The enrollment period for the federal marketplace has been cut in half, to 45 days, with hardly any publicity by federal officials. No one is sure how well government call centers and computer systems will handle the expected surge of applications leading up to the Dec. 15 deadline for people to enroll through HealthCare.gov.
In Washington and across the nation, supporters of the law are doing what they can to combat misperceptions.
“Consumers are unclear whether the marketplaces still exist, whether they still have an obligation to get coverage, whether the mandate exists, whether they can get financial assistance,” said Kelley Turek, a policy analyst at America’s Health Insurance Plans, a trade group. “Our message is: Come back. The marketplaces are still here.”
Here in Georgia, what had been the largest navigator group, Insure Georgia, lost 86 percent of its $2.3 million federal grant and had to lay off half its staff, leaving Mr. Branch and 10 other counselors to provide enrollment assistance for all 159 counties in the state. Humana is leaving the insurance marketplace here, and while three other insurers will remain, all but 10 counties will have a single company selling coverage for next year. Rates for popular silver-level “benchmark” plans are rising by 47 percent on average here, according to the Department of Health and Human Services, although most customers will qualify for subsidies that will grow by a similar amount. The department found that premiums for benchmark plans are increasing by 37 percent nationwide, compared with 24 percent last year.
Credit Audra Melton for The New York Times
Other types of plans may be less expensive, because to compensate for the funds they will lose now that Mr. Trump has ended the cost-sharing payments, insurers have generally raised the price of silver plans more than those in the bronze, gold and platinum categories. As a result, some gold plans will now be less expensive than some silver plans, even though gold plans cover more of the costs of a typical consumer.
Sorting through these complications will be difficult for many consumers.
At a Halloween “safety expo” at Coliseum Medical Centers here on Saturday, several hundred parents and children filed past an Insure Georgia table by the front door, where Amber Higgins, another navigator, asked over and over, “Do y’all have health insurance? You know anyone who’s doing without it?”
“My niece who just moved here from Ohio,” said one woman, taking a flier.
“My sister in Texas,” said another.
“Me,” said yet another woman, scanning the income requirements for receiving subsidies, which Ms. Higgins had placed in a frame.
The response was not surprising. Georgia has the nation’s fourth-highest number of uninsured residents, after Texas, California and Florida. In some of the state’s rural counties, enrollment under the Affordable Care Act dropped by as much as 36 percent this year, according to a new report, which pointed to the diminishing choice of insurers in rural areas as a likely reason.
Briana Zoellick, 26, told Ms. Higgins she had checked the HealthCare.gov website when it started allowing people to preview their options last week and was astonished to learn that her family’s subsidy would be a lot bigger next year even though their income has risen. Ms. Zoellick, a medical assistant and mother of two, said she and her husband, a graphic designer, canceled their coverage earlier this year because they could not afford their portion of the premium, about $140 a month.
Next year, she has learned, their subsidy will rise to more than $800, from $650 — “incredible,” she said — and their share will be less than before.
Yet Ms. Zoellick said her husband remained wary of signing up because of everything he had heard about Mr. Trump ending the payments to insurers. Many customers are mistakenly assuming that what he is blocking is premium subsidies, which are separate and not affected by Mr. Trump’s action.
“He was like, ‘I don’t know if that’s going to actually happen because of what Trump’s doing,’” Ms. Zoellick said, referring to their higher subsidy.
The California marketplace, run by an independent state agency, is spending $111 million on advertising, more than 10 times as much as the federal government intends to spend for the entire country. The New York marketplace, run by the state Health Department, is spending $15 million.
Credit Audra Melton for The New York Times
“Despite attempts at the federal level to take health care from New Yorkers, our marketplace is ready to open Nov. 1 as strong as ever,” said Donna Frescatore, the executive director of the New York insurance marketplace. “For many consumers, prices in 2018 will be the same as this year, or lower for the same level plan.”
In some states that run their own insurance exchanges, consumers will have more time to sign up. The deadline is Jan. 14 in Minnesota, Jan. 15 in Washington State and Jan. 31 in California and New York.
While many consumers will have fewer choices and will face higher premiums next year, the situation varies greatly from state to state.
In Tulsa, Okla., seven health plans will be available, all from one company. For the most popular plans, the average premium for a 35-year-old will be about $560 a month, according to HealthCare.gov. In Phoenix, consumers will have a choice of five plans, all from one company. For the two popular silver plans, premiums for a 35-year-old average $470 a month.
Mike Kreidler, the insurance commissioner in Washington State, approved rate increases averaging 36 percent last week, and he attributed 10 percentage points of the increase to Mr. Trump’s decision to cut off the subsidies known as cost-sharing reduction payments.
“I fear that many will go uninsured,” Mr. Kreidler said, while noting that some plans would not be affected by the president’s action.
In Macon next year, 13 plans will be available, all from Blue Cross Blue Shield of Georgia. A 50-year-old woman with income of $30,000 will be eligible for a subsidy of $597 a month. That subsidy would lower her premium to an average of $236 a month for silver plans and $77 a month for bronze plans, according to HealthCare.gov.
But for a 50-year-old woman in Macon with annual income of $50,000, costs would be much higher. She would not be eligible for financial assistance and would have to pay $768 a month — more than 18 percent of her income — for the cheapest silver plan. Prices in rural southwest Georgia and a few other parts of the state will be even higher, although in Atlanta they will be lower.
For Pat and John Curry of Augusta, who are both 57 and own a small coffee-roasting business, options will range next year from a bronze plan for $1,526 a month with a $13,500 family deductible to a gold plan for $3,142 a month and a $3,900 family deductible. Blue Cross is the only insurer selling in their county. The couple, who each have chronic conditions and take multiple daily medications, said they would research whether buying a plan directly from Blue Cross would be cheaper.
Ms. Curry will also consider buying coverage only for her husband, who is getting follow-up care for cancer.
“I don’t know what we’ll be doing for insurance,” Ms. Curry said, looking at rates under the Affordable Care Act, “but it won’t be this.”