Minnesota's efforts became so beset with problems that Democratic Gov. Mark Dayton issued a public apology and MNsure's top executive recently resigned.
"I believe in this program. But this has just been inexcusable," said Tom Beckfeld, a small business owner and Democratic activist in central Minnesota who's been stymied in his attempts to nail down coverage through MNsure.
Beckfeld already canceled his old plan. Despite spending many hours on hold with the MNsure call center, he said, he has been unable to correct problems with his application and is still unsure if he can count on new coverage on Jan. 1.
Minnesota's website has been down for long stretches, even as callers to its helpline sometimes spent more than an hour on hold. Oregon's exchange still has not been able to enroll anyone electronically and continues to accept only paper applications. Maryland Gov. Martin O'Malley, a Democrat, acknowledged last week that not every resident who wants insurance by Jan. 1 will necessarily get it. In Hawaii, the exchange had to delay the Oct. 1 start of open enrollment by two full weeks.
The problems have led to some high-profile departures of exchange leaders. April Todd-Malmlov of Minnesota and Rebecca Pearce of Maryland quit under surprisingly similar circumstances. Both faced public criticism for taking tropical vacations over Thanksgiving while their exchanges struggled back home. Top-ranking exchange officials also resigned in both Oregon and Hawaii.
"Many states made the same mistake that the federal government made — there was just no starting concept of how you deliver on high quality and high innovation," said Sanjay Singh, CEO of hCentive, a Virginia-based health technology company that helped set up exchanges in Kentucky, New York and Colorado, which had smoother rides. "If you started with a flawed foundation, then anything you build on top of it will suffer flaws as well."
No state's political leadership embraced all major facets of the federal overhaul more enthusiastically than Minnesota, the only state to implement all three major aspects: an expanded Medicaid program, an online insurance marketplace and a basic health program.
MNsure has not been a total failure. Minnesota has the lowest premium costs nationwide under the new law. And as of Dec. 14, nearly 48,000 people had completed applications for insurance coverage through MNsure.
But in recent weeks, even as many of the problems with the federal exchange seemed to ease, problems with MNsure were multiplying.
In addition to a sporadically functioning website and hard-to-reach call center, state insurance companies complained that data on enrollees from MNsure were filled with inconsistencies and errors. About 1,000 people learned they had to re-enroll after being notified that they did not qualify for federal tax subsidies, when they actually did.
"It's unacceptable," Dayton said Thursday, as he apologized to Minnesotans "who have been seriously inconvenienced or are distraught by the failures of MNsure."
The setbacks have been political fodder for Republicans who opposed MNsure's formation at every step. They have been happy to hang its failures around the necks of Dayton and Democratic lawmakers.
The problems left state officials scrambling to respond as the holidays approach and with the Jan. 1 coverage date looming. The new interim CEO quickly extended by one week a Dec. 23 enrollment deadline, meaning Minnesotans can sign up right up to start of coverage. MNsure, in tandem with insurance companies, also extended the payment deadline to Jan. 10 even for plans that kick in on Jan. 1.
In the meantime, MNsure has doubled its call center staff and is getting a surge of tech workers from IBM, one of its main contractors, to help iron out website glitches. Members of MNsure's board of directors have started to hint about taking a deeper look into possible failures by technology vendors.
As he stepped into the job after his predecessor's abrupt resignation, new MNsure CEO Scott Leitz was left to make promises about what it could still be.
"The potential for MNsure," he said, "is enormous."