Enrollment in the Affordable Care Act marketplaces is down nationally, including in Pennsylvania and New Jersey, compared with this time last year, and time is running out to sign up.

The deadline to enroll in coverage for 2019 is Dec. 15.

The final weeks of enrollment are notoriously busy — last year, more than two-thirds of people who bought ACA marketplace health plans in Pennsylvania signed up in the last two weeks. But according to a new poll by the Kaiser Family Foundation, 70 percent of people don’t know when the deadline to enroll is.

In the final stretch, Pennsylvania Insurance Commissioner Jessica Altman said her department will be imploring people to log on to healthcare.gov or seek out an in-person navigator to get help signing up.

As of Dec. 1, 123,918 Pennsylvania residents had signed up for coverage through the ACA marketplace, down 23 percent from the same point last year.

Nationally, just less than 3.2 million people in the 39 states that use the healthcare.gov platform have bought ACA health plans, down 11 percent from the same time last year.

Recent efforts by Republicans and the Trump administration to undo key aspects of the Affordable Care Act may be partly to blame, Altman said.

Beginning in 2019, people who do not buy insurance will no longer pay a tax penalty. At the same time, the Trump administration loosened restrictions on short-term health plans, which are much cheaper than the marketplace plans because they can deny coverage for services such as maternity care, prescription benefits, and pre-existing conditions.

People feeling pinched by high insurance prices may instead opt for a cheaper plan or skip coverage entirely. Others may have gained insurance through an employer, Altman said.

“February, March, April is when we’re going to start to see ... what the impact is," she said. “That’s when we start to get the calls from consumers who missed open enrollment and have a health care need or signed up for a short-term plan and are realizing their pre-existing condition isn’t covered at all.”

Enrollment is down in New Jersey, too, even though the state banned short-term plans and created its own state tax penalty for people who don’t buy insurance. About 89,700 New Jersey residents have signed up for ACA plans through Dec. 1, down 14 percent from the same time last year.

Shopping for health insurance is always daunting, but could be even tougher this year. Premiums for 2019 plans are declining compared with 2018, but many consumers in Philadelphia, Bucks and Montgomery Counties are finding they will have to pay more to keep the same plan.

That’s because with a new competitor in those counties offering lower-cost plans, tax subsidies are also going down.

“Fewer people are saying on the spot, ‘I definitely want to enroll.’ More people are going home, thinking about how it fits into their budget and figuring out what they want to do,” said Antoinette Kraus, director of Pennsylvania Health Access Network, an organization that helps people enroll in coverage.

Personal circumstances also can make this decision difficult.

Jessy Foster, an enrollment specialist with Pennsylvania Health Access Network, sat down in early December with a 62-year-old adjunct professor who enjoyed a $0 deductible this year because he qualified for an income-based tax credit. The Philadelphia man will have to pay $388 a month next year to keep the same plan.

He could have switched to a lower-premium plan, but the plan has a deductible of almost $7,000, which would have hit him hard because he takes several medications.

“We figured out the math, and it made more sense to opt for [the $0 deductible plan]. It can be tricky if you don’t know what you’re looking for,” Foster said.

Add to that: Like many Americans, the professor has to estimate his income because it fluctuates. This year, he underestimated, and ended up exceeding the tax credit limit. So he had to pay back both the credits and a tax penalty. Next year, he would do better to stop working once he hits the limit.

He was lucky enough to get to see an ACA expert who could help him figure out all that. Funding for navigator groups has been decimated under the Trump administration, which has also slashed the enrollment period from three months to six weeks.

Robin Stockton, director of navigator services for the Center for Family Services in New Jersey, said her group has been busier than ever. Last year, the group had $291,000 to spend on seven counties. This year: they’re covering the entire state with about $400,000.

“Every year the funding gets cut and there’s less opportunity to sit down with folks and we move to the telephone. It’s not the same, but it’s the best we can do,” Stockton said.

Pennsylvania Health Access Network didn’t receive any federal grants this year. The group has cobbled together about $75,000 in donations to keep three enrollment specialists working in Philadelphia, plus two others elsewhere in the state.

Despite the challenges, Altman urges consumers to get going now to check out the healthcare.gov website and seek navigator help if needed.

“If you miss the open enrollment window, you could really be stuck without a good option for health insurance," she said. “It is incredibly important that anyone who wants comprehensive health insurance or thinks they might, take the time [before Dec. 15] to log in.”