Barack Obama

By ROBERT PEAR
Published: December 21, 2013

WASHINGTON — For most Americans, Monday is the deadline to sign up for health insurance that takes effect on Jan. 1. It was supposed to be a turning point in the troubled history of the new health care law, the moment when the spotlight would shift from the federal government’s online marketplace to the insurance companies providing coverage to hundreds of thousands and eventually millions of people.

Sandy Praeger, the insurance commissioner in Kansas, expressed concern for people from high-risk pools.

But as the date approaches, a series of decisions by the Obama administration to delay some of the law’s most important provisions and to extend some deadlines has caused uncertainty among insurers and confusion among consumers.

Already the enrollment of young adults appears to be lagging behind the expectations of federal officials and insurers. And insurers, struggling with problems caused by the chaotic debut of the federal insurance exchange in October, have criticized the administration’s last-minute changes, saying they could cause instability in the market.

The sudden shifts have sent a mixed message to consumers about the significance of the Monday deadline. They reduce the sense of urgency but not the need for coverage. Accordingly, federal and state officials said they were prepared for an increase in activity on their websites and at telephone call centers as uninsured consumers rushed to beat the deadline.

“The Dec. 23 deadline is a huge milestone on the way to coverage that will provide relief and hope to a lot of people,” said Andrea J. Routh, the executive director of the Missouri Health Advocacy Alliance, a consumer group. “For many, this will be the best Christmas gift they’ve had in a long time.”

Julie Bataille, a spokeswoman at the Centers for Medicare and Medicaid Services, said the agency was adding staff, training and outreach efforts across the country. “People tend to have questions and act when they come up against deadlines,” she said.

President Obama said Friday that “more than one million Americans have selected new health insurance plans through the federal and state marketplaces” since they opened on Oct. 1. The administration had hoped that 3.3 million would be signed up by the end of this month, according to a memo prepared by the Health and Human Services Department in early September.

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