The outrage was swift and loud. Millions of people were feared to be in danger of losing their health insurance last year because their plans did not comply with the Affordable Care Act.
To keep people covered and quell consumer anger, President Barack Obama and many states allowed people to renew their old plans temporarily — including 73,000 in Maryland.
But that offer has expired and now people like Raymond Liu have been thrust onto health exchanges where they must purchase new plans. Many are finding higher premiums or less coverage, as they worried would happen.
"I tried to get as comparable of a plan price and coverage wise under the Affordable Care Act," said Liu, a self-employed Fulton resident, "but it was not possible."
Obama created the controversy when selling the reform law to consumers by repeatedly promising they could keep their health insurance plans if they liked them. Protests swelled when analysts predicted as many as 5 million people had policies that wouldn't comply with the new health care law.
While some are complaining a year later, after the short-term fix has run out, supporters of the new law contend the problem wasn't as widespread as once believed, and they insist the exchanges offer most people a good deal.
"With change like this, there are winners and losers," said Sabrina Corlette, senior research fellowand project director at Georgetown University's Center on Health Insurance Reforms.
Up to 85 percent of people buying insurance on the exchanges will get subsidies, making policies more affordable. They also will get new protections and benefits required by the law. For instance, those with plans that charged more because of pre-existing illnesses should now pay the same or less because the health law no longer allows that.
Exchange plans also ban lifetime limits on coverage and cap out-of-pocket costs. In addition, over time with greater competition and administrative savings on exchanges now that they are up and running, prices are expected to rise more slowly.
But some people, particularly young, healthy professionals and those with bare-bones plans, likely pay substantially more for coverage on an exchange, experts said.
"It might sound obnoxious when you're looking at a 100 percent premium increase, but the truth is that they were paying artificially low premiums," Corlette said. "Insurance companies didn't used to let sick people buy insurance, and now that they do, it's making it more expensive."
Also driving up costs is a requirement that exchange plans offer 10 specific benefits, including prenatal care, preventive exams and prescriptions coverage.
Nationwide, it turned out that only about 1.8 million people could not renew their 2014 health plans because of the Affordable Care Act, estimates Jon Gabel, senior fellow with the independent National Opinion Research Center at the University of Chicago and an expert on private health insurance.
That's out of more than 10 million policies written on the so-called individual market, for people who aren't insured through an employer.
Many likely would have dropped their coverage for personal reasons anyway, Gabel said. Studies show that just 17 percent of policyholders retain coverage for more than two years on the individual market. The rest get a new job, marry, qualify for public insurance or just go without coverage, he said.
The Maryland Insurance Administration said about 30,000 people — or 40 percent of those eligible — took the state up on its offer to renew plans that didn't comply with the law until 2015. Maryland was one of 28 states that allowed consumers to re-enroll in noncompliant plans.
Of those, about 14,000 renewed plans with CareFirst BlueCross BlueShield, the state's dominant insurer. That was about a quarter of its policyholders with noncompliant plans, and many of those who did renew have since dropped the policies because they bought a compliant plan or gained coverage another way, according to the insurer.
"Our message was that people were able to renew, but a lot would do better in the exchange," said Dr. Joshua Sharfstein, exchange board chairman and outgoing state health secretary.
So far, about 6.4 million have enrolled in health plans for 2015 through the federal exchange and almost 137,000 through the Maryland exchange. Open enrollment runs until Feb. 15.
Some shopping on the exchange for the first time chaffed at their options.
The Morning Sun
Robert Laszewski had a plan from CareFirst, which raised rates on the exchange this year as other insurers lowered them. He shopped around and found the insurer still had the best doctor network and out-of-pocket costs — at twice the premium.
Laszewski, president of Health Policy and Strategy Associates, a Washington area policy and marketplace consulting firm, said he worries that the higher prices for some could undermine the hoped-for outcome of health care reform — that more people get insured, keeping everyone's costs in check.
He said some long-insured professionals might drop coverage. In his case, he said, the 2015 rate increase amounts to $6,500 in additional annual premium costs.
"I can't make any kind of firm estimate but basic economics says for every increment costs go up we lose people from the market," he said.
For others like Liu, the exchange meant less coverage for him and his wife, who didn't want to exceed the $300-a-month premium they had been paying. They agreed to higher deductibles and co-pays instead.
"I won't know the bottom line out-of-pocket costs until I start getting bills," said Liu, who has a chronic neck condition. "So I guess I'll see how much the condition will financially hurt me when the non-insurance-paid-for costs start rolling in. Ultimately, I might have to pay more for a pricier plan down the road."