Facing higher premiums, less choice and a last-minute advertising pullback, fewer people signed up for coverage this year through HealthCare.gov, according to numbers from a preliminary government report Friday.
About 9.2 million people signed up through HealthCare.gov, the insurance website 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. Nonetheless 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 that has yet to emerge.
The insurance markets created by 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 health insurance markets were facing double-digit premium increases and a sharp drop in insurer participation.
In Tennessee, health insurers boosted rates anywhere from 40 to 62 percent this year over the 2016 rates, and the biggest insurer, the Chattanooga-based BlueCross BlueShield of Tennessee, pulled out of many of Tennessee's biggest markets to limit its ongoing losses from the program.
"The market in Tennessee is not healthy or stable," said Bobby Huffaker, CEO of the insurance broker American Exchange in Chattanooga. "People who make 250 percent of the poverty rate ($40,600 for a couple) or less are getting federal subsidies that help out under Obamacare, but others that don't get the subsidies have been scrambling to get on an employer plan, if they can. Something needs to be done in Tennessee."
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."
Last week the Trump administration pulled back about $5 million in ads that were part of a closing bid to woo the uninsured. Former Obama administration officials immediately cried foul.
Independent analysts said the report clearly highlights the challenges that Trump and the GOP Congress will face trying to deliver on their promises without disrupting coverage for millions.
"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 debate 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."
A final, national enrollment report isn't due until next month. Some of the state-run insurance markets have extended open enrollment through Saturday, although HealthCare.gov's sign-up season ended Jan. 31.