STEVE INSKEEP, HOST:
You may add health insurance exchanges into the mix of this year's holiday shopping because millions of Americans who want coverage in place for the start of 2014 have to buy it by December 23rd.
Fred Mogul of member station WNYC looks at New York's efforts to handle the demand.
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FRED MOGUL, BYLINE: The call center for the New York state marketplace is operated by a contractor called Maximus, located in the Corporate Woods office park on the edge of Albany. There's not much life outside on a wintry afternoon but inside things are humming.
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MOGUL: Joey Cappuccitti is one of more than a hundred customer service specialists here taking calls.
JOEY CAPPUCCITTI: Once you're finished setting up your roster, you'll then be given the option to look at the plans available.
MOGUL: Cappuccitti specializes in helping small businesses.
CAPPUCCITTI: I mean. again, you can stop the application now at any time and...
MOGUL: He says things have calmed down since the exchange debuted.
CAPPUCCITTI: Unfortunately, we were having issues with the website crashing.
MOGUL: That day, October 1st, top state health officials gathered several miles away in a small windowless conference room at the main computer hub in a converted shopping mall. After months of testing, contractor Chris Harmer says everyone was confident the system could handle what was coming.
CHRIS HARMER: We were excited, nervous, waiting for it to open.
MOGUL: But many customers couldn't get past the home page, and many of those who did get through only got a screen or two into the application process before it froze. At the call center, Cappuccitti says there wasn't much he could do.
CAPPUCCITTI: They would call us and we would explain how the marketplace worked and try back in a couple hours. You should be able to set up an account.
MOGUL: The state did two things. First, they tackled the technical problems. They expanded the servers immediately and went to work revamping the website. Donna Frescatore, the head of the New York state health exchange, says the online application initially required people to check a box early, on one of the top web pages, if they wanted financial assistance. But people didn't see it.
DONNA FRESCATORE: They'd get to the end and say, I thought I'd qualify for some, and I didn't. Why is that? And we'd go back and look in the application and they had missed it.
MOGUL: Web designers eliminated the check box and made that fork in the road much more clear-cut for applicants. New York's exchange has been running relatively smoothly, compared with the federal one. But almost every day still brings complaints about long wait times for calls and serious glitches online. Frescatore says there are no serious patterns of trouble, just individual issues that the state and its contractors address one by one.
FRESCATORE: We try to listen to everything - to social media, to customer service, to our navigators, and work every day to make it better.
MOGUL: The bigger, more abstract challenge is trying to adjust people's expectations - not over how quickly web pages should open, but over what it means to shop for health insurance online, where people have been told...
PRESIDENT BARACK OBAMA: You can compare insurance plans side by side, the same way you'd shop for a plane ticket on Kayak or a TV on Amazon.
MOGUL: That's what President Obama said on October 1st, and it's a description state and federal officials and politicians put out there for months, if not years, before the exchange rollout - much to the chagrin of contractor Chris Harmer.
HARMER: I don't think it's the correct analogy for a marketplace.
MOGUL: The complexity of the Affordable Care Act means the whole application process is complicated, too. It's a little like applying for financial aid for college; you have to put in a lot of personal information, before you figure out how much you'll have to pay.
HARMER: It does depend on the household, the ages. It depends on what tax credits you may be able to apply. So you need to know all those factors instead of just saying, here's a quote, which may or may not be correct.
MOGUL: Traffic has been steadily increasing over the past two months. And, as with stores this time of year, to meet growing demand, the call center has been increasing staff by 10 to 15 percent.
Officials say they're confident the system can handle a rush of insurance purchasers before the December 23rd deadline. About 50,000 have enrolled so far, but there are many more to go. The state's goal is to enroll about 300,000 people by the end of next year.
For NPR News, I'm Fred Mogul in New York.
INSKEEP: His story is part of a collaboration between NPR, WNYC and Kaiser Health News.
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