The open enrollment period for Washington state's health-insurance exchange has started, but it closes a month earlier than last year.

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Despite changes to the Affordable Care Act during the past couple of years, local health-insurance officials are optimistic that the state’s health-insurance exchange will flourish in 2019.

Since enrollment for 2019 began Nov. 1, about 400 to 600 people a day have been signing up for health insurance through the Washington Health Benefit Exchange. During the first week about 190,000 people signed up, which is about 5 percent more than the same period last year.

Michael Marchand, spokesman and chief marketing officer for the Washington Health Benefit Exchange, said the reason for the increase to this point is that there are more people renewing their health insurance through the exchange this year.

Unlike last year, enrollment began without Congress trying to repeal the ACA, also called Obamacare. Even though Congress took a year off from repeal efforts, there were other actions taken by the Trump administration and Congress that could impact the ACA.

The overhaul of the nation’s tax system eliminated the individual-mandate penalty, which was administered through tax filings. This will be the second sign-up period since President Trump rescinded the federal government’s payments to reduce costs for qualified applicants in the ACA.

“While both of those issues are a cause for consternation for the industry, the predominant feeling is that the individual market and consumer has made peace with them over the past year,” Marchand said.

Marchand said that adjustments in the state exchange’s silver plans have addressed the loss of the cost-reduction payments.

Washington’s individual-market customers will again encounter a premium increase for next year. The Office of the Insurance Commissioner (OIC) approved an average 13.6 percent increase for the 74 plans on the individual market. Health insurers were seeking an average 19.4 percent increase. Premiums have increased the four years before 2019, from 1 percent in 2015; inching up to 4 percent in 2016; 11 percent for 2017 and about 24 percent this year.

 Finding new enrollees, especially those traditionally under- or uninsured, is the job of Daphne Pie, the health-services administrator for Public Health — Seattle & King County. Pie said she and her colleagues drill down by ZIP code to find people lacking health insurance.

Plans are tailored to each targeted community, Pie said. Towns like Skykomish — which is remote, has a small population and a high rate of uninsured people — have materials dropped off at schools, stores and libraries. Pie said they try to make it easy for people to sign up via telephone.

The strategy is more hands-on for densely populated areas. In Renton, there are five ZIP codes with about 5,000 uninsured residents. There, the enrollment strategy includes advertisements before films at the Renton Landing movie theater, a couple of events at Starbucks and the library, and with the Renton Housing Authority.

Public Health — Seattle & King County will hold 55 events throughout the county during the enrollment period, working with 33 organizations and 272 “navigators,” people doing outreach and sign-up assistance for the exchange. People can also sign up online through the exchange’s Healthplanfinder.

Another new wrinkle for the 2019 sign-up period is the shortening of the enrollment window. Last year Washington kept enrollment open until mid-January, a month longer than required by the ACA.

This year enrollment ends Dec. 15. While this will put pressure on enrollment efforts, Pie said people know the drill.

“Part of me is not worried about it because people have it in their head if they want their coverage by Jan. 1 they need to be signed up by Dec. 15,” she said.

Washington’s exchange has seen an increase in sign-ups for health insurance. For 2018, about 209,000 people joined the exchange, a slight increase from 204,000 in 2017. About 60 percent of people on the exchange received a subsidy. Marchand is expecting a modest bump in enrollment for 2019, from 1 to 3 percent.

According to the insurance commissioner, about 406,470 residents, roughly 5.5 percent of the state’s population, are uninsured. King County has about 82,000 residents uninsured. Another 248,600 people are insured through health associations. Individuals and small businesses can buy insurance through these associations, which can get around ACA requirements.

The battle over the ACA took a toll nationally, with about 8.7 million people signing up for health insurance through the federally run site, a reduction of about 4 million from 2017.

Three million people enrolled in the 11 states that run their own systems, of which Washington is one. Doing so has allowed the state to create a more stable insurance environment, said Marchand.

The state’s exchange had bipartisan support from the beginning and was built with input from a wide range of stakeholders such as the Office of the Insurance Commissioner, health-insurance carriers and health-care providers, he said.