In Louisiana, wait times for callers lasted up to two hours. Blue Cross Blue Shield of Tennessee received nearly 1,900 calls by midday compared with about 800 the previous Monday. And in California, where enrollments surged toward the Obama administration's original projection of 1.3 million, the deadline day volume forced the state exchange to switch off a key function on its website and encourage people to finish their applications in the days ahead.
Across the nation, the interest in getting health insurance and avoiding a federal tax penalty was made clear in interviews with enrolmentcounsellors and consumers.
"I have not had a physical in over 15 years," said Dionne Gilbert, a 51-year-old uninsured woman from Denver who waited in a 90-minute line to get enrolment assistance. "I told myself, 'You need to do this. Your daughter loves you and needs you.'"
The last-minute rush was expected to significantly boost the number of Americans gaining coverage under the new law, and government officials told The Associated Press late Monday that they were on track to sign up more than 7 million Americans for health insurance by the deadline. But the months ahead will show whether the Affordable Care Act will meet its mandate to provide affordable health care coverage or whether high deductibles, paperwork snags and narrow physician networks make it a bust.
The administration has not said how many of those who already have signed up closed the deal by paying their first month's premiums. Also unknown is how many were previously uninsured — the real test of Obama's health care overhaul. In addition, the law expands coverage for low-income people through Medicaid, but only about half the states have agreed to implement that option.
In Washington, the law's supporters already have their sights on Version 2.0 — fixes for the next open enrolment season commencing Nov. 15.
The advocacy group Families USA, which has backed Obama's overhaul from its inception, plans to release a 10-point package of improvements Tuesday that it says the administration can carry out without the approval of Congress. Among the recommendations: more face-to-face sign-ups, co-ordinatingenrolment with tax-filing season to better show the consequences of remaining uninsured, eliminating penalties for smokers as California has done and improving co-ordination between the exchanges and state Medicaid programs.
"Clearly, the first enrolment period also informed us about different areas where improvements can be made," said Ron Pollack, the group's executive director.
On Monday, supporters of the health care law fanned out across the country in a final dash to sign up uninsured Americans. The HealthCare.gov website, which was receiving 1.5 million visitors a day last week, had recorded about 1.2 million through noon Monday.
At times, more than 125,000 people were simultaneously using the system, straining it beyond its previously estimated capacity. People not signed up for health insurance by the deadline, either through their jobs or on their own, were subject to IRS fines — a threat that helped drive the rush.
The federal website operating in 36 states stumbled early — out of service for nearly four hours as technicians patched a software bug. An afternoon hiccup temporarily kept new applicants from signing up, and the process slowed further as the day wore on. Overwhelmed by computer problems when launched last fall, the system has been working much better in recent months, but independent testers say it still runs slowly.
The administration announced last week that people who started applying for health insurance but were not able to finish before Monday's enrolment deadline will get extra time. A variety of issues led people to seek this extension.
Health insurers and advocates in South Dakota encouraged residents to try to start the process on their own or leave a message at a federal hotline should they have to cancel an appointment with an insurance counsellor because of a spring blizzard that dumped up to a foot of snow.
Those who showed up at enrolment events in other states found long lines and technical delays. Even those providing assistance were sometimes stymied.
In Fort Lauderdale, Fla., navigator Allie Stern waited 90 minutes to talk to an operator on a federal hotline. Patty Gumpee, 50, walked away without completing her application because of problems with the website. She made an appointment to try again next week.
"I need the health insurance. I need it for doctors' appointments," said Gumpee, who hasn't had insurance in years and goes to the emergency room when she's sick.
Braxton Rodriguez, a 19-year-old Topeka, Kan., resident, left an enrolment event at the city library frustrated. He was unable to verify an online identification after two weeks of trying. A part-time Wal-Mart worker, he didn't have health insurance and wanted to avoid the tax penalty.
"I'm not impressed with it at all," Rodriguez said of the federal government's website.
At a Houston community centre, there were immigrants from Ethiopia, Nepal, Eritrea, Somalia, Iraq, Iran and other conflict-torn areas, many trying anew after failing to complete applications previously. In addition to needing enrolment help, many needed to wait for interpreters.
Others found the process more bearable.
Michael Carradine, a 20-year-old Sacramento State University student, arrived early at a registration hosted by a union and got subsidized health care in about 45 minutes. Carradine said it was important, but admits it was his mother who got him out of bed and encouraged him to get signed up.
"She was like, 'We don't want to be fined,'" said Carradine, who enrolled in an Anthem Blue Cross plan with a monthly premium of $106 after subsidies.
Allison Webb hadn't had been insured since 2005 before signing up over the weekend at a Community Health Network clinic in Long Island City, N.Y.
"Luckily, I haven't been sick," said Webb, 29, who works full time for a messenger service that does not provide health insurance.
After choosing a comprehensive medical and dental plan that will cost her about $60 per month, Webb can start going to doctors or a dentist in May.
"I'm glad that I don't have to worry about it anymore," she said.
Associated Press writers Ricardo Alonso-Zaldivar in Washington, D.C., John Hanna in Topeka, Kan., Kelli Kennedy in Miami, Carolyn Thompson in Buffalo, N.Y., and Kristen Wyatt in Denver contributed to this report.
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