Once again, Obamacare has proved surprisingly resilient.
Nearly 8.5 million Americans signed up for 2019 coverage on the federal exchange, healthcare.gov, the Centers for Medicare & Medicaid Services said Wednesday. That's down a smaller-than-expected 4.2% from the 8.8 million people who selected 2018 plans a year ago.
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The figure factors in those who were automatically re-enrolled in Obamacare coverage in the 39 states that use the federal exchange, but does not include sign-ups on the state-based exchanges, some of which have longer open enrollment periods. The final tally likely won't be available until March.
Sign-ups for 2019, which had been lagging, picked up in the final days of open enrollment, which ended Saturday for the federal exchange. Some 4.3 million people selected plans last week, including roughly 918,650 new customers.
Americans have continued signing up for coverage despite repeated efforts by Republicans to undermine the law. The Trump administration has also pulled back its support of Obamacare, while making it easier for consumers to buy cheaper alternatives.
The final day of this year's open enrollment period was thrown into chaos by a Texas district judge's ruling late Friday night that Obamacare's individual coverage mandate was unconstitutional so the rest of the law must fall. However, the Affordable Care Act remains in effect because Judge Reed O'Connor did not issue an injunction stopping federal and state officials from enforcing it.
Still, the decision sparked widespread confusion as to its impact on coverage bought on the Obamacare exchanges. It prompted the Trump administration to tweet, send emails and post a red banner on the federal exchange, healthcare.gov, notifying consumers that open enrollment was continuing and the ruling had no effect on coverage for this year or 2019.
Even former President Barack Obama posted a message to Facebook urging people to sign up and informing them the decision has no immediate impact.
Obamacare had been under pressure even before the judge's ruling. Sign-ups on the federal exchange were falling behind last year's for several reasons, including a lack of advertising and enrollment assistance, the ability to purchase lower-priced alternative plans such as short-term policies and the elimination of the individual mandate penalty, supporters of the health care law argued.
Seema Verma, administrator of the Centers for Medicare & Medicaid Services, defended the Trump administration's actions Wednesday on Twitter, saying the smaller ad budget, elimination of the penalty and greater availability of cheaper alternative options didn't dampen interest. She also pointed out that New Jersey, which banned short-term plans and instituted its own individual mandate, saw 2019 sign-ups drop by 8%.
Still, sign-ups fell nationally for the second year in a row. Some 9.2 million people picked policies during open enrollment for 2017 coverage, which ran until Jan. 30 of that year.
Also, fewer new consumers are joining Obamacare. Just over 2 million first-timers selected plans for 2019, compared with nearly 2.4 million who had signed up for 2018 coverage.
The steep decline in newcomers -- more than 50% since 2016 -- is particularly troubling, said Joshua Peck, co-founder of Get America Covered, an advocacy group, and a former Obama administration official.
"New enrollment is especially important for the marketplaces because new enrollees tend to be younger and healthier," he said. "Advertising and outreach, which the administration significantly cut, play an especially important role in bringing new people into the marketplaces."
Several state-based exchanges, which have kept up their marketing efforts, are experiencing record interest. Maryland saw an unprecedented surge of activity on Saturday, the final day to enroll. This helped push sign-ups to nearly 157,000, an increase of 2% from a year ago.
In Minnesota, the number of people picking plans is 6% ahead of the same time last year, and enrollment continues until January 13.
Nearly 18,000 more New Yorkers have signed up for Obamacare plans, up 8.5% from a year ago. Empire State residents can select policies through January 31.
"Despite the constant threats to the Affordable Care Act, New York's health insurance marketplace stands strong," said Donna Frescatore, executive director of NY State of Health, the state's exchange.
Some, including Washington state and California, are trailing last year's tallies, however.
Consumers aren't considered enrolled until they pay their first month's premium.
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