WASHINGTON, DC (NBC News) - It’s the last day to sign up for health insurance on the federal exchange if you want coverage that starts Jan. 1, but government techies have built in a little wiggle room.
People have until midnight tonight to get started. But just to be safe, the administration has sneaked in an extra 24-hour buffer, the Washington Post first reported, giving people until midnight Tuesday night to get enrolled if they start the process by midnight Monday.
"Anticipating high demand 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," Julie Bataille, a spokesperson for the Centers for Medicare and Medicaid Services, which runs the site, told NBC news.
It's something like lining up for election day, the administration says — if you are standing in line when the polls close, you get to come in and vote.
So far, Monday was a record day for signups, the administration said. "Thousands visiting and enrolling now. Queuing deployed to help keep site smooth for users," the administration tweeted from the HealthCare.gov Twitter account.
Experience shows many Americans will wait until the last possible minute to buy health insurance. There’s nothing like a deadline to focus the mind. And in this case, experience also shows that people who waited may have fared better than people who tried to sign up early, although really last-minute users may have to line up.
President Obama said on Friday that a million people had signed up so far on the state and federal health insurance exchanges. He said more than 500,000 signed up on the federal website alone in the first three weeks of December.
More than a million people visited HealthCare.gov over the weekend, the Health and Human Services Department says, and 200,000 people called call centers, which have beefed-up staffing to handle the last-minute rush.
One of those expected to sign up Monday: President Obama himself, although he doesn’t need health insurance personally. As Commander-in-Chief any president has a personal physician and he and his family get full care at the White House Medical Unit and the National Naval Medical Center in Bethesda, Md.
Signing up for health insurance is a multi-step process. The White House and Health and Human Services Department are also scrambling to make sure that people take the last step and pay their first premium so the insurance actually begins.
It's not been easy for people using the federal website and some of the state sites. The Obama administration says the federal site is finally working well, but it’s not entirely clear if the so-called back end is working as it’s supposed to, transmitting the correct information to insurance companies.
Some people who started signing up early say they've suffered the most. Ricky Bridges, a 42-year-old government contractor in Monroe, La., started trying almost as soon as the federal exchange opened in October. "There were a bunch of glitches early on. They couldn’t verify my identity online," Bridges told NBC News. Bridges was still working out the kinks weeks later but finally got a high-deductible bronze plan for himself and his wife this month. He may upgrade to a silver plan next year.
Because of people like Bridges, the White House has laid some heavy pressure on insurers to provide coverage retroactively to Jan. 1 for people who have been trying but unable to get that final signup done. Different states have extended deadlines to different points, many as late as Jan. 10.
Last week, the White House added another exemption to the list of people who can get away without buying any health insurance next year without getting an extra tax: people who had been buying their own, private plans, whose plans are cancelled and who feel they cannot afford the premiums on one of the exchanges.
Some of the state websites say they are signing people up at a brisk pace as the deadline approaches. New York says 134,622 people got through the process as of a week ago, and it’s letting people pay their first premiums as late as Jan. 10. California’s website, Covered California, says 20,506 people enrolled on a single day last week, Dec. 18.
Government statistics show that more than 45 million Americans have no health insurance, and many lack basic preventive care as a result. Study after study shows people without a basic source of care wait until they are sick to seek help, and that’s when medical attention gets pricey. Taxpayers often end up footing the bill, or other patients do when hospitals raise their rates to cover the charity and emergency care they must provide.
The 2010 Affordable Care Act seeks to get more people covered, either on the exchanges or through expanded Medicaid, something about half the states are providing. It also forces insurers to provide more coverage than they may have been, including full mental health care, vaccinations, cancer screenings, maternity care and birth control.
In return, the insurance industry demanded the so-called individual mandate, the requirement that everyone get health insurance. This way, insurers can spread the costs and relieve some of their extra expenses by getting premiums from healthy people who don’t demand much care.
Monday, Dec. 23, isn’t the drop-dead date to get covered for 2014. People have until March 31 to sign up and get credit for having 2014 coverage. And anyone with health insurance already has no need to worry. About 85 percent of Americans are covered, either by an employer, Medicare, Medicaid or their own private insurance.
One person who won’t be signing up Monday is Luke Thomas, a 26-year-old literary agent in New York. Thomas took a tour of his state’s exchange but opted for employer-sponsored coverage instead.
“I decided the best option was to sign up for insurance via my fiancé's company, as her domestic partner,” Thomas said Monday. “It's a higher premium than the silver level ACA options I was looking at but the coverage is far superior.”
Thomas is one of the “Young Invincibles” coveted by insurance companies and says he’s been taking care —driving carefully, for instance — since he lost coverage on his parents’ plan when he turned 26 in November. His enrollment won’t count in the final tally of who got signed up by Jan. 1 on the state and federal exchanges, but he’s one more body the insurance companies, and the administration, are counting on.
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