The new federal health insurance exchange for Alaska rolled out Oct. 1 with glitches, but those were expected.

Valarie Davidson, government affairs director of for the Alaska Native Tribal Health Consortium, likened it to the first day of Alaska Permanent Fund dividend on-line enrollment.

“It will take a while for people to get used to it, but we’re Alaskans and we work through these challenges,” Davidson said at a press conference in Anchorage Oct. 1.

Susan Johnson, Region 10 director for the U.S. Department of Health and Human Services, hailed the day.

“It’s a day of many firsts, including the first day millions of Americans will not be excluded from affordable health coverage, and who will have peace of mind,” she said. “We’ve opened a door to a place Americans can find out what is available and affordable, and who will have assistance.”

The exchange in Alaska is for individuals but the special “navigators” hired to help individuals deal with the complexities of the on-line enrollment also can assist small businesses.

Joan Fisher, trained as a navigator by United Way, one of several nonprofits lending assistance in the enrollment, also is available to counsel small businesses and has had several inquiries already, she said.

Under President Barack Obama’s signature health care law, virtually everyone will be required to have health insurance as of Jan. 1. There are exemptions for financial hardships and religious objections, but those who ignore the mandate will face fines.

Those who select a plan by Dec. 15 can get coverage starting Jan. 1, while March 31 marks the end of open enrollment. Individuals can still enroll after that if they have a qualifying event such as job loss, birth or divorce, according to www.healthcare.gov, the government website where people will access the marketplace.

Figures released last week by the HHS show the average individual monthly premium for a benchmark policy known as the “second-lowest-cost silver” plan will be $474 for Alaska. Of the 48 states analyzed, only Wyoming’s average premium was higher in that category, at $516.

Premiums, though, have long tended to be higher in Alaska, with one of the biggest drivers being health care costs, said state Insurance Director Bret Kolb. Alaska also is a relatively small state, population-wise, with limited competition among insurers.

Premera Blue Cross Blue Shield of Alaska, the largest health insurer in Alaska, is one of two companies offering plans on the insurance marketplace, along with Moda Health. Premera has more than 9,000 individual members in Alaska and expects that number to double over time, said Eric Earling, a spokesman for the company.

There is no small business exchange in Alaska, unlike in other states, but Fisher said she can help small business owners work through the national small business exchange. The Affordable Care Act defines a small business as a firm with 50 or fewer employees. Fisher has an office at Providence Medical Center.

Johnson said she saw system upsets in the first hours the exchanges went live, including a website crash in Washington, D.C., and a report of someone in Ketchikan waiting 40 minutes to get access to the site.

When she logged on herself the morning of Oct. 1 she waited two minutes, Johnson said. Tyann Boling, chief operating officer for Enroll Alaska, a Northrim Bank brokerage established to help individuals and families sign up and understand their options, said early Oct. 1 that her group wasn’t able to enroll people or look at available policies online. She said her group can enroll people on paper in the meantime.

Gov. Sean Parnell refused to have the state establish its own state-created insurance exchange, so under the federal law the HHS created one for Alaska, and issued grants to nonprofits like United Way, ANTHC and the Alaska Primary Care Association to hire and train the navigators to assist people.

Enroll Alaska, which saw website traffic spike Sept. 30, according to Boling, plans to open sites in a number of communities, including Juneau, Anchorage, Wasilla, Sitka, Ketchikan, Kodiak, Fairbanks and the Kenai and Soldotna area.

United Way has people in Anchorage and Juneau but is still hiring for Fairbanks, said Sue Brogan, manager of the project for United Way. Until staff is hired and trained in Fairbanks assistance is available through Fairbanks Memorial Hospital, she said.

Nancy Merriman, administrative director of the primary care association, which represents community health centers, said her members served 98,000 patients in Alaska last year. Forty percent of them were uninsured, she said.

ANTHC is helping the enrollment effort in rural Alaska in partnership with tribal health organizations. Davidson said that many Alaska Natives who are eligible for Indian Health Service benefits are interested in purchasing insurance so they can secure health coverage for things the IHS does not cover, such as medical travel for non-life threatening problems.

In most small rural villages there are only health aides and any medical complication that requires a specialist, even a dentist, requires travel. Having access to insurance, if a policy that includes medically necessary travel is selected, will result in better health care, she said.

Davidson said having more Alaska Natives covered by health insurance will allow the tribal health corporations to bill the insurance companies for many services they provide that are not reimbursed by the Indian Health Service.

Overall only about 50 percent of the cost of providing health services to Alaska Natives is covered by IHS. The tribal health corporations have to cover the remaining costs from other sources, and having more patients with insurance will strengthen the finances of the entire system.

That’s important for non-Native Alaskans who live in rural communities and who are served by tribal health clinics, Davidson said.

Johnson and Davidson said they expected a light flow of people enrolling, and the glitches, in October and more people using the site in November and December. Next March is the enrollment deadline, for this first cycle at least.

Johnson said there are “hardship” exemptions that would allow people in special circumstances, such as loss of a job with employer health coverage, to enroll using the site after March without having to wait for the next enrollment period.

Johnson said about 60 percent of the estimated 139,000 uninsured Alaskans under the age of 60 are likely eligible for tax credits to help cover costs.

“That’s the story,” she said. “Not how long a wait it is, not how cumbersome a site may be for some. But the promise of the peace of mind that health insurance brings.”

Johnson said this is not the kind of thing that officials urge people to hurry up and get over. She urged people to “enjoy the shopping,” talk over their options and reach out for additional guidance, if needed. 

Davidson said people might want to wait a while until glitches are worked out, but not too long.

“You may not want to be first. You don’t want to be last, either,” she said. “Like with your Permanent Fund dividend, don’t wait untll the last minute. If something happens, a glitch, you might lose out,” in coverage, for at least a period, she said.

Tim Bradner is a reporter for the Alaska Journal of Commerce. Becky Bohrer of the Associated Press contributed to this article.