Open enrollment on Healthcare.gov faced many headwinds this year, but signups held steady. About 300,000 fewer people signed up for health insurance using the federal marketplace compared to last year.
From Nov. 1 through Dec. 15, around 8.5 million people enrolled for 2019 health insurance plans, according to the Centers for Medicare & Medicaid Services. 8.8 million signed up over the same period last year.
Another 100,000 people who would have signed up through the exchange got coverage when Virginia expanded Medicaid, CMS estimated.
The final numbers could end up higher. Healthcare.gov and a call center for signing up for health insurance received a surge activity as the Saturday deadline approached. Those who left messages will be able to buy plans, but weren't counted in the data released Wednesday.
Why enrollment might have dropped
A number of factors could have dampened enrollment. This is the first year people can skip health insurance without paying a penalty. The end of the individual mandate played a role in lowering enrollment, but not as big as experts predicted, said Timothy Jost, law professor at Washington and Lee University.
"Most people who are buying coverage are people who want coverage, not because there's some legal implication," he said.
Enrollment might have been higher if the Trump administration had reached out to more potential consumers through advertising and health care navigators. President Donald Trump slashed funding for outreach efforts over the past two years. The lack of outreach hurts less educated consumers, Jost said.
"Insurance has to be sold to people who don't have a lot of experience," he said. "They have to understand why it's important."
Few people know the basics when it comes to Obamacare, according to a Policygenius survey. The survey, conducted before open enrollment took place, revealed most people didn't know when to sign up for Obamacare.
Instead of promoting the health care marketplace, President Donald Trump pushed people toward alternatives. The administration expanded access to short-term health care plans, which cost less than marketplace plans, but also cover less. (Policygenius partner Agile Health can help you compare short-term health plans.)
Finally, some people may not have been able to afford plans on Healthcare.gov. While many people qualify for some kind of health care subsidy, prices may be out of reach for those who don't. Premiums dropped slightly this year to an average of $406 a month, according to CMS data.
You can still buy health care
The deadline to buy health insurance on Healthcare.gov may have passed, but the health care marketplaces in some states will stay open for a few more weeks. Some people may also qualify for a special enrollment period. If you missed the deadline, learn how you can still get covered for 2019.
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Hanna Horvath contributed reporting.
Image: Steve Debenport