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Launch of Health Care Exchanges Might Be Rocky

Buying health insurance will be as easy as purchasing a plane ticket or shopping on Amazon.com, the president has promised.

Maybe, but perhaps not on Tuesday — the day that millions of Americans are supposed to be able to start buying coverage under the sweeping law formally known as the Affordable Care Act and often called Obamacare by critics.

Widespread reports of computer problems and logistical glitches are casting a pall over what many supporters envisioned would be a triumphant day for the embattled program. State and federal health officials have said in recent days that some key functions of the online insurance sites called “marketplaces” will not be ready right away. Some of the consumer guides meant to help people sign up for coverage are not yet certified to do so.

Some people who had planned events in conjunction with the opening of the marketplaces have called them off.

“We just kind of laughed and said, ‘Well, I guess we’ll have to reschedule,” said Jason Andrews, an insurance broker in California. He had planned on Tuesday to get on the state’s online marketplace and enroll a couple of people who were excited about the health-care law and wanted to be among the first to sign up for coverage.

But he hasn’t been certified by the state to do the work. He hasn’t been able to see the exact rates his clients would have to pay on the marketplace. And he’s not confident that California’s site will be up and running, and fully functioning, come Tuesday.

California officials insist the marketplace will be ready, and that the brokers will be certified in early October.

Obama administration officials have warned there might be rough spots in the early days. They also have said those problems aren’t likely to prevent people from signing up for coverage that starts Jan. 1, when many of the law’s benefits and consumer protections kick in.

However, widespread problems on Tuesday, if they occur, will further fuel Republican attacks on the law’s viability. The program is at the center of a standoff between the White House and Republicans on Capitol Hill that could lead to a government shutdown on the very day the marketplaces are to open and an eventual default on the nation’s debt.

Under the law, more low-income citizens will become eligible for Medicaid, the state-federal program for the poor, while others will receive federal subsidies to help pay their premiums for private coverage bought on the marketplaces. Some of the marketplaces, also called exchanges, are being operated by the states, but most are being run at least partly by the federal government.

Some problems could be worse than mere glitches:

In the District of Columbia, people who use the online marketplace will not immediately learn if they are eligible for Medicaid or for subsidies.

In Oregon, people will not initially be able to enroll in an insurance plan on the website.

In Vermont, the marketplace will not be ready to accept online premium payments until November.

In California, it could take a month for an insurer to receive the application of someone who applies for coverage on the exchange on Oct. 1.

“Nobody is going to say we’re not starting on Oct. 1,” said Joel Ario, a health-care consultant who formerly oversaw exchanges at the Department of Health and Human Services. “But in some situations, you may see a redefinition of what ‘start’ means.”

From a practical standpoint, a slow start might not have a big impact on consumers. According to the latest poll by the nonprofit Kaiser Family Foundation, just 12 percent of the uninsured know that open enrollment starts Oct. 1.

One problem insurers have pointed out is that there are some errors in the premiums that shoppers would see online. A senior administration official said that such problems are being worked on and that the marketplaces will be ready on time.

But as the launch nears, more delays are occurring. On Thursday, the administration announced a delay in the online shopping system for small businesses and confirmed that the Spanish-language site for signing up for coverage will be delayed until mid-October. Earlier in the week, officials said Medicaid applications will not be electronically transferred from the federally run exchange to states until November.