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As a group, the 15 states plus the District of Columbia with state-based marketplaces, including those using the Healthcare.gov enrollment platform, exceeded last year's totals this year by.2 percent, while the 34 states that relied on the federal healthcare.gov marketplace saw total signups drop by about 5.3 percent.

"These are stable markets and a stable program", she said. A central pillar of the health reform law, the mandate requires almost all Americans to get coverage or pay a penalty.

"For the first time we now have the full national picture of how the individual marketplaces did this year and it is a picture of remarkable stability", Trish Riley, executive director of NASHP, said in a statement.

The report combined enrollment figures from the federal exchange, where enrollment ended on December 15, 2017, along with state-based exchanges that allowed customers to select plans as late as January 31. In the 12 fully state-operated marketplaces, enrollment ticked up just slightly by 0.1 percent, ranging from 6.3 percent drop in Vermont to a 12.1 percent increase in Rhode Island.

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"Put simply, marketing matters", Lee said. Five states with hybrid systems did best of all, according to a report compiled by the National Academy for State Health Policy.

With the Trump administration taking steps to undercut these marketplaces and congressional Republicans having spent much of previous year trying unsuccessfully to dismantle large parts of the ACA, leaders of state insurance exchanges and other health-policy experts said that enrollment was surprisingly resilient. The president also often publicly referred to Obamacare as "dead" or "over". "It's gone", Trump declared on the eve of the 2018 open enrollment period, which began November 1.

Leaders from those states said it also helped that an increase in federal subsidies lowered costs for many customers and that heightened news coverage of the ACA helped boost awareness. In all, enrollment dropped by 3.7 percent nationwide, less than 7 to 13 percent decline predicted by S&P Global Ratings. Arizona relied on the federal government to operate its marketplace. "More people may have job-based coverage as an option and not have a need for Covered California because they're getting health care coverage through their employer". That's a two percent drop compared to a year ago - about 35,000 fewer people.

Based on its figures, the 11 states - plus D.C. - that ran their own exchanges matched last year's sign-ups.


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