Obamacare open enrollment begins amid pandemic, Supreme Court challenge

Maryland will open enrollment Sunday for health insurance plans created under the Affordable Care Act amid a rise in coronavirus cases and a looming Supreme Court challenge to the law.

Demand is expected to be high as a result of the pandemic, which has infected more than 143,000 Marylanders and put tens of thousands out of work.

About 80,000 people signed up for immediate coverage of what is often called Obamacare during a special enrollment period started in mid-March on the Maryland Health Exchange, swelling the rolls of private insurance sold through the online marketplace and of Medicaid for low-income residents.

The open enrollment period will be open until Dec. 15.

Exchange officials and advocates say there is no indication people are being put off by the latest challenge to the law before the Supreme Court, with arguments scheduled for a week after the enrollment period begins.

“The Affordable Care Act has survived many challenges,” said Vincent DeMarco, president of the Maryland Citizens' Health Initiative, which supported a state measure to make it easier to enroll. “It’s working well, and people understand that."

The court will review the case, Texas v. the United States, to determine whether it remains constitutional without the “individual mandate” that had required all Americans to buy coverage. Republicans in Congress, who object to government involvement in health care or costs, eliminated the penalty under the mandate in 2017, and the justices agreed to review whether any of the law still can stand.

The law, which provides insurance to more than 20 million Americans, has retained wide support in Maryland, according to Michele Eberle, executive director of Maryland Health Benefit Exchange, which operates the marketplace.

She noted that when Republicans also cut off a key subsidy to help insurers pay for the costliest beneficiaries, the Maryland General Assembly stepped in with its own program that has lowered rates by more than 30% over the past three years. That offset the cost of premiums that had chased carriers and enrollees from the program.

UnitedHealthcare returned to the marketplace this year, bringing the number of carriers to three in many counties. CareFirst Blue Cross Blue Shield and Kaiser Permenente are the other insurers.

“We know there is great demand,” said Eberle, citing the special enrollment period aimed largely at people who had lost their employer-provided health insurance during the pandemic.

There are currently 160,000 people enrolled in private plans through the exchange, up 19% from a year ago, and 1.16 million in Medicaid, up 6% from a year ago. People can enroll year-round for Medicaid, but typically must sign up for private plans during a fall open enrollment period for the following year.

This year, however, the special enrollment period to acquire insurance immediately for those who lose jobs during the pandemic began in March and has been extended until mid-December.

Eberle said a study during the summer affirmed the coronavirus was the driver for many to seek coverage. Nearly 60% said they were more likely to seek insurance now than before the pandemic. For African Americans, disproportionately hit by the virus, 66% were more likely to want the coverage.

“We know that thousands have lost health coverage after losing jobs during the pandemic,” Eberle said. “Estimates of loss of health coverage in Maryland this year range from 65,000 to 195,000, according to analysis by our agency and other organizations.”

She also said she believed people were anxious about the continuation of the Affordable Care Act, which provides coverage to the uninsured but also benefits those with employer coverage. The benefits include allowing children to remain on their parents' plans until they are age 26, covering some preventive care and eliminating some coverage caps. The vast majority of people with exchange coverage also receive subsidies to cover premiums.

The outcome of the Supreme Court case is uncertain, said Jonathan Weiner, a Johns Hopkins University professor of health policy and management.

Weiner said the justices, even with a stronger conservative majority, could preserve some or all of the law.

If they strike it down entirely, Republicans in control on Capitol Hill could offer a modest replacement, including some means of covering those with pre-existing conditions, such as the 9 million Americans already infected with the coronavirus.

If Democrats take control next year, they also could replace or enhance regulatory or legislative provisions.

There is a cost when people don’t have health insurance, Weiner said. In Maryland, hospitals raise overall rates to cover the uninsured who need care.

“If the worst should happen,” he said, “Maryland is an innovative, forward-thinking state and it will undoubtedly undertake some legislative and regulatory actions to help fill the health insurance void the best it can on its own.”

To review available plans and sign up for coverage, residents can visit marylandhealthconnection.gov, download the “Enroll MHC” mobile app or make a toll-free call to 1-855-642-8572 toll-free from 8 a.m. to 6 p.m. weekdays. More than 700 trained brokers and navigators are available to help and many communities plan to host virtual events to help people secure coverage.

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