As Maryland enters the second year of enrollment for subsidized health insurance under the Affordable Care Act, we might ask this question: Is anybody feeling better? I don't mean about the ACA, or Obamacare, though we'll get to that subject in a moment. I mean, has the ACA made anyone healthier?

"Here's a good, concrete example of that," says Dr. Peter Beilenson, president and CEO of Evergreen Health Co-Op, which sprang to life for the ACA rollout and which does something unique: It provides doctor care as well as insurance.


"Out-of-control diabetics," Beilenson says, referring to approximately 30 patients who enrolled in Evergreen last year and who had dangerously high glucose levels in their blood. "Of those high-cost diabetic patients who came to us, there's none who has not brought [their blood glucose level] down and gotten it under control. And we achieved that with health coaching on-site, at our care centers, with doctor's visits, better nutrition, that kind of thing."

This was the original idea of Evergreen, a nonprofit insurance plan with salaried doctors, nurses and social workers at care centers in Baltimore, White Marsh, Columbia and Greenbelt. The way Beilenson envisioned it, Evergreen's emphasis would be on prevention, getting its members to develop healthier lifestyles. He is a physician, after all, and the former chief health official for Baltimore City and Howard County, where his Healthy Howard initiative took the same approach.

Because of the effectiveness of Evergreen's personal health coaching on the high-risk diabetics, none required hospitalization. Nor did Evergreen have to lease digital devices for the home-monitoring of the blood glucose of its patients. All that, plus the use of simpler tests, meant a significant savings for Evergreen and its customers, Beilenson says.

So Evergreen provides at least one example of how Obamacare was meant to work at its most progressive.

But it also provides an example of how terribly wrong things went in Maryland a year ago.

Because of the botched launch of the state's online health insurance exchange, Evergreen missed its first-year enrollment goals by thousands. Beilenson and his colleagues were hoping for 10,000 customers by last April; they ended up with only 450.

Evergreen was a startup competing against established insurance providers, including the dominant player, CareFirst BlueCross BlueShield. Despite having received a $65 million federal loan to establish itself as an insurance co-op under the ACA, Evergreen was prohibited from using any of that money for advertising.

If you saw Beilenson in television commercials last year, it's because Evergreen raised additional funds to pay for them.

Clearly, Beilenson was frustrated with Maryland's health exchange — not only were potential customers locked out when they tried to sign up, but the site appeared to favor other providers over Evergreen in how it presented premiums, deductibles and services to the public.

That was then, and this is now.

"I've shopped on the [new] site many times and it looks good," Beilenson says of the revamped Maryland Health Connection, the online insurance market. "People will be able to enroll easily. The question is, will people come?"

Yes, after the rollout mess, many might be leery of sitting at a computer and trying to enroll. That includes the thousands who persevered last year; they must sign up again.

As for Evergreen, Beilenson reports some interesting things about how his co-op adapted after the Maryland debacle and disappointing enrollment: It provided health services to patients covered by other plans. It also proposed helping the Veterans Administration reduce its backlog of veterans waiting for doctor visits. Beilenson says 225 veterans came to Evergreen care centers in the last two months.

Taking patients on other health plans runs counter to the original Evergreen concept, but it has helped the co-op get through a rocky year on the way to the second sign-up period.


Which is where we are now, and Beilenson is optimistic that more Marylanders will discover what his co-op has to offer. At the present rate, he predicts Evergreen will have at least 8,000 members by the end of the year.

"We are competitive in the small-group market," Beilenson says, referring to businesses and other organizations whose employees are seeking insurance through the exchange. "People have started hearing about us, a lot of them by word of mouth, and there will be some radio ads this week."

Beilenson believes there will be two surges of enrollment — the one happening now, as Marylanders respond to the state's new and presumably improved online market, and another after the holidays, when individuals and families hear about the federal tax penalties they will face if they do not get insurance.

Despite legal attacks and repeated Republican efforts to repeal the ACA, Beilenson thinks its central structure is here to stay.

"Obamacare is the single most important thing in health care in my lifetime," Beilenson says. "Take the [rollout] incompetence out of it, and people will see the benefits of Obamacare, the health care they would not have gotten otherwise."

Dan Rodricks' column appears each Tuesday, Thursday and Sunday. He is the host of "Midday" on WYPR-FM.