Millions of Americans can now shop on the insurance marketplaces at the heart of President Barack Obama's healthcare reforms, entering a world intended to simplify the mysteries of health coverage but that could cause yet more confusion - at least initially.
Whether consumers will be pleased with the experience, the premiums and the out-of-pocket costs of the plans offered to them will finally start to become clear Tuesday. The nationwide rollout comes after months of buildup in which the marketplaces, also known as exchanges, have been both praised and vilified.
Illustrating the heated political disagreements over the law, the opening of the exchanges comes the same day as the shutdown of the federal government, led by congressional Republicans who want to block the health insurance reforms from taking effect.
The shutdown will have no immediate effect on the insurance marketplaces that are the backbone of the law, because they operate with money that isn't subject to the annual budget wrangling in Washington.
Efforts early Tuesday to access the online marketplace in Missouri prompted a message saying traffic to the site was heavy. The website churned slowly to the log-in page.
A member of the Health Insurance Marketplace apologized for the inconvenience in a live chat with KCTV5. He said the site is "experiencing a few technical difficulties."
The marketplaces represent a turning point in the nation's approach to healthcare, the biggest expansion in coverage in nearly 50 years.
The Obama administration hopes to sign up 7 million people during the first year and aims to eventually sign up at least half of the nearly 50 million uninsured Americans through an expansion of Medicaid or government-subsidized plans.
But if people become frustrated with predicted glitches in the computer-based enrollment process and turn away from the program, the prospects for Obama's signature domestic policy achievement could dim.
"The promise of the law is that no one will go bankrupt because of medical bills," said Neera Tanden, president of the Center for American Progress, which helped work for passage of the law. "It won't happen in the first day or the first year. But when the law is fully operational, it will provide an economic benefit to roughly 30 million Americans."
Tanden cautioned against rushing to judge the marketplace's success on its first-day performance. Numerous observers have predicted bugs and setbacks. Trained outreach workers in many states are having trouble getting the certification they need to start helping people to enroll.
If people want to enroll, they will need accurate income information for their household, plus some understanding of how health insurance works, so they can get the financial assistance they qualify for and pick a health plan that's right for their needs.
The process involves federal agencies electronically verifying an applicant's identity, citizenship and income. Applicants will also have to sign that they are providing truthful information, subject to perjury laws.
The experience will be different depending on what state people live in.
"There are different taxes that are applied, there are different levels of minimum benefits that are offered, and then of course there are variances in our current health status from one state to the next," said Wayne Powell, chief of staff for Blue Cross Blue Shield of Kansas City.
At midnight, Kansas Republican Rep. Tim Huelskamp tried to sign up for the Obamacare exchanges.
"We have been warned time and time again that Obamacare is not ready for prime time. Well, it turns out that is right. When I tried to sign up for the exchanges, I was met with error messages, unfinished security forms and misspelled notices at every click," Huelskamp said.
Experts say applicants don't have to plow through the entire application at once. They can save their work and come back later.
Many states are predicting that people will initially test the online application system but actually sign up closer to Dec. 15, which is the deadline for coverage to start Jan. 1. Customers have until the end of March to sign up in order to avoid tax penalties.
Looming as one of the biggest challenges to the law's success is the ability of insurers to persuade relatively young and healthy people to buy insurance, as a way to balance the costs for the sicker people who are likely to get coverage as quickly as possible.
"You've got to launch this thing right the first time," said Robert Laszewski, a consultant who worked 20 years in the insurance industry. "If you don't, financially you will never recover."
Under the law, health insurance companies can no longer deny coverage to someone with a pre-existing medical condition and cannot impose lifetime caps on coverage. They also must cover a list of essential services, ranging from mental health treatment to maternity services.
Another obstacle: Nearly three-fourths of people under 65 who lack insurance are unaware the marketplaces open Tuesday, according to a Kaiser Family Foundation survey released over the weekend.
Copyright 2013 KCTV (Meredith Corp.) and the Associated Press. All rights reserved.