WASHINGTON -- The launch of President Barack Obama's Affordable Care Act was marred by the performance of the newly created state health insurance marketplaces.
With generous federal financial support, many states created these markets, also called exchanges, based on soaring promises: Individuals and small businesses could compare policies. They could get federal subsidies. It would be easy to sign up. And if people's income declined, they could enroll in their state's Medicaid plan.
It didn't work out that way. Websites didn't work. Data couldn't be accessed. Call centers were overwhelmed, and states spent millions on quick fixes, many of which failed.
Hawaii, Nevada and Oregon abandoned plans to operate their independent marketplaces and instead relied on the federal marketplace, HealthCare.gov. Other states, including California, Colorado, Massachusetts, Maryland and Washington, spent millions of dollars to overcome problems with technology.
The experience so rattled states that seven years later, only 11 of them, plus Washington, D.C., operate independent marketplaces. The rest either use the federal marketplace or a federal-state partnership.
But now at least six states -- Maine, New Mexico, New Jersey, Nevada, Oregon and Pennsylvania -- are creating their own marketplaces or seriously considering doing so.
Officials in those states insist they can avoid past failures and state-focused websites can help more residents get insurance. They believe they can piggyback on the successes of other states, and knowing their population and geography better positions them to increase enrollment and possibly reduce their residents' premiums.
In recent years, experts say, vendors have developed software and other technology to make the online sign-up systems work.
"A lot of kinks have been worked out, and the ability to set up marketplaces that run effectively and efficiently has gone up," said Jeanne Lambrew, commissioner of the Department of Health and Human Services in Maine, which hopes to launch its own exchange in 2021.
"We know much more now than states knew back in 2013," said Lambrew, who was Obama's deputy assistant for health policy and one of his top aides in the implementation of the ACA, including HealthCare.gov.