Chrissy Umberger, center, of Baltimore, and husband Jonathan Merrill, left, get help with navigator Kasey Fields on getting health insurance under the Affordable Care Act.
Chrissy Umberger, center, of Baltimore, and husband Jonathan Merrill, left, get help with navigator Kasey Fields on getting health insurance under the Affordable Care Act. (Kenneth K. Lam, Baltimore Sun)

Officials at the Maryland health exchange had a plan: Roll out their revamped online insurance marketplace slowly and have a tech team ready to jump on problems.

But unlike last year, when the site crashed the first day, open enrollment came and there haven't been any problems yet.

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The website, created under the Affordable Care Act to provide coverage to those who do not get insurance through their employers, functioned as it should when the officials quietly opened it to the public Monday.

"It's working unbelievably well," said Dr. Joshua M. Sharfstein, the exchange board chairman and state health secretary, who sent a tweet Tuesday to announce that the site was open. "This is a confirmation of all work happening this year and the incredible amount of testing we were able to do."

The site was supposed to be opened to the public Wednesday, but after two days of limited access through an enrollment fair, the exchange call center and other agents, Sharfstein said they were confident enough to launch more widely.

It remains to be seen whether the exchange holds up under higher volume.

Sharfstein said about 1,500 people purchased coverage Monday, the first day the website was open, though some bought through agents. Several hundred bought plans over the weekend by phone or at the fair.

As of 4 p.m. Tuesday, more than 5,300 applications had been started, and more than 1,900 had beedn completed, according to Andrew Ratner, director of marketing and outreach for the Maryland Health Connection.

Exchange officials hope positive word of mouth will overcome the negative publicity received from building one of last year's worst-performing state sites. They eventually ditched the technology and used software written for Connecticut, adding to the hundreds of millions of dollars in contracts awarded to develop and run the Maryland exchange.

Many states and the federal exchange, which serves 36 states, experienced at least initial technical troubles. This year, there have been few reports of troubles around the country, and observers say the focus will turn to enrolling more people in coverage.

The smooth start has many optimistic about the success of open enrollment, though some in the insurance industry say there are other factors that will influence how many people sign up.

Some consumers will find that their premiums have gone up since last year. In Maryland, CareFirst BlueCross BlueShield, the dominant insurer, increased prices and other providers reduced them. Consumers also might see higher out-of-pocket costs such as co-pays and deductibles.

"The exchange may be working like it was supposed to work a year ago," said Robert Laszewski, president of Health Policy and Strategy Associates, a policy and marketplace consulting firm. "That leaves the fundamental question: Will enough people buy into the program so that we have enough healthy people to make it sustainable?"

Consumers who bought insurance last year must re-enroll though the exchange to keep their federal subsidies. They must enroll by Dec. 18 to have the subsidies for coverage beginning Jan. 1, though open enrollment lasts until Feb. 15. About 81,000 people bought private plans in Maryland last year, but about 10,000 stopped paying their premiums because they moved, got other insurance or found no value in paying the premium.

Those who do not have coverage will pay a bigger penalty this year, 2 percent of household income or $325 per person, whichever is higher.

That will likely persuade more people to get coverage, said Laura Adams, a senior analyst at insurancequotes.com, which provides data and insurance quotes to consumers.

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She said many still don't understand insurance and it might be years before people are comfortable signing up for coverage each fall.

"There's a lot of industry jargon that is confusing for people who have insurance, so people who haven't bought insurance in a long time or ever are in brand-new territory." She said. "It'll be a long process, but this year we'll see more people enroll, and more next year and the year after that."

Grace Miller of Brooklyn Park was one who did not need convincing to buy insurance, though she said she did need help.

As a teacher, the 28-year-old had never had to shop for insurance before. But last year when she left that job to go to back to school and work as a nanny and her temporary insurance expired, she needed to find a policy on the exchange. Miller made an appointment with a "navigator" who was contracted by the exchange to help people enroll.

She said it was a "little scary" to pick a plan, and she knows many of her friends in their 20s still won't bother to buy insurance, despite the penalty.

Miller recently got a letter saying her premium would rise by $100 a month, so she plans to head back to the navigator to help her wade through options.

"I, for one, cannot afford to get hurt or get sick on the job and pay an arm and a leg for it," she said. "But I need to buy another plan within my budget."

Healthy Howard, one of the navigator groups, is booked with appointments for the next two weeks, mainly with people looking to re-enroll.

That organization is responsible for navigators from Columbia throughout Western Maryland and hasn't had a problem with the site, said Brian Mattingly, director of the group's Door to HealthCare Western Maryland program.

Healthy Howard expects more people will sign up this year than last because poor technology won't be a factor, he said.

"After our experience last year, we are really, really happy to see a good performing system on Day 1," Mattingly said.

The group will be hosting enrollment fairs and be available in various locations to consumers, but Mattingly said he believes more people will go online this year to enroll.

"A big driver last year for people seeking assistance was to work around the system issues," he said. "With the new system, I think consumers will find it much easier to do it themselves."

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