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story.lead_photo.caption Cornelius Mabin and Rumel Driver, health insurance navigators, discuss provider information Wednesday at the Laman Library in North Little Rock while waiting to assist people in signing up for or renewing Patient Protection and Affordable Care Act coverage. The law’s fifth annual enrollment season began Wednesday, and navigators for the Arkansas Health Insurance Marketplace will set up at various locations throughout the 45-day sign-up period. - Photo by Benjamin Krain

WASHINGTON -- Despite Republicans' attempts to tear down the Patient Protection and Affordable Care Act, the law's fifth annual insurance enrollment season began Wednesday morning, opening a 45-day window in most of the country for eligible consumers to buy health plans for the coming year.

As of 6 a.m. Central time,, the federal website on which Affordable Care Act marketplaces in 39 states rely, went from previewing insurance options to saying, "2018 Open Enrollment is here."

Unlike the past four years, when President Barack Obama's administration marked the arrival of each signup period with considerable hoopla from the White House on down, President Donald Trump and his health care advisers limited their statements about the start to a single tweet Tuesday afternoon from the Health and Human Services Department.

The uncustomary quiet -- federal health officials have slashed by 90 percent the government's spending on advertising and other strategies to spotlight the law's marketplaces -- is one of several dynamics prompting widespread predictions that fewer Americans will end up with coverage. Signups swelled during each of the marketplaces' initial years. They dipped slightly to 12.2 million for 2017, a decrease that appears to have been caused by a slowdown during the enrollment period's final days when Trump took office and his administration pulled much of the planned outreach campaign.

For the latest enrollment, recent surveys suggest that many Americans are confused about whether Affordable Care Act insurance still is being sold and that the vast majority of uninsured people eligible for such coverage don't know that now is the time to buy it. The law's marketplaces provide access to insurance to people who cannot get affordable health benefits through a job. More than 8 in 10 qualify for federal subsidies to defray the cost of health plans' premiums.

This lack of awareness is especially problematic, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, given insurers' continued departure from the marketplaces in parts of the country and the "unusual ways" monthly premiums are changing before subsidies are taken into account.

"It's going to be very important [for people] to go onto the marketplace site and see what their situation is going to be," she said. And with the enrollment period on cut in half from three months -- Dec. 15 is now the deadline for the federal exchange -- "waiting until the last minute is not a good idea. If people are used to waiting until after the holidays, they will be very disappointed. They won't be able to get insurance for 2018."

Consumers who already have Affordable Care Act coverage will have special trouble if they wait for the federal exchange to re-enroll them automatically. In previous years, they had several weeks to switch or drop plans after autoenrollment in mid-December. But there is no longer time available to make such changes; the renewals will be done the day after the signup season ends.

In the absence of a robust federal enrollment campaign, Democratic members of Congress, activists, local officials and several celebrities began a major push Wednesday at events across the country.

In Nashville, Tenn., Democratic Mayor Megan Barry joined Grammy Award-winning musicians Bill Lloyd, Ashley Cleveland, Gary Nicholson and Todd Sharp at a "Health Care Rocks" event. In New York City, Democratic Mayor Bill de Blasio planned to gather with other local officials, representatives from Planned Parenthood and others in the atrium of Harlem Hospital.

Supporters of the law will tweet with the hashtag #GetCoveredNow to spread the word that enrollment is underway, and former Health and Human Services Secretary Kathleen Sebelius, who oversaw the rocky beginnings of four years ago, planned to speak to the media about the importance of sign-ups.

Information for this article was contributed by Colby Itkowitz of The Washington Post.

A Section on 11/02/2017

Print Headline: Enrollment for health care underway

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