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In the days leading up to Tuesday’s launch of Washington state’s health-insurance exchange, state officials were confident they were ready, but acknowledged there would be glitches.

That may have been an understatement.

The exchange, called the Washington Healthplanfinder, was down for hours almost from its 7:30 a.m. launch Tuesday as consumers, businesses and others lined up online to get a look at the website.

The site was placed into “maintenance mode” and was unavailable for many of the enrollment events and other activities planned for the first day that people could begin buying health insurance in exchanges created under the Affordable Care Act.

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Washington’s exchange wasn’t alone in the technical-problems department. Heavy volume on health-insurance exchanges across the country meant many website users were met with messages citing high traffic or saying the system was down.

As significant as the technical problems were, however, Tuesday marked just the beginning of a six-month period in which the uninsured and people looking for individual health-insurance policies can purchase them on the exchanges. Those policies go into effect Jan. 1.

The impact of the exchange showed up around the region Tuesday, from consumers beginning to shop for insurance and calculate financial assistance, to specially trained “assisters” at clinics and hospitals to enroll people, to government officials touting the new system.

Roll with the punches

To get ready for Tuesday’s rollout of the Healthplanfinder, more than 120 staff from Harborview and University of Washington medical centers were trained as official navigators to help people sign up for insurance plans or expanded Medicaid coverage. Hospital staff hung posters promoting the Healthplanfinder website and displayed informational brochures.

But despite all the preparation, the guest of honor was late to arrive.

By 2 p.m., Harborview staff were still unable to get onto the new website, leaving them compulsively tapping the refresh button on their computers, hoping the page would launch.

State officials with the exchange said it should have been live by that time, though some users who tried a little later said the site still didn’t work right. Its performance had improved by early evening.

Harborview doctors treat 1,500 uninsured patients per month, and hospital officials said they expect to enroll 70 people per day in the exchange once it’s running smoothly.

In addition to the navigators, the hospital will have mobile computer workstations and a resource area where people can enroll themselves.

— Lisa Stiffler

Obstacles for patient

The Harborview staff had a hunch the Healthplanfinder website might have some hiccups, so on Monday they rescheduled patients who had Tuesday appointments to meet with financial counselors ready to help them navigate the new system.

Soavarin Jirasetpatana, a 63-year-old uninsured patient from La Conner, Skagit County, decided to come in anyhow.

Jirasetpatana has diabetes and high blood pressure. Despite the distance from home, the Thai restaurant owner comes to Harborview for her medical needs. Her income is low enough that she qualifies for the nonprofit hospital’s charity care, and she likes her doctors.

When Jirasetpatana arrived early for her appointment, toting a bag filled with financial and tax documents to help with the enrollment process, she got the bad news that the Healthplanfinder website wasn’t working.

Jirasetpatana and a Thai-speaking hospital interpreter did the next best thing and called the exchange help line to enroll by phone. After much back and forth, Jirasetpatana wound up creating a profile in the system, but nothing more.

Was she upset that she couldn’t secure insurance or Medicaid coverage?

“I’m not disappointed,” Jirasetpatana said through her interpreter. But she’s anxious she’ll be left without coverage. “I worry I might not get it,” she said.

Jirasetpatana will make the trip back to Harborview to try again.

— Lisa Stiffler

Medicaid coverage

Before reaching age 21, Ben Smith had endured two open-heart surgeries to replace malfunctioning aortic valves.

The Seattle resident, now 39, periodically has had health-insurance coverage through his family, but never bought it on his own or through his job as a laborer.

Tuesday, Smith was among a group of people who recounted their health-care stories as part of an open-enrollment kickoff at Carolyn Downs Family Medical Center in the Central Area, attended by Gov. Jay Inslee and King County Executive Dow Constantine.

“No matter what kind of shenanigans there is back in Washington, D.C., Washington state is moving forward with health care,” Inslee said.

In Smith’s case, he was without coverage a year ago when he suffered a brain aneurysm and doctors discovered a malfunction in his aorta. Harborview, he said, wrote off the cost of his care as charity.

But Smith said he left the hospital unable to find work in the midst of the economic downturn, and was unable to qualify for Medicaid or disability. And because of his pre-existing conditions, he has been unable to get any kind of coverage.

On Tuesday, Smith signed up for coverage, completing a paper form, and learned that he qualifies for Medicaid under the new rules.

— Lornet Turnbull

Helping hands

Three certified “in-person assisters” from WithinReach were at the Edmonds Food Bank for several hours Tuesday morning to answer questions about enrollment in the exchange.

The assisters receive training and are considered key to helping uninsured people understand insurance and sign up for coverage.

The WithinReach team didn’t sign up anyone at the food bank on the first day of enrollment. But they did talk to about 50 or 60 food-bank clients about their coverage options, said Mira Hattal, a WithinReach outreach and enrollment specialist who was there. “We’ve been doing a lot of demystifying about what is available.”

Hattal is one of 27 WithinReach staff members, including 10 AmeriCorps volunteers, who completed the training. She said they made about half a dozen appointments with people who asked to follow up, either in person or on the phone, for help with enrollment.

WithinReach expects to enroll several thousand people in qualified health plans or Medicaid through the exchange over the next three or four months, said Executive Director Alison Carl White, who was also at the food bank.

— Amy Snow Landa

Starting the hunt

On Tuesday morning, Leah Larson Rei was ready to get online to check the insurance options available to her and her husband.

The Kirkland couple “retired a little earlier than we’d planned,” said Rei, 57. So now they’re buying their own insurance through Group Health Cooperative.

At $522 a month, the insurance bill was already a strain on their budget. Then Rei got a letter explaining that come Jan. 1, they would be able to buy a comparable plan through the state’s insurance exchange for $965 a month.

The couple hope to qualify for income-based tax subsidies, which are only available for plans inside the exchange. People not covered through their jobs can either buy health insurance within the exchange or shop for plans outside the program.

“Before I got the letter and saw how much the premiums were going to increase, we thought about staying outside [of the exchange],” Rei said.

But with her premiums set to practically double, she realized the subsidy was going to be key to keeping coverage. While she doesn’t love the idea of taking a subsidy, Rei said she and her husband take care of their health with diet and exercise and require limited medical care, making them less of a burden on the system overall.

Despite her fitness, Rei is a strong advocate for health-insurance coverage because she recognizes that accidents and unexpected diseases do happen.

“My biggest beef goes back to the people who say they don’t need it,” Rei said. “Everybody needs it.”

Despite the bumpy start to the launch of the exchange, Rei didn’t find Tuesday’s technical problems troubling. She plans to visit the site again in coming days and look for deals.

— Lisa Stiffler

Baffling snafus

Tuesday’s launch of the Healthplanfinder went about as well as … well … the Seattle Mariners’ season.

Bethany Frey, a spokeswoman for the Washington Health Benefit Exchange, which manages the state exchange, said the site was pulled down shortly after it launched at 7:30 a.m. because users were encountering delayed page loads and an inability to complete sign-up processes.

While the benefit exchange didn’t know what the problem was, Frey said it was not caused by insufficient capacity to handle the Web traffic.

The site was relaunched at about 2 p.m., and the benefit exchange issued a news release saying “some users may still experience intermittent issues completing online applications. We encourage all applicants to save their information and return to should such a situation arise.”

Saving data, however, could be a problem. In one instance, four attempts to create an account resulted only in obtuse error messages.

The benefit exchange apparently isn’t certain what caused the problems on the site.

“We are doing additional investigating tonight to find the root cause,” Frey said Tuesday.

— Patrick Marshall

Information from The New York Times is included in this report. Lisa Stiffler, Amy Snow Landa and Patrick Marshall are Seattle freelance writers. Lornet Turnbull is a Seattle Times staff reporter. This report was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation.

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