Facing higher premiums, less choice and a last-minute advertising pullback, fewer people signed up for coverage this year through HealthCare.gov, according to data from a preliminary government report Friday.
About 9.2 million people signed up through HealthCare.gov, the insurance marketplace serving most states, said the Health and Human Services department. That's about 500,000 fewer customers than had enrolled last year in those same 39 states, or slippage of around 5 percent.
The report doesn't include figures from 11 states that run their own health insurance markets — including California and New York — so the final national number will be higher. But the preliminary report is being closely watched, because President Donald Trump and the GOP-led Congress have vowed to repeal the Obama-era health law and replace it with a plan yet to emerge.
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Insurance markets created by former President Barack Obama's law provide subsidized private coverage for people who don't have access to health care through their jobs. Along with a Medicaid expansion aimed at low-income adults, the Affordable Care Act has helped millions get coverage, reducing the nation's uninsured rate to a historic low of about 9 percent.
But even before Trump's election victory, the ACA's markets were facing double-digit premium increases and a sharp drop in insurer participation. Although most customers receive taxpayer subsidies for their premiums, the increases averaged more than 20 percent nationally and much higher in several states.
The night he was inaugurated, Trump signed an executive order directing his administration to provide relief from "Obamacare." That was interpreted as a signal that officials would waive the law's tax penalties meant to nudge uninsured people to sign up. Then last week the administration pulled back about $5 million in ads that were part of a closing bid to woo the uninsured. Former Obama administration officials cried foul.
Trump administration spokesman Matt Lloyd said Friday that "Obamacare has failed" and the new president looks forward to providing relief through "patient-centered solutions that will work for the American people."
But independent analysts said the report also highlights the challenges that Trump and the GOP Congress will face trying to deliver on their promises without disrupting coverage for millions. That includes many people in states that Trump won in November, among them Florida (1.8 million); Texas (1.2 million); North Carolina (549,000); Georgia (494,000), and Pennsylvania (426,000).
"While enrollment is down, this does not exactly paint a picture of a program collapsing," said Larry Levitt of the nonpartisan Kaiser Family Foundation.
"Enrollment had been tracking on pace with last year, but sign-ups slowed down in the final weeks of open enrollment," said Caroline Pearson of the consulting firm Avalere Health. The controversy over unwinding the health care law may have contributed, she said.
Nonetheless, Pearson said the demand for coverage "remains strong." She added, "Policymakers will need to consider how forthcoming changes will impact those currently purchasing coverage."
Supporters of the health care law, trying to beat back or blunt efforts to repeal it, blamed the Trump administration for the lackluster number.
Ron Pollack, executive director of the advocacy group Families USA, said Trump had tried to "sabotage" enrollment.
"Millions of consumers still got their insurance through the ACA," said Pollack. "The Republican rush to repeal the ACA without a replacement will do real harm to real people."
A final, national enrollment report isn't due until next month. Some of the 11 state-run insurance markets, including California, have extended open enrollment through Saturday. Washington, DC, also runs its own insurance market. HealthCare.gov's sign-up season ended Jan. 31.