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Health exchange works to counter confusion over Obamacare

Major last-minute changes at the federal level to the Affordable Care Act and additional rate increases at the state level threaten to undermine enrollment in health insurance this year, but Maryland health exchange officials are sticking to a goal of signing up at least as many people as last year.

The exchange, where people who do not get insurance through work can buy coverage, enrolled more than 140,000 people in private plans and about 280,000 in the expanded Medicaid program during the last year's enrollment period for 2017 insurance coverage.


The officials say they will rely on improved technology and targeted marketing to reach consumers and persuade them to re-enroll or sign up for the insurance known as Obamacare.

Andrew Ratner, the Maryland exchange's chief marketing official told members of the exchange board Monday, during its last regular meeting before enrollment begins Nov. 1, that messages from federal authorities are "contributing to consumer confusion."


President Donald Trump announced two measures last week that could undermine the health law — one that allows insurers to sell cheaper plans that don't comply with Obamacare's guaranteed benefits, and another one that would eliminate out-of-pocket subsidies for some enrollees.

The administration already had reduced the open enrollment period from 90 days to 45 days and slashed the budget to promote the federal marketplace that serves a majority of states.

Enrollment on the exchange dropped by about 3 percent last year in Maryland, but Ratner said a mobile app, enrollment promotion events, and marketing in movie theaters, shopping malls and online can help Maryland recapture its market.

Despite Trump's decision to end one Obamacare subsidy to insurance companies last week, Ratner emphasized that more than three-quarters of those buying private insurance on the exchange still will get subsidies that help them pay for premiums, and those subsidies go up with higher rates.

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The out-of-pocket subsidies, known as cost sharing reductions, that Trump is eliminating went directly to insurance companies, meaning consumers would not feel the pinch.

To compensate the insurance companies, state regulators now are deciding whether to allow a hefty last-minute increase in the rates they charge consumers for plans. They have not said when they would decide and board members, including Al Redmer Jr., the state's insurance commissioner, were mum on the issue during the meeting. Redmer did not respond to a request for comment.

The jump in rates, which already averaged 50 percent for the majority of policies because of multimillion-dollar losses by insurers in the Obamacare marketplace, would fall on the 20 percent to 25 percent of enrollees who earn too much to qualify for subsidies and pay full freight.

Ratner acknowledged some of those people could drop out of the market because the plans are no longer affordable, or cost so much that paying out-of-pocket for care could be cheaper. The Trump administration also has indicated that it may not enforce the individual mandate under the Affordable Care Act that requires everyone to get insurance or face a penalty.


Redmer previously said he would revisit the rates if the out-of-pocket subsidies were eliminated.