Elsewhere, there have been stumbles. In Minnesota, exchange director April Todd-Malmov resigned last week amid complaints over a bug-ridden website and long wait times at a state call center. Todd-Malmov also drew criticism for vacationing in Costa Rica last month, as the MNSure marketplace struggled. The exchange extended its enrollment deadline to New Year’s Eve and told 1,000 people they needed to reapply because of inaccurate subsidy calculations.

“MNSure must do better,” said Scott Leitz, the marketplace’s newly appointed chief executive officer, in a Dec. 17 statement.

Maryland’s exchange director resigned Dec. 6 and the state last week extended its deadline by four days, to Dec. 27. Governor Martin O’Malley said the state had hired Quality Software Services Inc., the UnitedHealth Group Inc. unit brought in by the federal government to oversee emergency repairs to healthcare.gov.

Hawaii’s executive director announced she was leaving Nov. 26, after earlier apologizing for the site’s poor performance. In Oregon, exchange director Rocky King took a medical leave of absence on Dec. 3. Consumers still can’t complete the entire enrollment process online. In the interim, the state has hired hundreds of workers to process paper applications.

‘Best Practices’

The Obama administration will “continue to work closely with all state-based marketplaces to support their work,” said Dori Salcido, a spokeswoman for the U.S. Health and Human Services Department. The agency is sharing “best practices so that citizens of every state have access to affordable coverage options.”

The problem states have had more success with Medicaid, the government program for the poor that is also expanding under Obamacare. Almost 40,000 people were deemed eligible through November, according to a Dec. 11 HHS report.

Even Massachusetts, whose 2007 exchange was a model for the Affordable Care Act, has struggled to switch to the new system. The state had enrolled 1,100 people through November and a Dec. 12 state report found “overall system performance is far from where it needs to be.”

Some of the states’ missteps mirror that of the federal government’s website. Like healthcare.gov, Oregon built its exchange without hiring an outside information-technology firm, known as a systems integrator, to organize the project.

“You really had to have somebody who understood large- scale implementation of an IT project,” Daniel Mendelson, chief executive officer at Avalere Health, a Washington-based consultancy, said in a phone interview. “Many states gave their exchange to really outstanding policy people as opposed to IT people. That’s not good. It will really not result in the desired outcome.”

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