When the numbers came in at the end of open enrollment on the state’s health insurance exchange this year, they were big, even record-breaking. But something else was apparent to workers in their 11th year of persuading holdouts to buy a plan.

It was working.

There were larger-than-usual gains in groups disproportionately lacking health coverage. The number of Black people who signed up for insurance jumped by 33% to more than 41,600. Enrollment by Hispanic people grew by nearly 30% to about 28,700.

The increase was particularly strong among young Black and Hispanic adults. Young adults generally showed up for insurance this year, too. They tend to get really sick far less frequently and are particularly coveted by insurers to balance risks and keep rates lower.

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Reaching those disproportionately uninsured Marylanders was “particularly gratifying,” said Andrew Ratner, chief of staff for the Maryland Health Benefit Exchange, which operates Maryland’s online insurance marketplace, before a news conference Thursday announcing the results.

Created under the Affordable Care Act, and often referred to as Obamacare, the exchanges have been derided by conservatives. Some uninsured people have resisted buying a plan because they think they’re not worth the cost or don’t know how to sign up.

After dropping from about 12% uninsured in Maryland to about 6% several years ago, numbers had plateaued.

The officials were not sure exactly why they had such success getting certain groups insured through the exchange, or how much the overall uninsured rate will go down — the undocumented immigrants making up a big share cannot sign up for exchange plans unless they are pregnant.

The increases may be due to a confluence of efforts by state lawmakers, exchange officials and an army of so-called navigators who have conducted extensive outreach. The state has also boosted subsidies, stabilized the insurance market burdened with high-cost patients, and made it simple to get information about choosing a plan through tax and unemployment forms.

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The coronavirus pandemic led to several rounds of special enrollment periods for people who were sick or feared becoming sick from the novel and deadly virus.

And certainly, approximately half of the record-breaking increase in enrollment this year was from people who lost Medicaid coverage once the public health emergency ended.

But groups working to enroll people in coverage in private plans said the push this year was extensive to reach the underserved Black and Hispanic residents, as well as those living in rural parts of the state.

“We’ve gone to hundreds of community events,” said Traci Kodeck, CEO of Healthcare Access Maryland, one of several groups contracted by the state exchange to find and enroll residents. She said workers showed up at food and naloxone giveaways and even one place giving free haircuts. Another stop was at a special photo-with-Santa day.

In all, the Maryland exchange signed up nearly 214,000 people for coverage this year, a 17% jump. That mirrored enrollment nationwide. About 20 million Americans enrolled in plans in one of the 18 states and Washington, D.C., with their own marketplaces. That’s an increase of 3.7 million for 2024.

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Michele Eberle, executive director of the state exchange, said all the outreach, plus subsidies to help with the cost, likely had a lot to do with it this year’s success.

“In Maryland, we have worked very hard to keep health coverage affordable, especially as the continuous coverage for Medicaid ends,” she said.

With thousands losing their coverage through Medicaid, the federal-state health plan for low–income people, there will be more outreach needed to ensure they know they can get low-cost exchange plans.

People can enroll in Medicaid year round and during a special enrollment period if they are cut from that program, said Ryan Moran, deputy Maryland health secretary and state Medicaid director.

“We’ve made a goal that no one would lose coverage” due to unwinding of people from Medicaid, Moran said.

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Shelly Eldridge said the exchange is also good for people like her, who don’t want to stay in a job just to keep their health insurance.

She recently left a job to launch Shelly the Confidence Coach, which helps people achieve personal and professional goals. She said she used to pay $400 out of her paycheck for insurance. She was offered a temporary continuation of coverage when she left that position costing $900.

“When a woman at the Maryland Health Connection told me I would pay $29 a month, I cried,” she said. “How many people feel they can’t follow their dream because they don’t know if they have health insurance?”

This story has been updated to include Washington, D.C., as offering its own marketplace along with 18 other states.

Meredith Cohn is a health and medicine reporter for The Baltimore Banner, covering the latest research, public health developments and other news. She has been covering the beat in Baltimore for more than two decades. 

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