Lodes said she would not describe their group as a shadow government, but she readily concedes they are trying to fill gaps created by the Trump administration, which slashed Obamacare’s public outreach budget by 90 percent, chopped the enrollment period in half, and is refusing to run television ads encouraging consumers to sign up for coverage. Democrats see the move as part of a broader campaign to undermine through administrative neglect—or worse—a law that Republicans in Congress have been unable to repeal legislatively. “This is a very systematic effort to shut down the various avenues that have been open to consumers to ask questions, get information, try and access health insurance,” Sebelius, who served as HHS secretary from 2009 until 2014, said in a phone interview. “It’s really very difficult,” she told me, to see the yearlong effort “as anything other than fundamental sabotage.”

The primary concern is that the Trump administration’s inaction, along with the president’s insistence on declaring the law already “dead” and “gone,” will depress enrollment so much that the insurance exchanges will collapse under their own weight. Market analysts already expect a significant drop-off from the 12.2 million people who signed up for plans last year, and the former Obama officials want to keep enrollment as stable as possible. “What could happen is more insurance companies leave the market, and the people who stay decide they have to raise rates even higher,” Sebelius said.

Insurers and health-care analysts have blamed instability caused by the Trump administration on rising premiums as company exits left many counties in the U.S. nearly bare. For months, the president wavered on whether he’d continue making subsidy payments to insurers under the law before deciding last month to cancel them. Yet because of the law’s complex subsidy structure, some consumers may actually pay less because of the decision, but it may not be with their current plan. “Shopping this year is hugely important,” Sebelius said.

On Wednesday, there was a stark contrast between the near silence of the Trump administration and the coordinated promotional efforts led by Obama, senior Democratic lawmakers in Congress and the states, and outside advocacy organizations. Aside from a pair of tweets from the official HHS account, there has been little high-level attempt to broadcast the start of open enrollment. Indeed, the only comments Trump made on health care Wednesday was to urge congressional Republicans, as part of their forthcoming tax bill, to repeal the Obamacare mandate requiring individuals to buy insurance at all. During a speech to a conservative group on Wednesday, Acting HHS Secretary Eric Hargan said the administration was “committed to making this year’s enrollment as consumer-friendly as possible.” But, he added, the administration’s ability to do so was limited by the law’s “flawed rules.”