Being the first to try something can be rewarding. Remember how amazing it was to have the first iPhone? But then, sometimes there's a downside, like using that early version of the iPhone map tool that led to some wrong turns.
Colorado is going through a version of this with the implementation of the health law. The state and 13 others aren't using HealthCare.gov. They built health insurance marketplaces of their own. They took on big financial risks and and the burden of all kinds of operational details from insurance plan offerings to advertising and outreach.
Some states, such as Connecticut and California, are reaping the rewards, leading the country in signing up people for insurance. Minnesota, Maryland, Oregon and others have spent lots of money only to see their technology stumble and sign-ups lag.
Colorado's insurance exchange has had some technological troubles and enrollment still running behind.
Months before the Affordable Care Act even passed, a big, bipartisan health reform study group here had already concluded the state should create an exchange.
On Oct. 1, 2013, Colorado opened its exchange - and there were glitches. "We did run into some intermittent error messages as people were creating accounts, and we did temporarily suspend the account creation while we solved them," CEO Patty Fontneau said then.
Colorado was hardly alone. Other states and the federal government had even worse problems. And, enrollment success varies, says Avalere Health's Elizabeth Carpenter.
"State-based exchanges, a number of them have really performed, but to be honest a number of HealthCare.gov states have also exceeded in our analysis," she says. "So there's not at this point kind of a direct correlation between whether or not you're a HealthCare.gov state or you're a state-based exchange state when it comes to your enrollment success, or lack thereof."
Colorado has signed up 90,000 people as of March 10. It's among the best-performing states, but its enrollment numbers to date are still below expectations.
But Ben Price with the trade group of health insurance companies in Colorado says the state is definitely better off.
"Every day that we get further into this, we're seeing more and more reasons it was good for us to go our own way and have a state level exchange," he says.
The insurers have worked closely with government agencies and consumer advocacy groups on creating the marketplace. They've had the chance to influence everything from the options users get on the exchange website, to specific marketing plans for different audiences and parts of the state. And when problems pop up, everybody pitches in and they get solved pretty quickly.
Price says a lot fewer people in Colorado would have health insurance now if the state had just used HealthCare.gov.
"It's not perfect," he says. "We'd like to see higher numbers. It's going to take some time and we're working out the kinks. But I think we're in a lot better shape than a lot of other states that chose to sit back and wait and see if the Affordable Care Act was going to stand, or just say, well, bring in whatever the federal government brings in."
Some states ended up with HealthCare.gov because they thought the law would be thrown out by the Supreme Court, or repealed by a Mitt Romney White House. But in Colorado, even some hardcore conservative lawmakers never thought that was a good strategy.
Republican Amy Stephens represents one of the most conservative districts in the state, but she co-sponsored the bill that established Colorado's health insurance exchange. She says she wanted to preserve as much state control as possible.
"I did not see the federal option as an option that was a good option," Stephens says. "And to me, and to the business community, creating something here in Colorado with a state exchange close to home in a pro-market manner was the best solution for us."
Stephens continued fighting to get Obamacare repealed, but wanted Colorado to have a backstop.
"We don't want to have to call some federal government number for our own health care," she says. "We want to decide it here. I think we've done a very good job."
The federal government gave Colorado $187 million to build its exchange. State Republicans have had a hard time attacking it when it has support from the business community, including hospitals and health care providers.
That broad base of support should serve Colorado well going forward, says consultant Elizabeth Carpenter.
"This was not a kind of go/no-go 2014 decision. This was a decision that states made looking into the longer term."
The first shot at signing up millions for health insurance wraps up at the end of the month. The state's long-term goal is getting as many people health coverage as possible. And Colorado, by building its own exchange, has managed to get groups that often disagree to work together on that.
This story is part of a partnership between NPR and Kaiser Health News.
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