The head of California's health insurance marketplace didn't flinch at questions about the almost nightly shutdowns of Covered California for revisions and repairs.
"So, night owls can't enroll," executive director Peter Lee said last week in Fresno.
Quick fixes to the Covered California website are a sign of good business, not failure, Lee said at a grand opening for the system's third call center.
He has a point. While the federal government's system for enrolling people in Affordable Care Act health plans has had more snags than a nylon sweater, California's system has had a comparatively smooth start.
Since Covered California went live on Oct. 1, it has captured 30% of the total number of enrollees in the U.S., Lee said — even though the state only has 10% of the population.
"We hope the rest of the nation catches up," he said.
Enrollment numbers through Tuesday show 79,891 Californians have selected health plans from the 11 offered in the state's health benefit exchange. More than 360,000 have completed applications.
As of last week, more than 1,800 people in the San Joaquin Valley have enrolled in plans and more than 8,000 have completed applications.
But enrollment numbers — at least for the Valley — could have been higher if the state's enrollment system functioned better, some health providers said.
Covered California got a "B-minus" grade earlier this month from Stephen Schilling, chief executive officer at Clinica Sierra Vista, one of the largest federally qualified health center systems in the state with clinics in Fresno and Bakersfield.
Clinica has 43 trained workers to help patients enroll in health plans, but until about a week ago they had been unable to log on to the system or would get booted off before applications could be completed.
Last week, Schilling gave Covered California good marks for improvement.
"The computers are not 100%," he said. "But they are getting better every day. They're not kicking us out as often. They're faster, but they still are slow in the afternoons, and sometimes they still freeze and kick you out."
The real test for Covered California could be yet to come.
Enrollment is expected to soar in December as the deadline approaches for people to sign up for health insurance to be effective Jan. 1. Californians have until Dec. 23 to choose a plan.
Californians can browse the state's website, CoveredCa.com, to determine eligibility for subsidized health benefits and compare insurance plans. More than 2.5 million already have clicked on the website.
The browsing function proved to be a good decision. The federal website, HealthCare.gov, was harshly criticized because it lacked that feature when it debuted.
Lee said California had time to fine-tune and make revisions to its system during its development. The federal government didn't have such a luxury, he said.
It wasn't clear until a year ago how many states would create individual insurance marketplaces and how many would rely on the federally run exchange. Ultimately, 36 states opted for the federal system.
By that time, California had chosen Accenture LLC, a global management consulting, technology services and outsourcing firm, to develop the Covered California system at a cost of more than $300 million.
Also on the development team: Oracle, a multinational computer technology company based in the Silicon Valley, and GetInsured, an online company that operates a marketplace for health insurance.
The project was put on a fast track.
"Many people said this project should have taken 36 months, and once we contracted, it took 18 months," Lee said.
Having Silicon Valley nearby, however, did not speed the work, he said. But having a small team — with one company in charge — made the project easier to manage.
Policy decisions about Covered California are made by Lee and Toby Douglas, director of the California Department of Health Care Services.
The online enrollment system is a joint venture between Covered California, an independent state government agency, and the Department of Health Care Services.
The system includes computer software for enrolling people in Medi-Cal, the state-federal insurance for the lower-income. California expanded Medi-Cal coverage under the Affordable Care Act to include more adults and families with incomes slightly above the federal poverty line.
With only two decisionmakers for Covered California, issues get resolved quickly, Lee said. The federal government likewise needs to have "someone where the buck stops," he said.
Some of the decisions that Covered California made have frustrated consumers and insurers, Lee admitted.
For example, California health plans did not receive any completed applications from the exchange until mid-November, he said. The delay was intentional: "That was absolutely a very conscious choice of sequencing our work load."
Shutting the system down for repairs also has been necessary but has prompted complaints.
The enrollment arm of the system has been taken down almost nightly for repairs to increase bandwidth and page-loading speeds, said Anne F. Gonzales, a Covered California spokeswoman.
"We're moving as fast as we can to get all the fixes," she said.
But only the enrollment function has been taken off-line, Gonzales said. The shop-and-compare and informational fact sheets about the exchange have remained on the website.
This weekend, part of the site is offline to prepare for small-business enrollments, Lee said.
Enrollment counselors at United Health Centers of the San Joaquin, based in Parlier, have reported problems connecting to the state computer system. Counselors are helping patients fill out paper applications at the clinics, said Norma Macedo, director of special projects.
She is OK with the delay, she said earlier this month. It's given counselors time to study the application and offer better assistance to patients.
"With any implementation, you're going to have these glitches," Macedo said.
Covered California is acting swiftly to address complaints, spokeswoman Gonzales said. "We know everyone is anxious to get on the system."
Lee said Covered California released results of surveys of people who had completed the enrollment process during the last three weeks of October: 70% found the application process easy to complete.
"The fact that the majority of consumers who actually used the website to enroll found it 'easy' should put to rest the drumbeat of stories about glitches and website problems and instead focus on the big story that Californians are enrolling in care easily and every day," Lee said.
And Covered California is listening to consumers, he said. Language on the website is being changed based on suggestions from focus groups.
While the website is the portal to enrollment, Lee said he expects the focus to shift to call centers, such as the one in Fresno — and to enrollment counselors in communities — as the deadline to have insurance on Jan. 1 approaches.
Said Lee, "As we move forward, it's going to be about person-to-person help."
The reporter can be reached at (559) 441-6310, email@example.com or @beehealthwriter on Twitter.