State Health Exchange Enrollment Up, Federal Enrollment Down

Dec. 10--As the state health exchange enters the final week of this year's open enrollment, Marylanders appear more interested in buying health insurance than many other Americans.

The number of people buying private policies through the state's online marketplace created under the Affordable Care Act is up a bit, while enrollment on the federal exchange that serves 39 states is down 11 percent.

"We're not done yet," said Michele Eberle, executive director of the Maryland Health Benefit Exchange, which oversees the state marketplace. "But we're hoping for a really strong ending."

This year, the program covered 11.8 million Americans, including about 150,000 Marylanders, who do not get their insurance through work. Program managers and advocates in the state say they hope to get more consumers to sign up for coverage for next year in the final days of the enrollment period, which began Nov. 1 and ends Saturday.

They say the program has survived repeated blows by Republicans who do not support the federal health law, known as Obamacare. That likely took a toll elsewhere, even as lawmakers and policymakers in Maryland, along with some other states, worked to protect their insurance markets and make insurance more affordable.

For example, the Trump administration cut funding for enrollment assistance to about $10 million, down from $63 million two years ago. Maryland has doubled its paid advertising to about $2 million and maintained funding of about $10 million for its navigator program, which pays for 115 consumer assistance workers. The state exchange also allows people to enroll all year in Medicaid, which has expanded the number of Marylanders insured through the government health program for the poor by about 250,000.

When the Trump administration did away with federal subsidies that were helping hold down premiums nationally, the Maryland General Assembly passed a reinsurance program that provided relief for insurance companies from the biggest users of medical services so they could reduce premium costs.

Maryland lawmakers have also floated a plan to require residents to have health insurance, possibly joining New Jersey and Massachusetts. This would replace the mandate in the Affordable Care Act repealed by Congress effective Jan. 1 that required those without insurance to pay a tax penalty.

There could also be outside factors in declining enrollment nationally, such as a low unemployment rate that means more people are getting insurance on the job rather than the exchange.

But Leni Preston, vice president of the advocacy group Consumer Health First, said there are clear reasons Maryland appears on its enrollment target. She specifically cited the increase in the exchange marketing budget and the state's reinsurance program.

"That, combined with its overall commitment to reach all eligible Marylanders, should make a substantial difference in our state," she said. "While we will not know the full outcome of these efforts until after Dec. 15, Consumer Health First believes that everything is on track for a successful year."

Costs do remain high for many consumers, especially the 25 percent of exchange buyers who do not qualify for any federal subsidy to help pay premiums. Preston also noted that the reinsurance program is temporary and needs a permanent funding source.

She and others are hoping that consumers, many of whom wait until the last week of open enrollment, will shop around for the best deal because the amount rates declined was different from plan to plan.

The Maryland Insurance Administration, which regulates prices, and MedChi, the state medical society for doctors, also recommended shopping around. MedChi specifically suggested checking that family physicians are in network and that needed medications are on approved lists. Also, the officials said, calculate co-pays and deductibles and consider paying a higher premium to lower those out-of-pocket costs.

People signing up for plans got help in several enrollment fairs over the weekend. At the Howard County Health Department in Columbia on Saturday, consumers were aided by the navigator group HeathCare Access Maryland.

Alex Karadimas, a restaurant server and bartender from Ellicott City, sat filling out forms in the crowded waiting area after having problems renewing his plan online.

"I just decided to come here and hopefully get it taken care of," the 30-year-old said. "I don't have any access to health care through the restaurant."

Because of his income level, Karadimas said, he qualifies for a Medicaid subsidy and ends up paying very little for insurance. But the policy doesn't cover treatment for some more serious ailments, such as rehabilitation from a chiropractor for a shoulder injury. For that, he pays out of pocket.

Karadimas said he wasn't aware he would no longer face a tax penalty if he doesn't sign up. He planned to look into that before deciding.

"If I'm not going to get fined, I can go without it for a while," he said.

Since graduating from college, Jakob Musick has not been able to find work that offers health insurance. The 27-year-old stayed on his parents' insurance plan until he was 25, then signed up for a plan in Florida where he was working as a server but has become unemployed. He recently moved back home with his parents in Cooksville, in Howard County, and is looking for a job in journalism. He came with his mother to Saturday's enrollment fair looking for options for when his Florida plan ends Dec. 31.

"I don't know really now what I need to do, or if I would be eligible for Medicaid next year," Musick said. "We're coming here to try to figure that out."

Musick said he was hoping for better options than his current Florida plan. "It is very expensive," he said, especially after he became unemployed. "I was only able to afford it with the help of my family."

Zachery Epps, 60, recently started his own trucking company and signed up for a new policy through the state's marketplace Saturday.

"This is my first time dealing with it, and they were very helpful," Epps, who lives near Woodlawn, said on his way out of Howard County's health department. The plan he ended up with "covers everything I need."

Health care turned out to be a major campaign issue for consumers in the midterm elections, helping propel Democrats to a majority in the House of Representatives, where support for the health law is now more assured. A Kaiser Family Foundation poll after the election found a slight uptick in overall favorability of the law to 53 percent.

But challenges remain. The national poll found the public was largely unaware of the open enrollment period. Only 24 percent knew of the Dec. 15 deadline to enroll. And about 40 percent of adults who buy their own insurance or are uninsured said they will forgo coverage next year.

The law also faces a pending lawsuit from Texas that challenges the law's protections for pre-existing medical conditions, a popular element of the law.

A big drop in the number of people insured, particularly young, healthy people, could drive up costs for everyone with insurance, whether they buy on the exchange or not. In Maryland, when uninsured people use emergency rooms and can't pay their bills, other hospital patients pay more to make up for the losses. In other states, people pay higher taxes to cover that uncompensated care.

Advocates say they hope consumers see value in buying a plan. Traci Kodeck, president and CEO of HealthCare Access Maryland, said people should seek out help as the deadline approaches.

"Rates for insurance plans are lower this year, and we are helping people shop around for the plan that is best for them," she said. "There is time for people to sign up before the Dec. 15 deadline. We have navigators in locations throughout the region who are experts. And we urge people not to wait until the final deadline to get started."

Baltimore Sun reporter Lorraine Mirabella contributed to this article.

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