As the Republican-led Congress and President-elect Donald J. Trump call for the repeal of the federal health care law known as Obamacare, insurance exchanges in Maryland and around the country continue to sign people up for coverage at a pace that could make it a banner year.
Officials at the online marketplaces are making an extra push to enroll consumers ahead of Thursday's deadline for coverage beginning at the first of the year.
"For us, it's business as usual and it's going well," said Traci Kodeck, CEO of HealthCare Access Maryland, a nonprofit organization supplying "navigators" to help people understand plan options and sign up.
Although the fate of the health care law is unknown, she said, for "now we have health insurance and an exchange, and we will continue to enroll people and tell people about the benefits they are eligible for."
This is the state exchange's fourth open enrollment, and Kodeck said the process seems easier this year for people who need coverage because they aren't on government programs and don't have insurance through work. Significant jumps in premiums haven't deterred people from enrolling, but many are seeking help identifying plans that can reduce out-of-pocket costs, she said. The majority of enrollees qualify for subsidies that reduce premium costs.
About 130,000 Marylanders have signed up so far for insurance plans for 2017 through marylandhealthconnection.gov. Open enrollment began Nov. 1 and lasts through January, though people who want insurance starting Jan. 1 must be signed up by Thursday. About 163,000 people were enrolled in private plans this year, an increase of 33 percent from 2015.
About 400,000 people were covered this year, including those who enrolled in Medicaid through an expansion of the federal-state program for low-income Americans, according to exchange officials. Medicaid enrollment is year-round.
The rollout of the Affordable Care Act coincided with a drop in the state's uninsured rate to 6.6 percent in 2015 from 10.2 percent in 2013, according to U.S. Census data. Some state residents are not eligible for exchange coverage because they are immigrants who are in the country without legal documentation.
"Maryland has seen fairly rapid progress for a problem that had been intractable," said Andrew Ratner, a spokesman for the Maryland Health Benefit Exchange.
More than 2 million people have bought insurance so far on the federal exchange, healthcare.gov, which serves residents in 39 states, officials say. That's about 97,000 more than at this point last year. An estimated 20 million people are covered this year through plans under Obamacare, including those who bought private plans and those added to Medicaid.
Trump and many Republicans, however, say the program has become too costly for government and burdensome for individuals, citing steep increases in premiums every year.
Trump and the lawmakers have pledged to repeal the program quickly when Congress reconvenes in January, though there is no agreement on how to replace it. Trump has indicated he would like to keep popular provisions such as those that ban insurers from denying coverage to those with pre-existing conditions and allow parents to keep their children on their plans until they are 26.
The Maryland exchange reports that an estimated 2.5 million nonelderly Marylanders have pre-existing health conditions, including about 320,000 children.
Insurers say it would be difficult to enforce and maintain the pre-existing conditions stipulation without requiring everyone to buy insurance because healthy people are needed to balance the risk pool.
People who don't buy coverage now pay penalties. This year it's $695 or 2.5 percent of income for a single person and $2,085 or 2.5 percent of income for a family.
Jonathan P. Weiner, professor of health policy and management in the Johns Hopkins Bloomberg School of Public Health, said one reason why enrollment hasn't slowed this year despite rising costs is the subsidies many people receive.
Consumers also may view this as their last chance to get subsidized health insurance without medical underwriting, or consideration of their health status. He said "repeal and replace fear" could lead to a futher surge in enrollment for 2017.
"With some degree of certainty, President Trump will 'repeal' Obamacare in his first month, if not week, of office," Weiner said. "However, even though he and the Republican Congress can't admit it publicly, they recognize the program is now essential to 20-30 million Americans. Coming up with a viable 'Trump-Care' alternative will take considerable time. So many key aspects of the [Affordable Care Act] will likely be kept intact, and called by another name."
Weiner expects uncertainty in the individual and small-business markets until the new landscape becomes clearer.
Already insurers have left exchanges across the country, citing losses. In Maryland, UnitedHealthcare pulled out of the market this year, and Evergreen Co-Op is not permitted to sell individual policies as it seeks to convert into a for-profit insurer.
That's left three insurers taking part in the state exchange. So far this year, about 68 percent have enrolled in CareFirst BlueCross BlueShield plans, 31 percent have picked Kaiser Permanente and 1 percent have gone with Cigna.
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People know things may change next year, Ratner said.
"Consumers have expressed their concerns about the future of coverage, especially to the consumer assistance workers," he said.
Some consumers say they are counting on that change.
Michael Joseph is an independent government contractor and buys a low-level plan for his family of four in Mount Airy. He earns too much to qualify for subsidies, and the monthly premium grew this year to $1,512 from $875, an almost 73 percent increase. He said he has to pay thousands in out-of-pocket deductible costs before coverage even kicks in.
To offset some of the increase, he felt compelled to take one of his adult children off his plan. She earns so little she qualifies for Medicaid.
"I think it's a good thing that pre-existing conditions went away as an issue and everyone can be covered, but it's a bad thing when something you have to buy goes up so much every year," Joseph said. "I'll be 60 years old, and I've got to keep working to pay for insurance that doesn't provide me anything."