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Pent-Up Demand for Health Insurance

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There were plenty of computer glitches when millions of Americans went online to check out their options for affordable insurance policies on the new health care exchanges that opened for business this week. It was frustrating, but it was also an indication of overwhelming interest that exceeded all predictions.

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In the first three days, there were 8.6 million unique visitors to the federal government Web site for health care exchanges, far more than had ever signed on at one time to a popular Web site serving Medicare patients. In New York, the state-run exchange had an astonishing 30 million visits in the first two days, although a large share almost surely consisted of repeat visits by people who were blocked by balky computer systems.

Earlier surveys had shown that most Americans were unaware that the exchanges would open on Oct. 1 and ignorant of what the health care reform law could provide for them. Many thought it was still just a proposal, not a law. (Congressional Republicans who have shut down the government over their demands to defund and weaken health care reform may have inadvertently fanned interest in exchanges by putting them in the news.)

Neither federal nor state officials were willing to say how many people actually enrolled in a health plan the first week, but the numbers are surely low. People need time to ponder their choices, and the computer problems haven’t made it easy. But the start-up problems are sure to be smoothed out as enrollment for coverage in 2014 goes on for the next six months. As federal officials stress, this is not a sprint but a marathon.

The administration’s goal is to enroll some seven million uninsured Americans in health plans on the exchanges in 2014. They hope that 2.8 million will be young people between the ages of 18 and 34, whose participation is needed to help subsidize coverage for older and sicker people. Administration officials estimate that with about 14 million uninsured people in this age group, the plans will need to enroll one in five of them, a goal that should be reachable with an aggressive recruiting effort.

Polls show that most uninsured adults want health insurance and plan to get it; many will do so because the law requires them to obtain coverage or pay a penalty. The penalty an uninsured adult will have to pay for 2014 is $95 or 1 percent of yearly income, whichever is higher, and rises to $695 or 2.5 percent of income, whichever is higher, by 2016.

In an astonishingly irresponsible campaign, conservative advocacy groups are urging college students and other young people to pay the penalty and forget the insurance. But even those who consider themselves “young invincibles” are vulnerable to catastrophic accidents or life-threatening infections.

Administration officials believe that enrollment will start slowly but will spike upward to meet the mid-December deadline for full-year coverage beginning on Jan. 1, 2014. They expect another spike in enrollment numbers near the March 31 deadline for coverage for the rest of 2014. In the end, people will enroll if they can find insurance that meets their medical needs and their budgets. There is good reason to believe they will.

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