It's getting harder to sign up for ACA health insurance. Here are 9 things to do about it.

More than 426,000 people in Pennsylvania and 295,000 in New Jersey signed up for health-care coverage this year through Affordable Care Act marketplaces. Gov. Wolf recently bragged that the uninsured rate in Pennsylvania is lower than it's ever been, thanks to the law better known as Obamacare. New Jersey is touting similar results.

And in Washington, the latest effort to "repeal and replace" the ACA was defeated without even a vote.

But people such as Antoinette Kraus, whose mission is to help people find health care, are hardly in a mood to celebrate.

"We're worried folks are going to miss the deadline" to keep their insurance in 2018, said the director of Pennsylvania Health Access Network.

Why the concern?

Despite years of effort, Obamacare's foes in Congress and the White House haven't been able to "repeal and replace" a law that has proved popular with most Americans.

Yet the political uproar has left people more fearful and confused than ever about what they must do to get insurance for next year, said Kraus.

Plus, the Trump administration does have the power to nibble around the edges of the law. Under HHS Secretary Tom Price – who recently resigned over his private-plane use — it has been doing so in ways that has people such as Kraus scrambling for ways to help consumers. Specifically, the federal Department of Health and Human Services, which answers to the president, recently announced it is:

HHS officials tout the savings they expect, including $90 million in advertising and $25.7 million in funds for navigators who assist consumers. They insist the planned site maintenance times are actually not much different than in the past; they are simply announcing them in advance.

Consumer advocates, meanwhile, are focusing on what happens if people don't have insurance in 2018.

"I am very concerned. Inevitably it will impact our providing assistance to those with the greatest need for support," said Christina Miller, a managing director with Public Health Management Corp., which contracts with social service agencies to provide health-care  navigators.

State officials too, are worried, especially about the shorter enrollment period. In the past, many people have waited until after the winter holidays to sign up. Now, with the Dec. 15 deadline, that won't be possible.

"Since the Affordable Care Act was passed, Pennsylvania's uninsured rate has gone down to 5.4 percent — the commonwealth's lowest ever," said Ali Fogarty, a spokeswoman for acting Pennsylvania Insurance Commissioner Jessica Altman.

"The federal government should be encouraging people to enroll in coverage to continue the progress the law has made, and Pennsylvania will do what we can to try to fill this gap and ensure that people know the coverage options that are available."

She did not explain exactly how Pennsylvania, which is fighting its own budget shortfall, would do that.

Caitlin Oakley, HHS press secretary, defended the cuts, citing rising premiums and the falling number of participating insurers as proof that the law "is not working. The Trump administration is determined to serve the American people instead of trying to sell them a bad deal."

But local insurance officials say the law is working well.

In New Jersey, just two insurance carriers are providing coverage through the ACA this year, according to the state Department of Banking and Insurance. Still, the number of people insured through the ACA rose by 24 percent in the first quarter of this year, compared with the same period in 2016.

Marshall McKnight, spokesman for the New Jersey insurance department, said three insurance carriers are expected to provide ACA policies next year. What's more, he said, 80 percent of premiums paid are returned to consumers in health services, as opposed to going toward administrative costs.

In Pennsylvania, five insurance companies provided insurance through the ACA this year, said Tia Whitaker, state director of outreach and enrollment for the Pennsylvania Association of Community Health Centers. The state insurance department confirmed there will be five carriers as well next year.

Another cause for concern: What navigator funds the federal government is giving out will be distributed based on how well agencies met their enrollment goals last year. That's to "ensure accountability within the navigator program," according to HHS's Aug. 31 announcement.

But Whitaker, herself a trained navigator, explained that all kinds of people — even those who have had insurance for years — need help with enrollment. Early retirement, layoffs, and other life changes can mean that people have to seek individual insurance for the first time ever.

Often, she said, people will talk to a navigator but go home and sign up for coverage on their own. These sign-ups don't  count toward the navigators' quotas — meaning that even effective programs will be penalized by the new HHS policy.

Complicated family situations — divorces, births, adoptions, remarriages — also complicate health insurance needs, and make navigators essential, said Miller of the PHMC.

"It can be very difficult understanding what plan is right for you and your family," she said. "It's a lot to digest."

So with the turmoil and cutbacks, how can consumers who need insurance protect themselves? Here are some expert tips: