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Health Law Sign-Ups Lagging at Deadline12/12 13:50

   WASHINGTON (AP) -- Health insurance sign-ups for the Affordable Care Act are 
down with just a few days left to enroll, even though premiums are stable, 
consumers have more choice and millions of uninsured people can still get 
financial help.

   Barring an enrollment surge, the nation's uninsured rate could edge up again 
after a years-long coverage expansion that has seen about 20 million people 
obtain health insurance.

   A status report Wednesday from the Centers for Medicare and Medicaid 
Services showed nearly 20 percent fewer new people signed up than at about the 
same time last year. New sign-ups drive the growth of the 
marketplaces, helping keep premiums in check.

   The sign-up deadline in most states is this Saturday, for coverage beginning 
Jan. 1. A few states that run their own health care websites have later 

   Trying to encourage enrollment, former President Barack Obama posted a 
whimsical video on social media Monday encouraging young adults to sign up for 
his signature program. That same day, a crush of people tried to enroll in what 
was the highest traffic this open enrollment season.

   Disappointing sign-ups will add to the long-running political blame game 
over health care. Democrats accuse the Trump administration of "sabotage" on 
the health law. Republicans counter that pricey Obama-law premiums are too high 
for solid middle-class people who don't qualify for taxpayer-financed subsidies.

   The administration said in a statement this week "our primary goal is to 
provide a seamless open enrollment experience for consumers and 
ensure that those who want coverage offered through the (program) can enroll in 
a plan." Health and Human Services Secretary Alex Azar also issued his own 
sign-up pitch, a straightforward video posted on Twitter.

   The new numbers suggest there may be less demand for government-subsidized 
insurance during a time of strong economic growth. But interviews with current 
and former officials, consumer organizations and independent experts also 
revealed several factors that appear to be cutting into enrollment.

   ---Lack of a strategy for expanding, the federal insurance 

   The Trump administration didn't set sign-up targets for the health overhaul, 
according to a report this summer from the nonpartisan Government 
Accountability Office. Such targets are a standard management tool for 
government agencies.

   "Marketing does matter," said Peter Lee, executive director of Covered 
California, a state-run insurance marketplace. "Not doing active promotion 
millions of Americans are not going to find their way to"

   The administration has been using targeted emails and social media messaging 
that's nowhere near the effort expended in the Obama years. Administration 
officials say they are focused on providing a smooth sign-up experience for 
consumers who want coverage.

   ---No penalty for being uninsured. 

   Congress repealed the fine for being uninsured, effective this Jan. 1. The 
tax penalty was the most unpopular part of Obama's law.

   "The really big change taking effect for this open enrollment period is 
repeal of the individual mandate penalty, so that is very likely a major 
factor," said Larry Levitt of the nonpartisan Kaiser Family Foundation.

   The administration also increased access to lower-cost plans that provide 
less coverage than the more comprehensive insurance offered under the overhaul.

   Short-term health insurance plans don't have to offer basic benefits such as 
prescription drugs, and insurers can turn down people with medical conditions. 
But such plans may appeal to healthy people looking for a measure of financial 
protection against an unexpected illness.

   ---Immigration fears. 

   Organizations working to enroll low-income workers report heightened 
concerns among immigrants that applying for health insurance could have 
negative consequences due to the administration's crackdown on illegal 
immigration. Only legal immigrants and citizens can get coverage through, but that hasn't calmed the fears.

   "We've had a lot of green card holders coming in because they think they 
might be affected," said Kori Hattemer of Foundation Communities, a nonprofit 
organization in Austin, Texas, that helps enroll people for coverage. "Pretty 
much every day we have someone asking us about it."

   Hattemer says their enrollment numbers are about 9 percent below the same 
time last year.


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