs with a bright smile and an outstretched hand.
ALEXANDRA DIXON: My name's Alex and I'm one of the new health care navigators. Have you heard about this new Affordable Care Act?
UNIDENTIFIED MAN: No, I don't think so.
GOLD: Dixon is one of 350 people in Maryland who've been hired uncertified to help consumers enroll in the new health insurance options that are offered as part of the Affordable Care Act. So far, she's been pretty booked up with appointments.
DIXON: Sure, I've had a couple of people go: ew, Obamacare, I don't want that, but for the most part people have been really excited and really happy and, you know, know what this is, you know.
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GOLD: Today she's helping Maria Hernandez, a construction worker who's a legal immigrant and has been uninsured for the past five years.
MARIA HERNANDEZ: (Foreign language spoken)
GOLD: She says sometimes she gets sick but without insurance it's better just to take some medicine and stay home. She's gotten her application started with Dixon's help, but pretty much every time Dixon tried to enroll someone, the Maryland exchange website freezes up.
So far, no one at the clinic has actually been able to enroll in an exchange plan. But whenever Dixon hits a roadblock, she just sets up an appointment for the patient to come back.
DIXON: Because the portal is much better this week than it was last week, so you know, I have every expectation that even next week it's going to be better than this week.
GOLD: And she has her state behind her. Maryland has been on the forefront of implementing the health law. It's one of only 16 states running its own insurance exchange. The rest are being run by the federal government, which has been stretched thin. Caroline Pearson works at Avalere Health, a consulting company that's been tracking exchanges.
CAROLINE PEARSON: The states that are operating their own exchanges just have a lot more funding available to do outreach and enrollment. The federal government really had limited funding left to do that and it was spread across a large number of states.
GOLD: One of those states is Ohio which got just $3 million in grants to do consumer outreach. That's compared to $24 million in Maryland, which has half as many people without insurance.
LISA HAMLER-FUGITT: It has been challenging, to say the least.
GOLD: That's Lisa Hamler-Fugitt, who runs the Ohio Association of Food Banks, the state's main consumer outreach group for the exchange.
HAMLER-FUGITT: We have too few boots on the ground. We need hundreds, if not thousands of individuals to assist us.
GOLD: Right now, she'll have about 40. On top of that, Ohio placed extra restrictions on navigators, including requiring them to go through a much longer certification process with the insurance department. Hamler-Fugitt says that's stalled the process of getting her navigators on the ground by three weeks. She says looking at states like Maryland is just frustrating.
These early differences between states could hamper the goal of the health law, which is to get as many people covered as possible, according to Caroline Pearson at Avalere.
PEARSON: Recent polling shows that only about 12 percent of the uninsured population who could benefit from exchanges understand that they are launching and began on October 1st. So doing a big push out in the community, you know, can potentially bring a lot of people into the market that you're not going to see in a state that isn't as proactive.
GOLD: But, she adds, this is only the beginning of the enrollment process and launching a program of this size is always a huge lift. Consumers have until the end of March to sign up for coverage in 2014 and as the kinks get worked out, it's possible that this year's enrollment will still be a success. For NPR News, I'm Jenny Gold.
SIMON: And that story comes to us from the nonprofit news service Kaiser Health News.
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