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Obamacare enrollment up in Maryland, despite uncertainty

Amid uncertainty about the future of the national health care law, record numbers of Marylanders signed up for coverage this year, according to figures released by the state Wednesday.

In what could be the final enrollment period of the Affordable Care Act, nearly 432,000 Maryland residents signed up for the law's various offerings, up 7.5 percent over last year.


All of that growth came from new Medicaid participants. The number of people buying into private plans declined 3 percent.

Though national enrollment figures are not expected until later this week, early indications point to a slight increase across the United States, even as President Donald J. Trump and congressional Republicans move to repeal President Barack Obama's signature health care legislation.


Republicans are eager to do away with the law but are divided over what to do about the millions of Americans who are now benefiting from it.

Nearly 8.8 million people signed up for private coverage through Jan. 14 in the 39 states where exchanges are run by the federal government, about 100,000 more than at the same point in last year's enrollment period. Maryland is one of 11 states that oversees its own health insurance marketplace.

Democrats and other supporters will argue that any increase in enrollment shows that Obamacare has been effective, despite years of sustained criticism.

"These numbers show there's a continued demand for affordable health care in Maryland and other places," said Sen. Chris Van Hollen, who supported the health care law as a member of the House of Representatives. "It also shows that repealing the Affordable Care Act will create havoc throughout the health industry and on people's lives."

Still, prior enrollment increases have done little to quiet the constant political opposition since Democrats passed the law in 2010. Trump was clear throughout his campaign that repealing the Affordable Care Act would be a top priority. He won the election, and voters kept Republicans in control of Congress to help him carry out the goal.

Rep. Andy Harris, a physician who ran for election in 2010 on a promise to fight the law, said it never lived up to Obama's sales pitch.

"Obamacare has failed to live up to most of the promises made, such as 'If you like your doctor you can keep your doctor' and 'If you like your plan, you can keep your plan,'" the Baltimore County Republican said.

On the day Trump was inaugurated, he signed an executive order aimed at curtailing federal agencies' ability to implement the law. His Department of Health and Human Services pulled advertising last week and temporarily stopped other efforts to boost enrollment.


Supporters of the law say those moves were intended to drive down interest.

"The Affordable Care Act is working for millions of people, despite President Trump's attempt to dampen enrollment by canceling advertising reminding people that the deadline for open enrollment was nearing," said Ron Pollack, executive director of Families USA. "The numbers speak for themselves."

Republicans on Capitol Hill are deeply divided about how and when to repeal the law, and what to replace it with.

Health care costs were growing long before Obamacare, and many Americans and businesses were dissatisfied with lifetime coverage caps and the ability of an insurer to deny coverage for pre-existing conditions.

Trump said before his inauguration that he would provide "insurance for everybody," but he has offered no details on how he would accomplish such a goal.

GOP lawmakers are now in a political bind: They are under pressure from the right to make good on long-standing promises to repeal the law, but they are concerned that a sudden move could have unpopular repercussions in a complicated insurance market.


Enrollment in Maryland grew by about 30,000 people to just under 432,000, the Maryland health exchange reported.

The number signing up for private plans dropped slightly to about 158,000. But more people qualified for an expansion of Medicaid, pushing the total on those rolls to 274,000.

That will further reduce the rate of uninsured in the state, which had already declined from 10 percent in 2012 to 6.7 percent in 2015.

Maintaining coverage for those families will be difficult without continued federal funding. State legislative analysts have said repeal of the health law would cost Maryland nearly $2 billion in Medicaid funding alone.

The majority of people in private plans also receive federal subsides to help offset the cost of their premiums.

Advocates called on Republican Gov. Larry Hogan and state lawmakers to step up the pressure on Washington and consider what can be done on the state level.


Vincent DeMarco, president of the Maryland Citizens' Health Initiative, said the increase in enrollment in Maryland and projected increases nationwide show the law is a success.

"It would be a terrible tragedy for Congress and the Trump administration to repeal or weaken it," he said.

"Frankly, I don't think they will. How can they throw 20 million people off their health care? It would just be immoral and a political disaster."

Bradley Herring, a health economist at the Johns Hopkins Bloomberg School of Public Health, said there will likely be some kind of coverage available next year for those who have recently signed up.

But he said the plans could be far more expensive, especially if the GOP succeeds in eliminating a requirement that everyone, including younger, healthier people, purchase coverage to help spread the insurance risk.

Insurers have blamed large premium increases partly on an unexpected number of older, sicker enrollees.


With so much uncertainty, Herring said, insurers that didn't sell a lot of policies on the exchange might be tempted to walk away while dominant carriers continue selling policies.

"But they would likely react by getting a lot more conservative and raising rates," he said.

Insurers will be required to begin telling state regulators in the spring if they will sell policies on the exchange.

Exchange officials said they were pleased by the turnout, given a significant increase in premiums on private plans and the loss of an insurer on the exchange.

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"Consumers had uncertainty, too, they told us, which played a part," said Andrew Ratner, an exchange spokesman.

The exchange never stopped marketing the health coverage, and worked with advocates and others, including faith-based organizations, to help people sign up.


They also added a mobile app, popular with younger enrollees, who made up about 30 percent of those who bought private plans.

Jonathan Kromm, acting executive director of the exchange, said officials expect to work over the next couple of months to plan for the next open enrollment.