Crunch time again for health law; sign-up deadline is today

WASHINGTON -- It's crunch time to sign up for coverage under President Barack Obama's health care law. The website works much better now, but rising premiums and shaken faith among insurers have cast new shadows.

Today is the deadline for millions of uninsured procrastinators to sign up in time for coverage to begin Jan. 1. As the health-insurance expansion enters its third year, their decisions are critical to its economic viability. A surge of younger, healthier customers could hold down premiums in a market that's struggling to grow.

"Medical costs of enrollees have been higher than expected, and total enrollment remains low," said Caroline Pearson, a vice president at the consulting firm Avalere Health. "If participation is leveling off, then plans may be stuck with a risk pool that is not particularly balanced."

More than half of the health law's 23 nonprofit insurance cooperatives have folded, and even some major industry players recently have gone public with doubts.

There have been bumps with the health law, said business owner Rayna Collins of Lincoln, Nebraska, but overall she counts on it.

She's surprised, however, many people she knows have remained uninsured.

"It's heartbreaking to think that they could have affordable insurance," Collins said. "They think it's like going on welfare."

One friend believed incorrectly insurers still could turn down customers with pre-existing health conditions -- a practice barred under the law.

Collins, a graphic designer, has had to make adjustments. She switched insurers for 2016 because the company she was with left the market.

Her premium will remain about the same, after subsidies the law provides for private coverage. But her deductible will spike from $500 to $2,600.

"I'm getting less coverage for about the same, and I'm not happy with that," Collins said. "But I don't know what I would do if I weren't getting the government subsidy. I was already being priced out of health insurance before Obamacare."

The coverage allows her to get regular preventive care that's important for people like her, in their early 60s.

The Obama administration said it's seeing a vigorous consumer response this sign-up season, with more than 1 million new customers.

"All the evidence for us is that the marketplace is strong, it's vibrant and it's growing," said Andy Slavitt, head of the Centers for Medicare and Medicaid Services, which runs the government's major insurance programs.

Still, the administration's sign-up target for 2016, the president's last full year in office, is modest: 10 million people enrolled and paying premiums at the end of the year, an increase of about 10 percent.

Drew Altman, president of the Kaiser Foundation, said the health law's insurance markets appear to be making progress. But they're not there yet.

"It's going to take more people enrolled to be fully successful," Altman said.