Just 106,000 Americans, including about 3,500 Floridians, chose new health plans during the first month of the troubled Obamacare insurance exchanges, according to federal data released Wednesday. That's a fraction of the enrollment expected by now, and the announcement came amid mounting discontent both from longtime critics of the Affordable Care Act as well as Democrats worried about growing political fallout.
The Florida number is particularly dismal, given that the state has an estimated 3.8 million uninsured residents under age 65. One-fourth of Floridians have no insurance, the second-highest rate in the United States.
Obama administration officials said technical problems with the healthcare.gov site clearly prevented people from signing up for coverage. But Health and Human Services Secretary Kathleen Sebelius told reporters she expects most people won't sign up until the end of the enrollment season in March, a pattern seen in Massachusetts, which began mandating health coverage in 2006.
"Even with the issues we've had, the marketplace is working and people are enrolling," she said.
Others, however, were quick to jump on the low figures. Florida Republican Sen. Marco Rubio called the numbers "abysmal" and "another early warning sign that this legislation is deeply flawed and ultimately cannot be fixed."
Even Democrats are getting nervous. In a closed-door meeting Wednesday of House Democrats and White House officials, lawmakers complained the president put them in a bad spot politically by wrongly promising consumers that they could keep their existing health care plans. A vote is expected in the House on Friday on a Republican bill to preserve individual health plans that are being canceled for failing to meet the new law's standards. The White House says that would only let insurers continue to sell plans with skimpy coverage. Still, some Democrats are threatening to support it if the White House doesn't come up with a better idea by Friday.
In general, states like Florida that refused to establish their own exchanges performed especially poorly during the first month of enrollment. Fewer than 27,000 Americans signed up through the federally run website. The rest came through the 15 marketplaces run by states and the District of Columbia.
Across the nation, Medicaid was the success story, even in states that didn't accept federal dollars to expand eligibility. All told, 326,130 people learned their incomes are low enough to qualify for Medicaid or the Children's Health Insurance Program — more than three times the number who picked private plans.
In Florida, which refused to expand eligibility, 12,800 more adults and children may be eligible for Medicaid programs. They qualified even under Florida's stringent rules, but may have applied only because of publicity over the insurance marketplace.
Alexis Lambert, a spokeswoman for the Florida Department of Children and Families, said Wednesday that the state's Medicaid enrollment increased by about 2,500 people over the month of October. The program is jointly funded by the state and federal government, and the amount of the state budget it consumes is a perennial thorn for many legislators.
Despite published reports suggesting that healthcare.gov is far from being fixed, Sebelius insisted it is on track to work well for most people by the end of the month. "We can reasonably expect these numbers will grow substantially over the next five months," she said.
Yet another issue: how the federal system connects with private insurers. Already, stories have emerged of people believing they'd signed up for a particular insurance, yet the carrier had no knowledge of their enrollment.
Open enrollment ends in March, but people who want coverage Jan. 1 must sign up by Dec. 15, a tight deadline officials continue to insist they can meet. "Through all the means we now have for people to apply and enroll in coverage, we believe consumers will be able to have coverage at the time they want," said Julie Bataille, spokeswoman for the Centers for Medicare & Medicaid Services.
The data revealed another surprise: Just about 30 percent of the 1.1 million people who have gone through the Marketplace eligibility process qualify for premium subsidies. That suggests the government may be missing its target audience, another problem officials said they were addressing.
Among the states whose enrollment is being handled by the federal government, Florida actually had the highest enrollment. In Texas, 2,991 selected a plan. Alaska was at the bottom, with just 53 people enrolled.
One point of contention is how enrollment is defined. The administration includes anyone who has selected a marketplace plan. But the health insurance industry says enrollees don't count until they start paying — and that figure wasn't reported.
One of the 3,500 Floridians with a new plan is Beverly Borrelli, 61, of Tarpon Springs.
She started trying the day the site opened, and refused to quit, even through website crashes, enrollment packages that never arrived in the mail, and hours spent on the phone. The process took her more than a month.
Borrelli purchased a Florida Blue mid-tier "silver" plan for $27 a month after her subsidy. Jan. 1, she will have insurance for the first time since her employer of 27 years laid her off in June. Suffering from painful arthritis, Borrelli feared not being able to afford care, especially from her orthopedist.
She has already paid her first month's premium, and says she's glad to be insured despite the hassle.
"I wasn't going to give up," she said.
Information from the New York Times was used in this report. Jodie Tillman can be reached at firstname.lastname@example.org or (813) 226-3374.