To some extent, people should think of this as maybe a two- or three-year decision. Some plan options may go away, cheap plans may become expensive -- people should maybe expect to change plans in the future.

Each one is a little different, but they all share this 'I had this nice, stable situation' aspect, where people knew what they had, even if it was somewhat spotty help through pharmaceutical assistance programs. Now they have to disrupt that and at least make a decision, or in many cases make a shift. That's hard for people.

They could have waited a year, or phased it in slowly through the year. So you had all these people going into the program at once. That overloaded the system for the non-Medicaid patients folks as well.

The task consumers face will be quite challenging. Because nearly every plan has a unique plan design, even researchers like myself find it challenging to sort out the choices.

It may be impossible for some consumers to find the ideal plan -- and it will certainly be time-consuming and difficult at best.

After a battle is over, people talk a lot about how decisions were methodically reached, but actually there's always a hell of a lot of groping around.