WEDNESDAY, Dec. 11, 2013 (HealthDay News) -- Many more Americans signed up for a health plan in November than in the troubled first month of open enrollment through the new state and federal marketplaces created as part of the Affordable Care Act, the federal government reported Wednesday.

Roughly a quarter of a million people selected coverage in November alone, the report indicated.

In all, nearly 365,000 consumers have selected a health plan through the state and federal marketplaces -- also known as exchanges -- during the first two months of operation.

Still, the pace of enrollment remains sharply below the volume needed to reach the Obama administration's initial goal of enrolling 7 million people in 2014.

Consumers seeking coverage through state and federal marketplaces must enroll by Dec. 23 and pay their first month's premium by Dec. 31 to have coverage effective on Jan. 1.

The report's release came just an hour before U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius appeared before the House Energy and Commerce Committee to update members on the status of the health-reform law sometimes called "Obamacare."

Sebelius on Wednesday announced a three-pronged internal review of the flawed launch of the website.

"Now that the website is working more smoothly, I've determined it's the right time to begin a process of better understanding the structural and managerial policies that led to the flawed launch, so we can take action and avoid these problems in the future," she told the committee.

Sebelius said she has asked HHS Inspector General Dan Levinson to review the development of the website, including contractor acquisition, overall management of the project and performance and payment of contractors.

She also announced the creation of a new "chief risk officer" position within the U.S. Centers for Medicare and Medicaid Services (CMS) to look at risk factors leading to the botched roll-out.

Sebelius further instructed CMS to update and expand employee training so that all employees are versed in best practices for contractor and procurement management rules and procedures.

At Wednesday's hearing, Sebelius said there's no question that the troubled launch of "put a damper" on people's enthusiasm about early sign-up.

Of the nearly 365,000 people who enrolled in health coverage in October and November, two-thirds of them signed up via state-based marketplaces, also known as exchanges, operated in 14 states and the District of Columbia, according to the government report. State-based exchanges typically appeared to be having fewer glitches than the federally run portal.

However, enrollment through the federal marketplace showed tremendous improvement in November, quadrupling the October enrollment figure of approximately 27,000. is the gateway for selecting a marketplace plan for consumers in 36 states.

Another 1.9 million individuals made it through the so-called "eligibility process." They have applied for coverage and are eligible to enroll in a private health plan but have not yet selected a health plan.

In addition to buying private coverage, Americans may also use the state and federal exchanges to find out if they are eligible for Medicaid and the Children's Health Insurance Program. Through the end of November, more than 803,000 people were deemed eligible for one of those programs, the report noted.

The roll-out of the marketplaces on Oct. 1 set in motion the historic expansion of health insurance coverage envisioned under the Affordable Care Act. But the botched launch of the website and problems experienced with some state exchanges made enrolling online frustratingly difficult.

Sebelius now says the federal website is working for the vast majority of users but acknowledges that efforts to improve the site continue.

Separately, Consumer Reports National Research Center released results of a survey conducted between Nov. 8 and 10 showing widespread consumer confusion about the law over the last month.

Thirty-eight percent said they felt less informed about the law, while nearly half (48 percent) mistakenly believed the Affordable Care Act created a government-run health plan.

More information

To learn more about the Affordable Care Act, visit Families USA.

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