In states that handle their own systems and advertising, like New York, Colorado and California, sign-ups were essentially flat.
The data in Wednesday's report are based on the most recent "enrollment snapshot" that the Health and Human Services Department released in December for the federal-exchange states, plus final tallies from state-run marketplaces - the same data those states are reporting to HHS for a government report due out next month.
Florida, which uses HealthCare.gov, and California continue to lead all states with 1.7 million and 1.5 million enrollees, respectively. A central pillar of the health reform law, the mandate requires almost all Americans to get coverage or pay a penalty.
The modest dip in sign-ups shows the importance of the Affordable Care Act to consumers, advocates argue. Yet numbers don't back that up.
"While we've seen remarkable stability in 2018, 2019 looks very troubling", Lee said, noting that premiums could rise by 30% in some states. In the five state-based marketplaces using the Healthcare.gov platform, enrollment increased by an average of 1 percent.
That in large part reflects extensive efforts in many of these states to market health coverage, lengthen enrollment periods and conduct aggressive outreach campaigns to attract younger, healthier consumers who are critical to insurance markets.
Several states, including Alaska and Minnesota, already have reinsurance programs. The standouts included Rhode Island, which saw a 12.1% increase, and Washington, which had 7.7% more people pick plans.
The report combined enrollment figures from the federal exchange, where enrollment ended on December 15, 2017, along with state-based exchanges that allowed customers to select plans as late as January 31.
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"Put simply, marketing matters", Lee said.
Sixteen states increased their enrollment from previous year, according to AP's analysis.
The latest open enrollment period was indeed unlike any other saw far in the ACA's history, as it was not only half as long for many states but also taking place after a year in which Congress tried repeatedly to repeal the law that created the individual marketplaces.
"Obamacare is finished. It's dead".
Korbulic credited the state's Republican governor, Brian Sandoval, with helping to stabilize a shaky market even as insurers stopped selling plans in the state and threatened to leave consumers in some rural areas with no choice of plans. However, 423,484 of those consumers were new enrollees, which is up three percent from a year ago.
Despite the smaller-than-expected decline, enrollment in the ACA's exchanges has fallen from a peak of about 12.7 million in 2016, and the overall individual market has turned out to be smaller than estimated when the health law was passed.
"There could be a number of different reasons for that", says James Scullary with Covered California. Those on-market price hikes were largely offset by jumps in tax credits for consumers receiving subsidies.