FARGO - Enrollment for health insurance through the new online marketplace continues at a trickling pace in North Dakota.

As of the first week of January, when coverage started through plans under the Affordable Care Act, 977 members had signed up with Blue Cross Blue Shield of North Dakota, the state’s dominant insurer.

The Sanford Health Plan enrolled 92 in North Dakota through the new marketplace exchange.

“The numbers are still relatively small,” said Denise Kolpack, executive vice president for communication at Blue Cross Blue Shield of North Dakota. “Every day seems to get a little better.”

Insurers are baffled about the small number of enrollments.

“That’s the million-dollar question everywhere,” Kolpack said. “It’s hard to say.”

One possibility is the drumbeat of negative publicity about the rocky rollout of the marketplace in the fall, she said. That might have discouraged some from exploring their coverage options.

“It has continued to be very slow,” said Lisa Carlson, director of planning and regulation for Sanford Health.

Interestingly, the Sanford Health Plan enrollment in South Dakota, a sister state with similar demographics to North Dakota, has been much higher, at 490, she said.

A Sanford analysis of enrollments in North Dakota and South Dakota combined indicates that 88 percent who signed up under the new marketplace qualify for subsidies, Carlson said.

“The people who are getting it on the marketplace are likely to be eligible for the subsidy,” she said. Premium subsidies, based on income and family size, are available up to 400 percent of the poverty guidelines.

A stigma for accepting assistance in the form of premium subsidies might be one reason the enrollment is so low in North Dakota, she said.

By contrast, enrollment in North Dakota under expanded Medicaid eligibility stands at about 1,700 in the first week of January.

Under the Affordable Care Act, states that opted to expand access to Medicaid can enroll people with incomes up to 138 percent of the poverty level.

In North Dakota, estimates of new Medicaid enrollees under the expanded eligibility have ranged from an increase of 20,000 to 32,000, with 66,000 now enrolled in the program.

The signup has been going without major hitches, said Maggie Anderson, executive director of the North Dakota Department of Human Services, which administers Medicaid.

“We’d like it to be smoother, but it hasn’t been rocky either,” she said.

Some of those who have enrolled for Medicaid were shopping for health insurance on the new online marketplace, healthcare.gov, which determined they were eligible for the program.

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