When searching for Week 1 winners in the Great Health Exchange Rollout, it's probably best to avoid healthcare.gov. You can't log onto the site anyway. If you live in Louisiana, you probably haven't tried (seven enrollees as of Oct. 7).

But healthcare reform has arrived, with glitches (some would call them more than glitches) slowing it in many places. Some state-run exchanges are running in a faster lane, however, and enrollment has gained steam and stepped clear of the pitfalls plaguing the federal exchange Website.

At Connect for Health Colorado, a ZIP code and birth month will get anyone a range of available plans, premiums and formularies. Within its first two days, the site drew 107,000 unique visitors and had 8,400 accounts created. The dropoff between visits and accounts might seem precipitous, but in the first week of enrollment, people are more likely to window shop.

At Kynect (Kentucky's exchange), a few quick questions about age, family, household income and tobacco use lead to a menu that lets consumers sort plans by premium, deductibles, out-of-pocket maximums, and metal tiers, and allows for searches by hospitals and providers. That last piece might be the most important; for most people, a cheap premium isn't worth a lot if they have to find a new physician.

In its first five days, Kynect screened 142,242 people for eligibility. In its first week, Kynect had 22,000 applications started and nearly 15,000 completed. More than 200 small businesses are also in the application process. In Washington State, the health exchange has signed up 9,500 people and has applications pending for another 10,000.

Oregon has not fared as well; despite 230,000 unique visitors, Cover Oregon's site won't complete applications till the end of October. Despite that hurdle, 1,300 Oregonians have completed paper applications. Among state exchanges, Maryland might have suffered the biggest stumbles with its Health Connector enrolling just 326 people.

Arkansas is juggling a partnership exchange and offering its Medicaid expansion population subsidized exchange coverage. In a survey of uninsured people using Department of Health Services programs, 55,000 were interested in the private option, a good sign for its viability in Arkansas and beyond.

All in all, it's hard to get worked up over seven people signing up in Louisiana or 326 in Maryland. But remember that Medicare Part D enrollment got low marks in its early days. For the most part, state-run exchanges are working. The federal exchange still has time to smooth out the wrinkles.

The date to watch remains the same: Dec. 15, the last day to sign up for coverage that starts Jan. 1. If exchanges struggle with crashes and enrollment problems at that late date, they will be courting enrollment catastrophe.

Follow Bill Melville on Twitter @BillMelvilleHLI

What drives the therapy selection test market?

View Now