By Jonathan Cooper - November 20, 2013

PORTLAND, Ore. (AP) -- With all the problems facing the rollout of President Barack Obama's health care overhaul, nowhere is the situation worse or more surprising than in Oregon, a progressive state that has enthusiastically embraced the federal law but has so far failed to enroll a single person in coverage through the state's insurance exchange.

Despite grand ambitions, an early start, millions of dollars from the federal government and a tech-savvy population, Oregon's online enrollment system still isn't ready more than a month after it was supposed to go live. The state has resorted to hiring or reassigning 400 people to process insurance applications by hand.

"We're all surprised and frustrated that we're in the position that we're in now," said Jesse O'Brien, a health care advocate at the Oregon State Public Interest Research Group, which lobbied for the exchange.

The state has received about 18,000 paper applications, at 19 pages each, and is scrambling to manually file and clear them. State officials have not been able to say when they expect the online system to launch, nor have they established a deadline to submit paper applications in order for coverage to begin Jan. 1. Meanwhile, the exchange's board is demanding answers from the executive director about when the website will work and how his team will get people enrolled on time.

For consumers, the application process can be long and frustrating.

"I've been trying since the very first day of October just to try to find out the coverage I could get," said Donna George, 43, a bookkeeper from Bend, Ore., who's been uninsured for three years.

When the online system wouldn't work, George submitted a paper application Oct. 7 for herself and her husband. Finally, on Nov. 12, she received an enrollment packet that tells her how much of a tax credit she'll receive and lays out her coverage options. She's now waiting to meet with her insurance agent to pick a plan and return the forms.

Oregon has long prided itself on being a leader in health policy. Its Medicaid system has been a testing ground for new innovations since the early 1990s. The state started laying the groundwork for an insurance exchange a year before Congress passed the health care law that called for one in every state. Gov. John Kitzhaber, a former emergency room physician, is a respected voice on health reform.

The state also has a large population of young, underemployed progressives who might provide a burgeoning market for affordable coverage. Its ultra-competitive health care market led to lower-than-expected premiums. Lawmakers from both parties have embraced the law. And the Portland area is a thriving hub of technology companies known as the Silicon Forest.

In other words, Oregon had everything going for it.

But its exchange, known as Cover Oregon, became a victim of its own lofty ambitions and the state's stubborn refusal to dial them back until it was too late.

While exchanges in many states are telling applicants who appear to qualify for Medicaid to contact a separate agency, Oregon insists its exchange must be a "one-stop shop" for both Medicaid and private insurance. The state also wants its exchange to eventually be able to help enroll people in a wide array of public-assistance programs, not just health care.

Exchange leaders stuck with their plan even as risk consultants warned repeatedly that they were in danger of missing the Oct. 1 deadline to launch.

"We won't know whether we made the right decisions until our system is up and running," said Amy Fauver, chief communications officer for Cover Oregon. "But we're going forward in the way we feel we can best serve Oregonians."

Exchange officials say they haven't fully launched their website because their software still can't accurately determine whether applicants are eligible for Medicaid or the Children's Health Insurance Program, particularly for people with complex family arrangements.

Kitzhaber, a Democrat, has pledged that the problems won't "interfere with our objective of making sure that every Oregonian that wants to be enrolled" by the start of the new year "is, in fact, enrolled."

Oregon does have one big success to brag about. The state has enrolled 70,000 people in Medicaid, reducing the ranks of the uninsured by more than 10 percent. The large number of Medicaid enrollments came in large part thanks to a "fast-track" enrollment process approved by the Obama administration. Using income data already on file, the state mailed a simple seven-question Medicaid enrollment form to people in the Supplemental Nutritional Assistance Program who qualify for health coverage under the federal health law's expansion of Medicaid.

Pressure is growing on exchange officials to fix the problems. U.S. Rep. Kurt Schrader, a moderate Democrat who took heat after voting for the health care law, released a sharply worded statement on Friday demanding that the exchange and its main contractor, Oracle, make it work.

"The implementation of Oregon's health insurance marketplace has been abysmal," Schrader said. "The current situation is completely unacceptable, and I expect much more from a state with a reputation for being an innovator in the field of health care."