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For Americans who don’t have health insurance, Monday is the deadline in most states to sign up for coverage set to begin Jan. 1 under the Affordable Care Act (ACA), President Barack Obama's signature legislation.
With the deadline looming, more than 1 million people visited the refurbished federal enrollment website, HealthCare.gov, over the weekend, and a federal call center received more than 200,000 calls. Thirty-six states rely on the federal website for enrollment. Some 850,000 people visited the site Monday, as of 2 p.m. EST, five times higher than the number who had visited by that time last Monday.
For others, Monday is not the final deadline.
Obama administration officials have quietly changed the rules so that people who attempt to enroll today but don’t finish in time will have one extra day to do so, in the way that people who are waiting in line when polls officially close on Election Day are still allowed to vote. Government officials and outside IT contractors who operate the marketplace’s computer system made a change that will give enrollees a coverage start date of Jan 1. if they enroll by 11:59 p.m. on Tuesday, Dec. 24.
"We recognize that many have chosen to make their final decisions on today's deadline, and we are committed to making sure they can do so," said Julie Baitaille, a spokeswoman for the Centers for Medicare & Medicaid Services, in an email to Al Jazeera. "Anticipating high demand, which we indeed saw starting early Monday morning, and the fact that consumers may be enrolling from multiple time zones, we have taken steps to make sure that those who select a plan through tomorrow will get coverage for Jan. 1."
The administration said that there would be a hardship exemption for some that would permit them to not sign up for any kind of health insurance and not face a penalty — the hardship being problems they encountered with the rocky ACA rollout — and that there would be a good-faith exception for others, according to a senior Obama administration official. "We'll have a special enrollment period," the official said last week, for "all those who make a good-faith effort to get enrolled by the deadline" but fail to do so. The official did not say how the government would determine whether the effort was made in good faith.
Still others may simply get a break from insurance companies, which the administration has urged to be flexible with people who miss the deadline.
Such is the uncertain state of "Obamacare" as it approaches what was originally supposed to be a defining moment: a sign-up deadline that would provide the first real test of the viability of the health care program.
Adding to the confusion is that the original deadline for obtaining medical coverage was Dec. 15. That was extended to Dec. 23 after the federal government's website proved dysfunctional and sometimes nonfunctional.
The administration has reserved the right to change the deadline again, "should exceptional circumstances pose barriers to consumers" enrolling on or before Monday.
Obama said Friday that 1 million people had enrolled in new insurance plans through HealthCare.gov and the 14 state-run marketplaces.
Many more enrollments are a major priority for health care reform, which officials are hoping will help millions of uninsured and underinsured Americans finally obtain medical coverage.
It is not known how many consumers may have no insurance coverage for part of 2014 because they failed to sign up by Monday.
Some of the 14 states running their own health insurance exchanges have extended their sign-up deadlines past Dec. 23.
On Thursday the Obama administration announced that if people's old insurance plans were canceled because of new standards required under the ACA, they could claim a hardship exemption to the requirement that all Americans must have coverage by March 31 or face penalties that start at $95 for an adult. Some who qualify for the exemption may not sign up.
The administration says it is trying to be flexible, but some Republican critics of the law say the frequent delays and changes have muddied the waters and confused people.
"With no clarity as to when people should sign up and who they should pay and when, it's a virtual certainty that many consumers will find themselves uncovered for a period of time through no fault of their own," Sen. Orrin Hatch, R-Utah, said last week.
Administration officials said Friday there are fewer than 500,000 people who have received cancellation notices from their insurance companies and have not yet found alternatives. Some were automatically enrolled in other plans by their insurance companies, the officials said.
The pace of sign-ups has picked up since October and November, when technical problems crippled the HealthCare.gov website.
The administraton has reached out to those who were not able to apply for insurance because of the website's glitchiness in those months. More than 2 million emails have been sent to people who could not advance through the website. Workers have made more than 600,000 phone calls to consumers and mailed notices to hundreds of thousands of people, officials said.
"We are confident that we are doing everything we can so that individuals know what their options are to get coverage, whether it is at the marketplace or seeking it through the private insurers," the senior official said.
Still, major problems abound that are not necessarily technical, say brokers who have been hired to help people sign up for insurance plans.
"If you want to do comparisons or get accurate information on whether your doctor is in the network, it's difficult," said David Marom, the owner of a small health insurance consultancy in New York City who trained to become a broker assisting individuals to enroll through New York state's exchange.
Marom told Al Jazeera that he shopped for insurance for his family through the exchange after the new health care law's parameters meant that he and his one employee no longer qualified for group health insurance. He said that one of his doctors appeared to be in the network of the new plan he selected, according to the exchange's website, but when he called the doctor's office, he was told his new insurer was not a participant.
While Marom's monthly premiums will stay about the same, about $1,500 a month for HMO coverage for his family of four, he'll now have a $3,000 deductible, whereas before he had none.
But, he said, some of his clients have been able to secure better coverage at cheaper rates or had their premiums reduced from their previous plans, which had been canceled. "It's such a mixed bag," he said.
Marom added, "I believe it will get better, but it's still been frustrating. On the other hand, I still support the law."
Al Jazeera and wire services. Marisa Taylor contributed to this report.
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