Obamacare has been under fire all year in Washington, but against all odds the start of this year's open enrollment has been business as usual. Health insurers such as Oscar Health say consumers have been actively shopping since the start of enrollment on Nov. 1.
"We definitely have seen (volumes) above projections in pretty much all the markets we're in," said Mario Schlosser, CEO of the five-year-old New York-based health insurer. "We're very happy with the first week."
Oscar is offering plans in major metropolitan markets in six states for 2018, up from three this year. Early demand for its new co-branded plan with the renowned Cleveland Clinic in Ohio has been strong.
"Of the members who've signed up in the past week, 25 percent have chosen their primary care physician through the Oscar mobile app, even before they've paid their first bill," Schlosser said.
Oscar and Cleveland Clinic are trying to be cautious.
"We're not looking for this to be too big the first year. We want to work very closely with Oscar and market this appropriately," said Steven Glass, Cleveland Clinic's chief financial officer.
But now they're bracing for potentially bigger first-year numbers than they had planned, after Anthem's exit from the Ohio exchange last summer amid uncertainty over the fate of the Affordable Care Act. And they are anticipating strong demand from enrollees with chronic conditions attracted to the health center's reputation for high-quality care.
"We expect that we're going to get some percentage of those lives coming over to our product," Glass explained.
President Donald Trump has used executive orders to undo parts of the Affordable Care Act, including cutting some subsidy payments and slashing outreach for open enrollment. That spooked a lot of insurers and raised concerns that this year's open enrollment might be chaotic.
Yet, the administration is upholding the letter of the law when it comes to open enrollment, even as senior health officials like the director of the Centers for Medicare and Medicaid Services (CMS) disparaged it.
"We're making sure that people are aware of their choices and their options. But the reality is Obamacare is not working," said Seema Verma, CMS administrator, on a visit to Cleveland Clinic last month.
CMS says more than 600,000 people signed up for coverage on the healthcare.gov federal exchange in the first four days of this year's open enrollment. That's up 79 percent from the comparable period a year ago, and a record start, according to former Obama health officials.
Early enrollment trends are also strong on state-run exchanges. Officials from California's state exchange, Covered California, tell CNBC they saw a 25 percent increase in plan selections on opening day of open enrollment. Washington state's exchange saw a 24 percent increase in traffic during the first seven days of open enrollment, with new applications up more than 50 percent on the Washington Healthplanfinder site from a year ago.
This summer's uncertainty over the fate of exchange plan policies led high premium increases for 2018, up an average of 37 percent from a year ago, according to CMS. Those price hikes will hit hard for consumers who don't receive tax credits but may actually result in lower costs for those who do get premium assistance.
In most states, insurers loaded up the biggest increases on benchmark Silver exchange plans, which are used to determine tax credits. As a result, 2018 tax credits will be up 45 percent on average from a year ago. So, the 85 percent of enrollees who receive premium assistance will be insulated from price hikes.
"The premium tax credit will cover the increase for the vast majority of consumers," said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, but she adds that this year it really pays for those with subsidies to consider trading down to cheaper plans if their overall health costs are low.
"For a 40-year old with income at around $25,000, in about half of the counties in the United States, that person could get a Bronze plan for free. The increase in the tax credit will be so much that it will completely cover the premium for the lowest-cost Bronze plan," Pollitz explained.
According to CMS' own data, 80 percent of enrollees will pay less than $75 a month for premiums, and in some cases $0 once tax credits are applied. Health insurance brokers say that is leaving enrollees more than a little confused.
"There is a lot of confusion from a customer standpoint … primarily about $0 premium plans they see in the marketplace and why that is when Trump cut the subsidies," said Nate Purpura, a spokesman for online insurance brokerage eHealth. "People are seeing $0-$10 for bronze and gold plans … and calling to make sure they're seeing the numbers right."
Oscar and Cleveland Clinic are hoping that by working together, they can get the numbers right on their new health plan. They expect to do better than break even, no matter what happens with health policy in Washington.
"We have to drive quality, and we have to make care more affordable," said Cleveland Clinic CEO Delos Cosgrove. "Those are 'no regret' moves. And if we keep moving in that direction, regardless of what happens in Washington, we'll be okay."
— Follow Bertha Coombs on Twitter: @coombscnbc