Even as California leads the country by signing up uninsured people, Covered California has stumbled by failing adequately to extend coverage to Latinos, the largest uninsured population in the state.
Given the size of California's Latino population, the misstep is disappointing and surprising in an otherwise successful launch.
Covered California executive director Peter Lee's persistent efforts to "accentuate the positive" and "eliminate the negative," as the song goes, should not mask that hard reality.
The first major deadline for coverage was Dec. 31. California's target for overall enrollment was 611,000; the actual number enrolled was 498,794.
Exchange officials expect a surge of enrollment by March 31, the end of the open enrollment period for this year. A surge probably will occur. But to reach the state's target of 1.3 million, more than 800,000 people will have to sign up during the next two-and-half months.
That means the state must do a better job of reaching Latinos, who account for 59 percent of the state's uninsured population.
Critics have pointed to technical issues, such as the Spanish-language version of the website not working until late November, and a lack of a Spanish-language paper application until late December. These start-up problems undoubtedly will be repaired for the 25 percent of Latinos who are Spanish-language dominant and generally older.
That alone won't solve the problem, however: 58 percent of California Latinos are bilingual and 17 percent speak English-only, according to the health exchange's 2012 marketing plan. The exchange has boosted spending on television and radio ads in English and Spanish.
But mending the website and doing more advertising is no substitute for addressing the real issue, which is to connect with target communities in person.
Word of mouth from trusted sources matters more than fly-by ads, especially among people who have never had insurance and don't use the internet.
Further, in a state with a long tradition of immigration, a major issue is that many people come from "mixed-status" immigration families. Nearly half of California's immigrants are U.S. citizens, 26 percent have other legal status, including green cards and visas, and 27 percent are in the country illegally. Family members in the country legally may get insurance in the exchange, but those here illegally cannot.
In-person help clearly is needed to work through these complexities.
The dearth of boots on the ground is reflected in 40-minute average wait times at call centers, when the goal is 30 seconds.
It also is reflected in the low numbers of enrollment counselors. Covered California originally had plans to train 20,000 enrollment counselors by Dec. 31; the actual number was 3,000.
Critics reasonably question the exchange's mix of spending - $80 million for advertising versus $40 million for in-person outreach.
State Sen. Norma J. Torres, D- Pomona, wrote an opinion piece for The Bee that called for Covered California to "immediately adjust its Latino strategy and outreach team and dedicate significant time presenting details of a revised plan at its next board meeting Jan. 23." She is right.
California is one of 14 states where more than 20 percent of residents are not insured. To expand coverage significantly, California will need to fully understand what the barriers to enrollment were in the first three months of operation, particularly among Latinos.
As a group, Latinos are younger and healthier than the general population. The state needs Latino enrollment to make the new insurance pool work as intended, with a mix of old and young, healthy and sick people. By getting this right, California's new health care system truly can lead the nation.