Massachusetts has long held a special status in the debate about President Obama's health care law. It was a 2006 Massachusetts law that provided the inspiration for the 2010 national law, and Massachusetts already had near-universal coverage before the federal law took effect.
Now the state that gave birth to a sweeping expansion of health coverage nationally is trying to knit the two laws together and struggling to make sure no resident falls through the insurance net.
At the center of their frustration is a glitchy website that has forced the state to rely on workarounds to ensure access to coverage.
About 5,400 shoppers were able to enroll in health care plans through the Massachusetts Health Connector by the end of December, according to a report by the federal Health and Human Services Department. Of those, 31 percent were between the ages of 18 and 34.
But state health officials say that the number of new people who were able to access subsidized coverage through the Connector and MassHealth programs despite the website problems was higher - about 28,000.
Even so, 26,000 other people ran into technical roadblocks and had to be enrolled in temporary subsidized coverage through MassHealth, the state's Medicaid program.
Officials say they're focused on improving those numbers before March 31, when the federal health care law's first open enrollment season ends.
Jean Yang, executive director of the Health Connector, said the agency had to come up with creative ways to work around the website failures.
That included increasing call center capacity to help people who were unable to use the website. On Dec. 31, there were about 200 call center staff on hand - three times the original capacity on Oct. 1.
Massachusetts Secretary of Administration and Finance Glen Shor said the state is determined to protect the gains made since 2006. Massachusetts has the highest percentage of insured residents of any state.
He also said that the federal health care law, despite its complexity, is good for Massachusetts and will help beef up the state's already strong record on providing coverage.
"At the end of the day we have to remember this is not about a website, this [is] about health security," Shor said.
Connector officials have brought in outside consultants to help assess the website and come up with solutions. The assessment team is being led by experts from MITRE, a nonprofit research and development center with expertise in systems engineering and integration.
The report was originally due Friday, but Shor say MITRE was putting the final touches on the study, which they expected soon.
Connector officials said the report could provide critical information as they decide whether to pursue legal action against CGI Group, the Montreal-based information technology company hired to create the new website. CGI also was the top contractor on the troubled federal website.
CGI says it remains focused on helping Massachusetts residents get insured by enrolling in qualified, affordable health plans online.
"CGI and its resources are dedicated to delivering continuous improvements in system performance and the user experience for the Massachusetts Health Connector," said company spokeswoman Linda Odorisio.
Josh Archambault, health care policy director for the Pioneer Institute, a conservative-leaning Boston-based think tank, said part of the frustration is that Massachusetts had a functioning website before the federal law was passed.
"The big question is whether the state could have built off its existing website or did it have to start all over?" He said.
Archambault said the federal law is a "net negative" for Massachusetts because it adds another layer of bureaucracy while many of the benefits of the federal law were already covered by the state law.
The health care woes have already become an issue in the Massachusetts governor's race with Republican hopeful Charlie Baker calling for the state to seek a comprehensive waiver from the federal law.
"We have a system in place that works and addresses all the goals of the (federal law), so I believe we should be doing everything we can to see that we are able to keep it," Baker said in a statement last week.