WASHINGTON — More than one million people signed up last week for health insurance under the Affordable Care Act, pushing the total in the federal marketplace to nearly 4.7 million, the Trump administration said Wednesday, days before the annual enrollment period is scheduled to end.
The number of sign-ups on HealthCare.gov from Nov. 1 through Saturday was about 17 percent higher than the same time last year. But the final tally is likely to fall short of the 9.2 million who were in plans at the end of the last open enrollment period, which was twice as long as the current one.
Insurance counselors around the country, who help consumers enroll, said they had seen a surge of activity despite sharp increases in premiums, a smaller selection of health plans and confusion about the future of the Affordable Care Act after a year in which Republicans have repeatedly tried to dismantle the law.
About 1.4 million new customers have signed up this year, and 3.3 million people returned to HealthCare.gov to select the same plan or a different one for 2018.
People who have coverage this year and take no action may have their coverage automatically renewed. If their plan is no longer available, the government may assign them to another health plan offered by the same company or a different insurer, and that could significantly increase overall enrollment.
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The numbers reported on Wednesday were for the 39 states that use HealthCare.gov. They do not include data for 11 states that run their own insurance marketplaces.
When the last open enrollment period closed in January, a total of 12.2 million people had signed up for coverage under the Affordable Care Act in federal and state marketplaces. But, the Trump administration said, some people failed to pay their premiums or found other sources of insurance, so the number with marketplace coverage declined to about 10 million by the end of June.
Among states using the federal exchange, the largest numbers of sign-ups in the last six weeks were in Florida (more than one million), Texas (580,000), North Carolina (271,000), Georgia (246,000) and Pennsylvania (206,000).
Sign-ups this year are higher than at the same point last year in all states using the federal exchange except Louisiana and West Virginia. The greatest increases were in Mississippi (up 37 percent), Wyoming (34 percent) and Texas and North Dakota (29 percent each).
The Trump administration sharply reduced grants to insurance counselors known as navigators and cut spending for advertising to publicize open enrollment. But in their zeal to repeal the Affordable Care Act, President Trump and Republicans in Congress have heightened public awareness of the law. So the pace of enrollment has been brisk.
"The political stigma has declined, and people see their neighbors who've got health coverage and are happier and healthier," said Roy Mitchell, the executive director of the Mississippi Health Advocacy Program, adding: "Most people are realizing it's a really good deal for them and their families. For so long, we were having to sell the program to people. Now, just this year, that has stopped. People want to take full advantage of it."
Chris Jacobs, a conservative health policy analyst, said the new numbers suggested that, after four years of marketplace operations, the federal government did not need to spend tens of millions of dollars selling the virtues of health insurance under the Affordable Care Act.
"How long do we need to have taxpayer funds subsidize an advertising campaign?" Mr. Jacobs asked. "That's something insurers can do for themselves, and have been doing."
Lori Lodes, an Obama administration official and a founder of Get America Covered, a nonprofit group, said, "Over all, demand for health coverage continues to outpace demand from previous years, showing just how much people value having health insurance."
"Historically," she said, "we've seen the start of the deadline surge in the week before the final deadline. Given the lack of outreach this year, many consumers are still learning that the final deadline this year is on Friday."
In some states that run their own insurance exchanges, consumers will have more time to sign up. In California and New York, for example, the deadline is Jan. 31.
More than 80 percent of people insured through the exchanges qualify for financial assistance in the form of tax credits, and when premiums rise, federal subsidies also increase. The average amount of tax credits for an eligible person was $373 a month this year, or 29 percent more than in 2016, the Trump administration said.
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