Obamacare signups surging in Pa., N.J. and nationally. Will it last?

People around the Philadelphia region, like consumers around the country, are rushing to sign up for health insurance under the Affordable Care Act, also known as Obamacare, advocacy groups reported Friday.

More than 600,000 people nationally selected insurance plans in the first week of the annual open enrollment period — a pace that could be double last year's signups early on. Given that President Trump and congressional Republicans  have spent the past year attacking and trying to dismantle President Barack Obama's signature law, that is stunning many observers.

State enrollment figures were not available, but local health-coverage advocates reported strong interest. Calls to the Pennsylvania Health Access Network's help line were running at roughly double the pace of last year's first week, as were the number of consumers who enrolled with the organization's help, said Antoinette Kraus, executive director of the nonprofit.

Still, the rapid pace may not mean that more people get insurance through the ACA marketplace this year. That's because the Trump administration cut the enrollment season by half — it will end on Dec. 15 — and slashed federal funding for marketing, which many consider crucial to reaching younger and healthier people, who tend to sign up later and cost insurers less to cover. The actions have led to widespread confusion.

"In the past, we saw a surge in enrollment at the end of the enrollment period but that was largely due to advertising, which the feds will not be doing this year. What is happening now is a good sign, but we are still very concerned that enrollment will be significantly depressed," said Raymond Castro, director of health policy for New Jersey Policy Perspective.

Assistance is available but you have to know where to look.

The big numbers for the 39 states that use the federal website for enrollments in subsidized insurance cover Nov. 1 to 4. On Election Day, the Trump administration's efforts against the ACA ran into a backlash. Maine voted overwhelmingly to expand its Medicaid program under the Affordable Care Act, and Democratic victories increased the likelihood that Virginia would do the same. Political observers attributed turnout for Democratic candidates elsewhere in part to growing public interest in making health care more accessible and affordable.

Trump also tried to chip away at Obamacare by ending the cost-sharing payments that allow insurers to reduce out-of-pocket costs for lower-income customers. But what really happened was far different. Most people who buy their insurance on the exchanges receive federal subsidies, which the law designed to increase as premiums rise. For that reason, many purchasers will experience none of the huge rate increases that have been widely reported — while the government will pay billions more in subsidies.

Insurance companies are required to send letters to consumers about rate increases, and many were shocked by what they received some weeks ago, Kraus said. But that was before many learned that thanks to the higher federal subsidies, they could buy better plans for the same or less cost.

The Trump administration's own data show that 80 percent of purchasers in Pennsylvania can now buy the lowest-cost plan, effective Jan. 1, for less than $75 in monthly premiums after tax credits, compared with 59 percent last year. In New Jersey, 61 percent will be able to get plans for less than $75, up from 54 percent last year.

"Instead of turning people off, [the partisan debate] has really gotten people's attention," said Joel Ario, who was Pennsylvania insurance commissioner under Gov. Ed Rendell and Obama's first director of the insurance exchanges that sell the plans. Now a managing director at Manatt Health, he left the government job two years before the debacle of Healthcare.gov's initial rollout.

Losing out, he said, will be people who earn too much to qualify for subsidies (more than $48,000 for a single person, $98,000 for a family of four), who will bear the full brunt of rate increases that grew significantly to make up for the loss of federal cost-sharing payments.

Ario had high praise for how Pennsylvania's insurance department prepared for the Trump administration's last-minute policy changes. The state insisted that insurance carriers create plans available off the exchange, without subsidies, that could be directly compared with the subsidized plans. That means consumers here will have among the best options as well as the most help making choices in all but a handful of other states, he said. The insurance department also worked with an independent "Ralph Nader-kind of operation," as he called the Consumers' Checkbook website.

It goes well beyond what the federal HealthCare.gov site offers by directing consumers to plans both on and off the exchange, with and without subsidies, by calculating their financial information and other details. (In his work as a consultant, Ario represents a private health-care company, Stride Health, that he said got a link this week from Pennsylvania's insurance department-based Checkbook based on the usefulness of its own insurance-sales site.)

New Jersey, too, offers consumers high-quality assistance through CoverNJ.org, a site run by New Jersey Citizen Action.

What is different there, said Maura Collinsgru, health care program director for the advocacy group, is that Republican Gov. Christie's administration, unlike that of Democratic Gov. Wolf's in Pennsylvania, "has done nothing to promote the ACA open enrollment." Still, she said, the initial response has been strong.

The Philadelphia area has excelled at enrollment in the past. During the first year of Obamacare, in 2014, federal data that compared regional achievements showed that Southeastern Pennsylvania's well-coordinated efforts by local organizations offering assistance to consumers had achieved the second-highest percentage of potential signups among regions across the country. (Miami was then No. 1.)

Back then, the entire concept of shopping for health insurance online was new and hard to grasp, and the website was a major embarrassment for Obama with real political consequences. Now, the site is working smoothly; its success in the face of intentional disruptions could be viewed as an embarrassment to Trump.

"People are not giving up," said Suzanne Cohen, a spokeswoman for the Health Federation of Philadelphia, which offers enrollment assistance.