Residents are signing up for the Affordable Care Act even after months of battering in Congress and by the Trump administration. Here’s a look at how some are handling the uncertainty.

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Nikita Milord came to the Columbia Public Health Center for help wading through her health-care insurance options.

She wasn’t alone. On the Saturday after the Nov. 1 start of open enrollment for the Affordable Care Act (ACA), a steady stream of people showed up at the South Seattle center to either sign up for health insurance for the first time or to peruse other plans.

The Columbia City event is one of many Public Health – Seattle & King County will have throughout the county to help people through the insurance labyrinth.

Milord’s health-insurance history is a common story. In her 20s, she had employer-provided insurance but lost it when she switched jobs. Under the ACA, also known as Obamacare, the 31-year-old was eligible for coverage under the law’s expansion of Medicaid, called Apple Health in this state. Like many at the health center, Milord heard about the event through a family member.

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“Just trying to see what is out there,” she said, while a Public Health employee, Enrique Palacios, booted up his station. “Trying to get some help for me and my daughter.”

The health insurance Milord uses through the Washington Health Benefit Exchange for herself and her 3-year-old daughter isn’t guaranteed to always be available. The ongoing debate in Congress and the Trump administration’s attempts to weaken the law have left consumers confused and flummoxed those working to get people insured.

Yet, despite the administration’s ending federal-subsidy payments to insurance companies that reduced out-of-pocket costs for patients, enrollment is off to a hot start.

Since the ACA passed in 2009, Republicans have campaigned for its repeal. Threats to the law’s existence became real when Donald Trump was elected president.

Congress has twice tried to kill the ACA this year while the Trump administration continues its verbal takedown of the law and issued rule changes designed to impede it. The efforts to repeal Obamacare have contributed to the large jump in average rates nationally and in Washington state.

Increase in sign-ups

The Washington Health Benefit Exchange, which runs the state’s marketplace and exchange website, received 12,000 applications for sign-ups during the first two weeks of the enrollment period, an increase of about 58 percent from the same period last year.

In Idaho and California, two other Western states running marketplaces and associated websites, the numbers are also up. California had about a 25 percent increase of people selecting plans during the first week of enrollment. In Idaho, Pat Kelly, executive director for Your Health Idaho, said that state has seen a 35 percent increase in visitors to its exchange website over last year.

The Centers for Medicine and Medicaid Services (CMS) says states using the federal website HealthCare.gov reported about 1.5 million plan selections through the first two weeks of open enrollment, or about a 47 percent increase over last year. Of that number, 345,719 were new customers, a 40 percent jump from 2016.

Michael Marchand, spokesman for the Washington Health Benefit Exchange, said he expects at least a 3 percent increase in enrollment this year, but that number could be affected by actions taken by Congress and the Trump administration.

The Washington Health Benefit Exchange launched the Healthplanfinder website this fall, where plans can be compared. In an effort to reach the shrinking number of uninsured, more locations where people can get assistance were added across the state.

The state also allocated $1.5 million for the 2017 biennium budget for advertising. The federal government slashed its advertising budget by 90 percent.

Because Washington runs its own exchange, it was able to set its enrollment period from Nov. 1 to Jan. 15. The Trump administration settled on a truncated time period for states using HealthCare.gov, from Nov. 1 to Dec. 15.

The increase in registrations isn’t a complete surprise.

Sara Collins, vice president of The Commonwealth Fund, a private foundation focusing on access to quality health care, says the elevated number of new enrollees and renewals this year can partly be attributed to growing awareness of the ACA, in its fifth open-enrollment cycle, and media coverage from the recent health-care debate.

Collins is curious to see what happens after the first couple of weeks. “Once you get past those highly motivated enrollees, are you going to see this kind of takeup when you get to healthy people and the young?” she asked.

The number of uninsured has dramatically declined in Washington since the ACA opened for business in 2013. In Washington, 5.8 percent were uninsured in 2015, the last year numbers are available, compared to 14 percent in 2013. In King County, which has more recent data, the percentage of uninsured fell from 16.4 in 2013 to 6.7 in 2016.

New complications

Another complication arose Nov. 14 when U.S. Senate Republicans announced the ACA’s individual mandate would be targeted for repeal to help pay for the proposed overhaul of the tax code.

Losing the individual mandate, which requires people to be insured or pay a penalty, could be a crippling blow to the ACA. The system is predicated on having a large pool of insured that includes as many healthy and young people as possible to help offset the higher costs incurred by older people, those with pre-existing conditions and the sick.

During a recent phone call with reporters, Sen. Patty Murray, D-Wash., said Republicans should heed the recent election results in Virginia, where voters elected a governor and candidates for the commonwealth’s House of Delegates who support the ACA, and in Maine, where voters overwhelmingly chose to expand Medicaid.

“It’s time Republicans got the message,” she said.

Murray and Sen. Lamar Alexander, R-Tenn., introduced a bill last month to restore the cost-saving payments to insurers, which are used to reduce out-of-pocket costs for customers who qualify, through 2019 and give states more flexibility to regulate health insurance under the ACA. Despite bipartisan support, the bill has yet to make it to the Senate floor, and it’s not clear it will.

“Enough is enough”

Finding the perfect insurance plan can be a challenge for numerous reasons, including fewer plans being offered by fewer insurers. Both King and Pierce counties went from seven to four insurance providers offering plans from this year to next. Snohomish County dropped from six to three, while Kitsap County went from four to three.

Jon Walton is among those struggling to find a plan that works for him. He supports the idea of everyone being insured but is frustrated by few choices and high cost.

The 47-year-old software architect from Skagit County owns a consulting firm. After 25 years working in corporate America with health benefits, he struck out on his own in 2014 and had to buy insurance for himself and his wife. Walton was informed by letter last month that BridgeSpan, the insurer he bought a Bronze plan from last year, was leaving Skagit County. The county is only served by one provider, Kaiser Permanente.

Walton initially believed that Kaiser didn’t have any health-care providers in Skagit County because the company’s website only showed providers to existing, not prospective, customers. The thought of not having local doctors forced Walton to ponder if he could travel to Seattle for a doctor, or check out plans on the individual market outside the exchange.

Walton only discovered there were Kaiser doctors and clinics in his county after a reporter contacted the Office of the Insurance Commissioner.

Kaiser has a plan that might work for Walton. But, he said, he is worried about other middle-class families that don’t qualify for Apple Health or the cost-sharing subsidies.

“The problem is those of us who are stuck in the middle who have to buy these pathetic plans,” he said.

Even though he can afford to pay what is offered on the exchange, it has him re-examining his choice to start his own company.

“It’s been fun, but the health-insurance thing is almost enough for me to put up the white flag and say, ‘Enough is enough,’ ” he said.

Sam Watson is in a similar situation. After years of having health insurance provided by the U.S. law firm he worked for in New York and Tokyo, Watson moved to Redmond in 2009 and started his own company, buying a catastrophic plan for his wife, two children and himself. When plans were offered on the exchange in 2013, he bought a plan that was a lot pricier.

“We were fine with that (pre-Obamacare) plan. Lived with that for a little bit, then Obamacare kicked in, and my premium doubled,” he said.

Watson, like Walton, is also on a Bronze plan. It was the cheapest he found that allowed for a Health Savings Account (HSA). And, like Walton, he also believes everyone needs to be insured and help spread the cost.

“I’m happy to help as long as everyone is chipping in.”

Elusive issue

Universal health care has been an elusive, partisan issue in the United States for decades. That hasn’t changed since the ACA was made law in 2009. Republicans have been running elections centered on its demise, and Democrats have been pushing for changes to make the ACA more stable and lasting.

None of that mattered in early November in the Columbia Public Health Center, where people with laptops sat at six tables covered in either King County- or Healthplanfinder-labeled tablecloths, working to get people insured.

The assistance and having access to insurance, whether it be Medicaid or a Gold plan, are invaluable, Milord said. She added that people shouldn’t be afraid to ask for help based on their station in life.

“A lot of people think it is a lower standard, but I don’t look at it like that. We all deserve a fair chance,” she said.