California's health insurance exchange was scrambling to help consumers before the deadline hit to enroll for coverage that starts Jan. 1.
Enrollments under the federal health law began ramping up dramatically as the Monday deadline approached, according to Covered California, which reported tens of thousands of applicants signing up daily last week.
The agency that runs the exchange said enrollments surged to more than 20,000 in just one day.
"December is turning out to be an enormous month for Covered California," said Peter Lee, agency executive director.
He said 53,500 people enrolled during a three-day period last week, compared with about 31,000 during all of October. He had expected December to be busy.
"What we are seeing, though, is a testament to how hundreds of thousands of Californians are anxious, excited and determined to get coverage through the Affordable Care Act," he said on a conference call with reporters.
But just like the problem-plagued federal health care website, California's exchange has also seen its share of woes.
Those included a glut of 25,000 paper applications dating to the site's Oct. 1 launch that Covered California had to process in December and a lack of paper enrollment forms in Spanish. In addition, about 1.1 million Californians had their existing individual insurance policies canceled because they didn't meet the tougher standards of the federal law.
The cancellations forced some consumers into more expensive plans and many were upset over the change, especially after President Barack Obama had repeatedly promised that people who liked their health coverage could keep it. That turned out to be false.
In response, the board that oversees Covered California pushed back the enrollment deadline from Dec. 15 but decided against allowing insurance companies to extend those outdated plans through 2014.
Overall, the exchange has reported more than 109,000 enrollments through the end of November, the most recent date for which the exchange has released official figures. It is about half the 220,000 sign-ups the federal Health and Human Services Department projected for that period in California.
But Lee is optimistic the exchange will meet the enrollment target of 700,000 it set by the end of March, thedeadline for people to get insurance for the coming year and avoid a federal tax penalty.
Given the rate of sign-ups, Lee said, "We could easily exceed those projections."
So far, enrollment has skewed toward older people. That could cause financial problems for insurers if the pool becomes heavily weighted toward those who require more medical care and does not include younger and healthier people in sufficient numbers.
Some lawmakers also have raised concerns that too few Hispanics have sought coverage compared with their percentage of California's uninsured population.
In response, Lee said Covered California has doubled spending on marketing in the run-up to the deadline and for online and radio ads in Los Angeles and other Hispanic markets. Spanish-language paper applications will not be ready until Jan. 1.
Covered California also extended service hours and was getting help processing applications from other state agencies.
Lee said people are becoming anxious about the status of their applications. He promised that anyone who made "a good-faith effort to enroll and apply" before the Dec. 23 deadline but experienced a problem caused by Covered California would be enrolled for coverage in the new year. That would be true even if their applications were not finished until after the deadline, he said.
Customers who enroll in a health plan have until Jan. 6 to pay their premiums.
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