Former President Barack Obama has made few public statements about the Affordable Care Act since leaving office, even as Republicans have repeatedly tried to undo his signature domestic achievement. | Julio Cortez/AP Photo First day of Obamacare enrollment stays drama-free

Former President Barack Obama sought to boost his namesake health law Wednesday by appearing in a video urging people to sign up for coverage on the first day of the 2018 enrollment season.

Obama’s call comes as the Trump administration has taken numerous actions to undermine the law while doing almost nothing to publicize the start of the six-week enrollment season that wraps up on Dec. 15.


Still, sign-ups got off to a smooth start on Wednesday, in a muted opening day that belied the still-tense political climate surrounding the health law.

“HealthCare.gov is open for business right now,” the former president said in the video released by Get America Covered, an advocacy organization run by former Obama health officials. “You can shop for a health insurance plan that's right for you and your family. It only takes a few minutes and the vast majority of people qualify for financial assistance.”

Obama has made few public statements about the Affordable Care Act since leaving office even as Republicans have repeatedly tried to undo his signature domestic achievement.

Confusion has clouded the 2018 enrollment season as President Donald Trump and many Republicans continue to insist they will dismantle the law despite the collapse of their earlier efforts. In a dramatic shift from the Obama years — when the administration pulled out all the stops to get people covered — the Trump administration has cut the enrollment period in half, gutted its own outreach budget and kept the fanfare to a minimum.

Trump himself remained silent on open enrollment — instead floating on Twitter the prospect of repealing Obamacare’s individual mandate as part of a tax reform bill.

"Wouldn't it be great to Repeal the very unfair and unpopular Individual Mandate in ObamaCare and use those savings for further Tax Cuts," Trump tweeted. "The House and Senate should consider ASAP as the process of final approval moves along."

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Neither HHS acting Secretary Eric Hargan nor CMS Administrator Seema Verma held events promoting enrollment either. And during an appearance at a Council for Affordable Health Coverage event, Hargan criticized Obamacare for driving up prices.

“We are committed to making it as consumer friendly as possible,” he said of open enrollment. “But as you can guess from the rising premium numbers, our ability is limited when we have such flawed rules governing which products Americans buy.”

That has pitted a government largely apathetic about the health law against a loose but growing apparatus of outside advocacy organizations, health care companies and prominent Democrats united by the goal of getting more Americans insured — and hammering home the political message that Obamacare remains very much alive and well.

Steven Lopez, associate director of health policy with UnidosUS, said there has been a lot of confusion over the ACA in the weeks leading up to the open enrollment period because of the rhetoric from Washington.

“We are trying to be that clarifying voice,” said Lopez, whose group, formerly known as the National Council of La Raza, has 14 community-based organizations in Florida spreading the word among Hispanics about signing up for Obamacare.

UnidosUS staffers also plan to promote the ACA with a “tour” of Spanish language radio stations in select cities in Florida and nationwide to reach millions of Hispanics.

Kevin Knauss, an insurance agent based near Sacramento, Calif., said his call volume for the start of open enrollment has been higher than usual and people have questions about whether the individual mandate still exists or whether they’re supposed to follow the guidelines of the state exchange Covered California or those listed on Healthcare.gov. He added that the message that California’s enrollment period will last through end of January, unlike the federal period which ends Dec. 15, hasn’t reached the masses.

“There’s just more confusion,” Knauss said, adding that his general message to people is to stay calm. “There’s a lot of angst out there.”

Covered California on Wednesday kicked off its annual bus tour — a 22-stop trip around the state to promote enrollment — in Los Angeles.

In Washington, Senate Democrats on Wednesday toggled between urging people to sign-up and slamming Trump for complicating the process ahead of what policy experts project could be Obamacare’s worst enrollment period yet.

Sign-ups had shown signs of hitting a plateau even before Trump swept into office on promises to immediately repeal Obamacare, and little that’s happened since is likely to alter that trajectory.

“Let’s be honest about it: We can’t do this by ourselves,” said Sen. Dick Durbin (D-Ill.). “We will have fewer people enrolled because of the president’s efforts to sabotage the sign-ups.

Health analysts at S&P Global Ratings predict that enrollment could drop as low as 10.6 million — the lowest point since Obamacare's inaugural 2013 sign-up period and a 13 percent decline from last year. That reduction will likely be driven by a lag in new customers, along with more people who don't receive federal subsidies deciding to go without coverage rather than pay far higher premiums.

Trump health officials have declined to issue an enrollment projection. In an email, a CMS spokesperson said the agency's target is a "seamless open enrollment" and that the sign-up numbers "will take care of themselves."

In the absence of any cheerleading from the federal government, outside groups have taken the lead on correcting misconceptions and encouraging enrollment. The high-volume political war that on several occasions this year pushed the law to the brink of repeal undermined confidence in Obamacare's stability and generated confusion about whether it still exists, even though Obamacare remains fully intact and on its surest political footing in months.

Trump's rhetoric and his unilateral actions — highlighted by his October decision to pull key subsidy funding to insurers — further stoked fears of destabilization, driving a flurry of last-minute activity aimed at tamping down premium increases and keeping health plans from fleeing the market.

"So many people think that the law has been repealed, and we're just having to explain to them that it's not," said Brian Burton, the state director for the enrollment assistance group Navigators for a Health Louisiana.

Obamacare advocates have stressed the affordability of health plans for the roughly 80 percent of those in the market that qualify for federal subsidies. They’re also hoping to seize on enthusiasm generated by the ongoing campaign to defend Obamacare against the GOP's repeal and replace plans — an effort that has pushed the law's public approval rating to new highs and that navigators say is prompting an unprecedented level of volunteer interest in helping to drive sign-ups.

Illinois gubernatorial candidate J.B. Pritzker’s campaign is spending $1 million to run radio and digital ads promoting open enrollment throughout the state. Get America Covered is also helming a six-figure nationwide digital campaign.

And across several states, appointed officials and outside activists have focused on building out a formidable grassroots effort.

“They can put out messages about doomsday, about how it’s ending, about how it’s imploding to confuse us,” Herminia Palacio, New York City’s deputy mayor for health and human services, said at an enrollment event Wednesday. “The ACA is still the law of the land, and the more of us are involved, the more of us lift our voices, the more of us they have to piss off to take it away.”

In Washington, D.C., well over 100 people gathered outside a charter school in the city’s Columbia Heights neighborhood’s to hear a similar message: Ignore all the noise coming from Capitol Hill and get signed up for coverage.

“We will be all over our city for the next twelve weeks making sure we find people who don’t have health care coverage and we get them enrolled,” Mila Kofman, executive director of D.C. Health Link, the city’s exchange, told the crowd.

D.C.’s open enrollment season will be twice as long as the federal sign-up window and local officials are pledging additional resources to help make up for cuts in federal marketing and outreach.

A similar effort was revving up in deep red Texas, which boasts one of the nation’s highest uninsured rates. Enrollment assistance group The Community Council of Greater Dallas said it’s bracing for a surge of visits in the next week, and is coordinating with local churches and the county hospital to handle the crowd.

“We don’t like to have folks in long queue lines, because it dehumanizes the process,” CEO Ken Goodgames said.

Advocates hope doubling down on that on-the-ground work will fill the void left by the Trump administration. The government pulled back on its traditional community outreach activities slashed funding to state-based enrollment assistance groups, forcing many of those so-called navigators to lay off staff or even shut down completely.

That has deeply shaken the trust between the administration and enrollment organizations that had grown used to working with federal officials equally invested in Obamacare's success. A relatively routine technical issue with HealthCare.gov's health plan previewing tool in the run-up to open enrollment sent nervous titters through the navigator community — prompting one navigator organization to print out hard copies of each plan's details for fear that CMS wouldn't fix the issue in time.

And on Tuesday, CMS sent a notice telling navigators and enrollment officials that it would shut down HealthCare.gov for maintenance from 10 p.m. Eastern until "the morning" of open enrollment. That surprised those who believed sign-ups would be available starting shortly after midnight.

A CMS spokesperson said that the start time was consistent with how HealthCare.gov's rollout was handled last year.

Despite the early jitters, enrollment advocates reported a first day that went off largely without a hitch. HealthCare.gov remained up and running smoothly, and across both blue and red states, navigators saw a steady workday crowd eager to come in and enroll.

“We had a line outside by 8:30 a.m., and we were scheduled to open at 9,” said Elizabeth Colvin, the director of Insure Central Texas at Foundation Communities. “It has been a great day.”

Paul Demko, Renuka Rayasam, Dan Goldberg, Arthur Allen, Victoria Colliver and Alexandra Glorioso contributed to this report.