A new poll of consumer satisfaction with the Affordable Care Act's health insurance exchanges confirms what headlines having been saying since the online marketplaces' launch: things have not gone smoothly.

Forty percent of Americans said the introduction of the insurance exchanges hasn't gone well, 20 percent said it's gone somewhat well and 30 percent had no opinion. Just 7 percent said the launch, which began Oct. 1, had gone "very well" or "somewhat well," the AP-GfK poll found.

Seven percent of those polled said someone in their household had tried to sign up for insurance through the exchanges -- potentially 20 million people. But three-quarters of those who tried to sign up reported problems, the Associated Press reported Thursday.

The online poll of 1,227 adults was conducted Oct. 3-7, the news service said.

But unlike the highly publicized problems that have plagued the federal health exchange website created to help Americans register for insurance coverage, many state-run exchanges are operating well, according to published reports.

The reason for the disparity: the sprawling federal website has been overwhelmed by visitors and -- some experts contend -- hampered by faulty design and software. The state-run sites, by comparison, are much smaller and nimbler, and technicians can react quickly to fix problems that arise, The New York Times reported.

"Individual state operations are more adaptable," Alan Weil, executive director of the National Academy for State Health Policy, an independent nonpartisan group, told the newspaper. "That does not mean that states get everything right. But they can respond more quickly to solve problems as they arise."

Another difference that helps to explain the relatively smooth launch of the state-run exchanges: some states let consumers explore insurance options -- such as costs and the pros and cons of different policies -- without first having to create an online account. On the federal exchange, called HealthCare.gov, shoppers must first create an online account. And creating an online account has been a major stumbling block and source of frustration for many people trying to use the federal exchange, the Times reported.

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Minnesota's health exchange is an example of a state-run exchange that is performing well, the newspaper said.

Robyn Skrebes of Minneapolis, who is 32 and had lacked insurance, said she signed up for health coverage in about two hours on Monday using the state-run website, MNsure. She said she purchased a policy for $179 a month, before tax credit subsidies, and also got Medicaid coverage for her 2-year-old daughter, the Times reported.

"I am thrilled," Skrebes said. "It's affordable, good coverage. And the website of the Minnesota exchange was pretty simple to use, pretty straightforward. The language was really clear."

Other states with state-run exchanges that seem to be operating well include California, Connecticut, Kentucky, New York, Rhode Island and Washington, the Times said.

Meanwhile, problems continue to dog the federal health exchange website, which serves people in 36 states, although they are occurring less frequently, according to published reports.

And the Washington Post reported Wednesday that big insurance companies, state health officials and Democrats friendly to the Obama administration said they'd been warning federal health officials for some time that the federal exchange had serious shortcomings. The White House proceeded with the Oct. 1 launch despite those warnings, the newspaper said.

Rep. Robert Andrews, D-N.J., played a major role in helping to get the health-reform law known as the Affordable Care Act passed in 2010. The online exchanges -- the federal site and the state-run ones -- are key components of the law, sometimes called Obamacare, which is designed to bring health insurance coverage to millions of uninsured Americans.

Andrews told the Post that he told White House officials early this summer that he'd been hearing from insurers that the federal online system was flawed.

"Nothing I told them ever surprised them," Andrews told the newspaper. "The White House has acknowledged all along something this massive was going to have implementation problems."

One senior administration official, who requested anonymity from the Post, said the Obama administration expected some problems with the launch of the federal health exchange, "but we had a lot more traffic than we thought, and so discovered problems managing that load."

HealthCare.gov stumbled out of the gate Oct. 1 -- the first day of open enrollment under the Affordable Care Act -- as consumers tried to peruse their health-plan options and enroll in coverage.

In the hours and days after its launch, consumers encountered long lag times and technical difficulties.

U.S. health officials have said they see the heavy traffic on HealthCare.gov as an indication of the demand for health insurance. The administration hopes to enroll 7 million uninsured people through the federal and state health exchanges by the end of March 2014.

More information

Here's how to find the health exchange serving your state.

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