The Affordable Care Act may be facing its challenges from the Trump administration, the CEO of Connecticut's "Obamacare" exchange said last week, but people without health insurance will still be able to get free help buying it through Access Health CT starting Nov. 1.

As of the beginning of October, 96,000 Connecticut residents were signed up for private Anthem or ConnectiCare health insurance through Access Health CT, Connecticut's Affordable Care Act marketplace — up 2 percent from last year.

The law remains in effect, and Access Health will be looking for more people without insurance to sign up through the exchange starting Nov. 1, despite President Trump shortening the enrollment period, cutting payments to insurers that keep middle class enrollees' premiums down and cutting the national budget for outreach and advertising.

Access Health CT has responded by making changes to its in-person enrollment locations, closing two storefronts in New Haven and New Britain and opening enrollment centers in 10 new places, including Norwich. Historically about half of Access Health enrollees have signed up in person and half have used the www.accesshealthct.com website, according to Jim Wadleigh, the CEO of Access Health CT.

More than 50,000 people in New London County have signed up either for Medicaid or private insurance plans through Access Health, he said.

People who have health insurance through Access Health do not need to renew their plans or visit an enrollment center.

"As we continue to get ready for our fifth open enrollment, Access Health CT continues to be the only place where anyone can come and get financial help for coverage," Wadleigh said last week. The open enrollment period in Connecticut will last from Nov. 1 to Dec. 22.

The physical changes are part of the marketplace's attempts to make itself as accessible as possible to uninsured people after a months-long Republican effort to repeal the health care law failed but confused many.

Efforts to prepare for the opening of the enrollment period have been further complicated this week as Trump and Congress negotiate over cost sharing reductions, payments to insurance companies that sell plans on Affordable Care Act exchanges and keep low-income enrollees' health care costs down.

About 75 percent of Access Health enrollees qualify for cost-sharing reduction payments, and will continue to receive them under the law, regardless of Trump's decision to defund them or the outcome of a plan announced Tuesday in the Senate to keep them in place.

But for another 25 percent of current higher-income Access Health enrollees who don't qualify for subsidies, Wadleigh said, losing the cost-sharing reductions could mean their premiums shoot up.

Anticipating Trump's decision, the state insurance department ruled that Anthem and ConnectiCare could sell policies on the Access Health exchange at rates that would be higher by an average of 31.7 percent for Anthem customers and 27.7 percent higher for ConnectiCare customers.

The higher rates kept the two providers selling insurance through Access Health, whereas Anthem and other companies have abandoned Obamacare exchanges in other states, but they also might tempt some people who don't qualify for subsidies to drop their insurance or avoid signing up through the exchange this fall, Wadleigh said.

Access Health has not seen a significant number of people dropping their Access Health plans for 2018, he said. But confusion about the failed effort to repeal the health care law — and the Trump administration's decision to cut funding to the Obamacare advertising budget from $100 million to $10 million for the 2018 enrollment — also means fewer people might be aware of the enrollment period.

"There's a myriad of things that could lower enrollment," Wadleigh said.

"Last year people saw ads on TNT and TBS, during basketball games," he said. "With that advertising now disappearing, we lose the benefit of that national coverage."

The location of the enrollment center in Norwich has been finalized and will be announced soon. But Wadleigh said anyone who wants to come to the center when it opens Nov. 1 will be helped by Access Health staff members. They should be ready to present proof of their birthday, Social Security information, immigration status, their most recent tax return, recent paychecks, and information about their employer and current health insurance, if they already have a plan.

Signing up at www.accesshealthct.com may be the more convenient option for those with access to a computer, smartphone or tablet, Wadleigh said.

Wadleigh urged those with health insurance not to give it up even if their costs increase, and the approximately 3.5 percent people without insurance in Connecticut should still try to sign up and ask what their rates would be.

"(Leaving the exchange) puts families in the position of having to risk not having coverage," he said. "It could bankrupt them with one visit. That is by far not what we want."

m.shanahan@theday.com