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Health Sign-Ups Show Staying Power     12/16 11:05

   WASHINGTON (AP) -- A deadline burst of sign-ups after a tumultuous year for 
the Obama health law has revealed continued demand for the program's subsidized 
individual health plans. But the Affordable Care Act's troubles aren't over.

   On the plus side for the overhaul, official numbers showed a sizable share 
of first-time customers, 36 percent, were among those rushing to finish applications in the run-up to Friday's enrollment deadline.

   "People need health care, that is plain and simple," said Kevin Watkins of 
Florence, Alabama.  A self-employed consultant helping small businesses sell 
online, Watkins re-enrolled for 2018. He'll pay under $100 a month after 

   Final national enrollment numbers aren't expected until next year because 
some states running their own insurance websites extended sign-ups to Jan. 31. 
States in charge of their own programs are striving to equal last year's 

   Enrollment in the 39 states served by is expected to be 
lower, which could intensify criticism of the Trump administration's decision 
to cut the federal sign-up season in half. The administration has extended the 
deadline for some people to finish their health insurance: Callers to the service center on Saturday morning got a recorded message saying 
"don't worry" --- if they had left their phone number before the deadline, they 
will get a return call and still can enroll for 2018.

   Nationally, 12.2 million people had enrolled by the end of the Obama 
administration's final sign-up period. Under Trump, there could be 1 million to 
2 million fewer sign-ups, said Larry Levitt of the nonpartisan Kaiser Family 

   Still, it was only a year ago that the health law seemed headed for oblivion 
as Donald Trump swept into the White House with a Republican-controlled 
Congress. Now its full repeal seems to be off the table. But the program for 
people who don't have job-based coverage faces the same old challenges of high 
premiums and declining insurer participation, along with some new ones.

   One new challenge comes from the GOP tax bill, which repeals the law's 
requirement that people have health insurance or risk fines.

   Parallel to that, the administration is preparing to issue rules 
facilitating the sale of lower-cost insurance plans that will deliver less than 
the law's "essential" benefits package.

   Put the combination together and experts say it will draw healthy customers 
away from already shaky ACA insurance markets, raising premiums for those left 
behind and giving insurers new reasons to drop out.

   The law's supporters were still upbeat as the shortened open enrollment 
season in most states wound down.

   "What we are seeing is that this insurance is meeting people's needs and it 
is affordable if you receive financial assistance," said Elizabeth Colvin of 
Foundation Communities, a nonprofit in Austin, Texas, that helps low-income 
people enroll. "So much of the story has been telling people that the ACA is 
not working. That's not the reality in central Texas."

   It was Trump who most notably predicted a spectacular collapse for the law.

   "It's imploding, and soon will explode, and it's not going to be pretty," he 
said this year.

   After a repeal failed in Congress, Trump stopped payments to reimburse 
insurers for subsidizing copayments and deductibles, thereby boosting premiums. 
His administration also cut the federal open enrollment season in half, slashed 
the ad budget and pulled back money for counselors who help people sign up.

   But as premiums increased, financial assistance also went up for those 
eligible. Under the law, their premiums are limited to a percentage of 
household income, so those who qualify for help are cushioned from premium 

   Instead, the full impact of rising premiums hit an estimated 8 million to 9 
million people who buy individual health plans but aren't eligible for 
income-based assistance.

   "I am at my wits' end," said Kris Case. "I would love to have health 
insurance, but it's like a luxury. Every year it's gotten more expensive."

   The Denver-area resident, who's in her 50s and doesn't have coverage through 
her job in client relations for a startup, says she's seen premiums as high as 
$1,400 a month.

   Ongoing turmoil will translate to demands for Congress to act. But with 
lawmakers divided by party and faction, it's not certain what can be done.

   "Any thought of 'repeal and replace' is clearly gone," said health economist 
Gail Wilensky, who served in a previous GOP administration. Alabama voters' 
election of Democrat Doug Jones to the Senate underscores that, she said. 
"Undoing something that has been in place now for close to four years is not a 
practical way to resolve issues."

   Pending legislation could have contradictory consequences.

   Many experts believe the GOP tax bill's repeal of the insurance mandate will 
undermine markets by giving healthy people an out.

   But other measures would tend to stabilize insurance markets. One is a 
bipartisan Senate bill that would restore insurer subsidies cut by Trump. The 
other proposals would provide money to help insurers cover the care of 
high-cost patients.

   Meanwhile, one of the most visible symbols of the health law seems to be 
doing just fine. Once prone to crash, the website has been 
humming along amid the crush of deadline week sign-ups, according to a 
performance analysis by the technology firm Catchpoint for The Associated Press.

   "It's like an e-commerce website on Black Friday," said Catchpoint CEO Mehdi 


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