The disappointingly low number of Americans who signed up for private insurance since online marketplaces were launched last month under the nation's new health care law had one big bright spot -- California.
From Oct. 1 to Nov. 2, the state's new health care exchange enrolled 35,364 people, almost 10,000 more than the 36 states whose residents must use the U.S. government's troubled health care website, according to figures released Wednesday. Overall, Californians made up a third of the total number of people who signed up for a health plan on one of the nation's new insurance marketplaces.
For weeks, anticipation had been building before the release of the numbers -- the first hard look at how many people had taken advantage of President Barack Obama's signature legislation. While critics seized on the low nationwide enrollment as evidence that it was an abject failure, supporters of the law said the nation's largest state offered proof that it can be successful when an exchange website actually works and is aggressively marketed.
"It's a very proud day," said Peter Lee, executive director of Covered California, the state's exchange. "We're very pleased with the number and the momentum."
In the first 12 days of November, Lee noted, the sign-up pace doubled to more than 2,000 a day as the mid-December deadline looms for picking a plan to start Jan. 1. As of Tuesday, the total number had climbed to nearly 60,000.
The numbers still represent only a tiny percentage of the 1.4 million that the exchange hopes to sign up by the end of 2014, but California officials and consumer health care advocates point to the initially dismal numbers when a similar health care law was enacted in Massachusetts.
"Only a couple hundred people in Massachusetts were signed up in the first months of their health reform effort in 2006, but now they have less than 1 percent uninsured," said Anthony Wright, executive director of Health Access, a California consumer group. "The experience in California and nationally is that enrollment starts slowly but then ramps up."
Another encouraging sign was how many people discovered they would receive free or low-cost insurance through Medicaid, the nation's health program for the poor that was expanded under the health care law. So far, 396,000 people across the U.S. have qualified for Medicaid, known as Medi-Cal in California. The expanded program is so popular that 120,000 people have tried to sign up in states that have refused to expand Medicaid. In California, 79,500 people had signed up for Medi-Cal by Nov. 2.
Republican politicians, however, put a much different spin on the numbers.
State Sen. Jim Nielsen, R-Gerber, a member of the state Senate Health Committee, said "the paltry participation numbers for the California exchange, like the federal health care exchange ... are clearly insufficient to build a sustainable government-run health care system."
Republicans also noted that the nationwide number of 106,185 sign-ups through Nov. 2 was barely a fifth of what Obama administration officials had projected -- and a fraction of the 14 million people whose plans in the individual market have been canceled, largely because those plans don't comply with the new law.
"The pace of enrollment is a little slower than I expected," said Gerald Kominski, a professor of health care policy and management at UCLA. "But I think that is largely due to the fact that it is a long open enrollment season ... so people feel there is still plenty of time."
Under the health care law, Americans with few exceptions must have medical insurance by March 31 or face a minimum $95 penalty. And if they enroll before Dec. 15, the insurance will start on New Year's Day.
Kominski was not surprised by the sluggish rate of enrollees nationwide, which he largely attributed to "endless reporting on the daily glitches with the website."
Covered California, Lee said, never expected October to be a big month for enrollment. It was simply a time for Californians to do "some shopping ... making some comparisons and picking the plans that are right for them," he said.
Both Lee and Kominski noted that of the 30,830 Californians who enrolled by Oct. 31, only 4,852 were eligible for federal subsidies. Health care experts said that means the rates of the nonsubsidized policies are reasonable enough to attract buyers.
California, with roughly 6 million uninsured residents, has long been considered a bellwether in the implementation of the 2010 Affordable Care Act, often called Obamacare.
Lee said a demographic breakdown of the enrollment figures -- including the age of the enrollees -- is expected to be released at Covered California's next board meeting on Nov. 21. The age of the people buying plans on the exchange is critical to the law's success because to make the new online marketplaces work, the government must persuade millions of young and healthy people to sign up to subsidize the cost of insuring older and sicker people.
In recent days, the Obama administration has been touting the improved federal website and, for the first time, indicated a willingness to consider legislation to stave off the wave of cancellations in the individual marketplace, where people who don't get insurance at work buy their plans.
Administration officials and senior congressional Democrats, meanwhile, expressed confidence in the program's future.
"We expect enrollment will grow substantially throughout the next five months," said Health and Human Services Secretary Kathleen Sebelius.
Republicans, meanwhile, are holding hearings to keep the health care overhaul's problems in the spotlight ahead of an election year.
"It's kind of interesting to see as Obamacare implodes how everybody's running for cover," said Rep. John Mica, R-Fla. And Senate Republican Leader Mitch McConnell of Kentucky said, "Obviously, panic has set in on the other side."
Asked how it felt to have California beat so many other states in enrolling people, Lee demurred, saying, "We see this not as a race but a partnership.''
The Associated Press contributed to this report.
Contact Tracy Seipel at 408-275-0140. Follow her at Twitter.com/taseipel.