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Ruling Striking Down Obamacare Moves Health Debate to Center Stage

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From Nov. 1 to Dec. 8, about 4.1 million people had signed up for Affordable Care Act coverage through the federal marketplace, with new enrollment in the 39 states that use the federal website Healthcare.gov down by 20 percent compared with the same period last year.

In all, 11.8 million people in all 50 states signed up for health insurance through the law’s marketplaces for 2018. This year’s enrollment period is now ending except for in Rhode Island, where it will end Dec. 23, and in California, Colorado, Massachusetts, Minnesota, New York and the District of Columbia, where it will end in January.

“During a year when most people don’t know when the deadline is, if the only news you hear is that the A.C.A. was struck down, that is only going to hurt enrollment,” Josh Peck, a co-founder of the group Get America Covered and the former chief marketing officer for Healthcare.gov during the Obama administration, said in an email.

The administration has slashed marketing efforts and enrollment assistance and encouraged people to buy skimpier, less expensive plans that do not meet the standards of the law. These actions, and the elimination of the law’s tax penalty for not having coverage starting next year, are most likely among the reasons fewer people are signing up.

Even as enrollment in private plans under the Affordable Care Act will most likely be smaller next year, hundreds of thousands more low-income adults are expected to enroll in expanded Medicaid in five states that recently gave them the option through citizens’ initiatives or legislative action. Those states are Idaho, Maine, Nebraska, Utah and Virginia. Last month’s Kaiser tracking poll found that 59 percent of respondents living in the 14 states that have not yet expanded Medicaid want them to do so.

Other broadly popular provisions of the law are one that allows young people to stay on their parents’ health insurance plan until they turn 26, and another that allows people to get certain types of preventive care, like vaccinations, mammograms and other types of screenings for diseases, at no charge.

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