The pressure is on for the federal government and states running their own health insurance exchanges to get the systems up and running after overloaded websites and jammed phone lines frustrated consumers for a second day as they tried to sign up for coverage using the new marketplaces.
In some ways, the delays that persisted Wednesday were good news for President Barack Obama and supporters of his signature domestic policy achievement because the holdups showed what appeared to be exceptionally high interest in the overhauled insurance system. But if the glitches aren't fixed quickly, they could dampen enthusiasm for the law at the same time Republicans are using it as a rallying cry to keep most of the federal government closed.
"It was worse today than it was yesterday," Denise Rathman of Des Moines said after she tried for a second day to log onto the Iowa site.
Rathman has insurance through Dec. 31 but said she is eager to sign up for a policy because of her psoriatic arthritis, which has caused her to be denied insurance in the past.
David Berge, a pastor with two young children in Shoreview, Minn., tried unsuccessfully at least 10 times to create an online account on the state-run site MNsure. His high-deductible plan expires at the end of the year.
"I'm anxious to see what the insurance is going to look like for my family at the beginning of the year," Berge said. "That's a big unknown right now. I want to figure that out as soon as possible so we can begin planning."
In California, home to 15 percent of the nation's uninsured, officials pulled the enrollment portion of the Covered California site down overnight for emergency upgrades. It was restored midmorning Wednesday, and 7,770 people had started applications by then, spokesman Roy Kennedy said.
California is one of a handful of mostly Democratic states that opted to set up their own exchanges rather than let the federal government do it for them. In the 36 states being operated by the federal Department of Health and Human Services, consumer patience was still being tested.
Agency spokeswoman Joanne Peters said many Americans successfully enrolled on the first day, but she declined to put a number on it. She said the delays were due to "overwhelming interest" and high volume.
It's not as if nobody warned them. Just three months ago, the congressional Government Accountability Office said a smooth and timely rollout could not be guaranteed because the online system was still getting finishing touches and had not been fully tested.
The Obama administration shrugged off the evaluation.
The bumpy debut has the hallmarks of a technology project that may have rushed to meet the Oct. 1 deadline, said Bill Curtis, chief scientist at CAST, a software quality analysis firm, and director of the Consortium for IT Software Quality, which develops standards.
"When you are in a rush, you typically make a lot of mistakes and you don't have time to test them all out," he said.
High volume can also expose software flaws that were not detected in testing, Curtis said, like the recurring problem consumers encountered trying to set up accounts on the federal site. Drop-down menus that were supposed to provide security questions did not work.
The department issued survival tips for aggravated consumers after 4.7 million unique visitors logged in to the healthcare.gov website on Tuesday. As new health insurance markets went live around the country, the federal call center also received 190,000 calls.
In suburban Cleveland, Sharon Schorr finally gave up on the federal exchange website after eight hours of failed clicks.
"It almost reminded me of going online and trying to buy Springsteen tickets," said Schorr, a self-employed accountant who works for her husband's recruiting firm in Orange, Ohio.
Others simply resorted to old-fashioned pen and paper.
Luis Veloz, a college student in Dallas, was so eager to have insurance that he had already mailed in a paper application by Tuesday night. He is hoping to avoid racking up major bills like his parents, who incurred $250,000 in debt when his father had a heart attack.
"It's an exciting moment because my family has never had preventative care," Veloz said.
Workers at the Florida Association of Community Health Centers printed out applications ahead of time.
"We don't care about the politics. This is about people so we were trying to make it easy for the patients," President and CEO Andy Behrman said.
Connecticut Gov. Dannel P. Malloy said the law, also known as "Obamacare," was working well because his state embraced the health reform law early on instead of fighting it. The state processed 373 applications for coverage by the end of Wednesday.
"Because we took the time and effort to be ready, to handle the calls, to have our ducks in a row if you will, we are in far better shape than those states and governors that have turned their back on this historic program and historic offering," said Malloy, a Democrat.
The Obama administration hopes to sign up 7 million people during the first year. Using an expansion of Medicaid or government-subsidized plans, the White House would eventually like to cover at least half of the nearly 50 million Americans who are uninsured.
Many states expect people to sign up closer to the Dec. 15 deadline to enroll for coverage starting Jan. 1. Most customers will need to pay the first month's premium when they do, which could lead them to put off choosing, said Bob Dickes, director of sales and marketing for the nonprofit insurer Oregon's Health CO-OP.
"I expect people to shop and see what's out there," Dickes said.
Customers have until the end of March to sign up to avoid tax penalties.
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 care.