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Today is the last day for people in most of the country to sign up for coverage through the Affordable Care Act.

Expand chart

Note: Data includes partial weeks. The 2018 open enrollment window is Nov. 1 to Dec. 15, 2017. The 2017 window was Nov. 1, 2016 to Jan. 31, 2017; Data: Centers for Medicare & Medicaid Services; Chart: Chris Canipe / Axios

The final results from this signup period will help insurance companies figure out whether their outlook for the future is terrible, or merely bad.Be smart: Insurers are already beginning to look ahead to 2019 — and they're seeing a policy landscape that leads directly to higher premiums, if not to giving up altogether on some of the ACA's exchanges. It's impossible for ACA enrollment to make that outlook much better, but a disappointing number this year could make things even worse.

Where it stands: Enrollment ends today in the vast majority of the country. A few state-run exchanges, including New York and California, have extended enrollment into January.

  • The number of sign-ups is surging right now, as the deadline approaches. But it was already so far behind that this year's totals are highly unlikely to match last year's.
  • Enrollment is supposed to be going up. When it goes down, that's bad. And it's probably going to go down.

What's next: Beginning in the spring, insurers will start to take stock of their customer base and make preliminary decisions about whether they want to keep selling insurance through the exchanges — and if so, where.

  • Congress appears highly likely to repeal the ACA's individual mandate in the meantime. And the Trump administration will also move ahead soon with regulations expanding access to cheap, skimpy short-term health plans.
  • Both of those changes will likely pull healthy consumers out of the market for ACA coverage.
  • Insurers almost certainly would respond by seeking major premium hikes. The conventional wisdom within the industry and among policy analysts says some parts of the country probably won't have any insurance plans to choose from after this all shakes out.

The bottom line: No outcome from the enrollment period that ends today could make that landscape look much better.

  • There's simply no universe in which enrollment will be good enough to make ACA insurers comfortable with the loss of the individual mandate and the return of short-term plans.
  • Particularly low enrollment, however, could make this bad landscape look even worse, because insurers would have fewer customers to help absorb the blow from future policy changes.

Go deeper

Updated 3 hours ago - World

Biden reviews U.S. arms deals with Saudi Arabia and UAE

Trump struck several large arms deals with Mohammed bin Salman (L) and Saudi Arabia. Photo: Kevin Dietsch-Pool/Getty Images

The Biden administration has put on hold two big arms deals with Saudi Arabia and the United Arab Emirates which were approved in the final weeks of the Trump administration, a State Department official told Axios.

Why it matters: The sales of F-35 jets and attack drones to the UAE and a large supply of munitions to Saudi Arabia will be paused pending a review. That signals a major policy shift from the Trump era, and may herald sharp tensions with both Gulf countries.

Trump supporter found with pipe bombs accused of plot to attack Democrats

Five improvised explosive devices that the FBI says "were fully operational and could cause great bodily harm or injury if handled improperly." Photo: FBI/Justice Department

The FBI believes California Gov. Gavin Newsom (D) and the Bay Area headquarters of Twitter and Facebook were targets of a man facing federal explosives charges, according to a criminal complaint.

Driving the news: Prosecutors charged Ian Benjamin Rogers after finding weapons including five pipe bombs, 49 guns and thousands of rounds of ammunition following a Jan. 15 search of his Napa County home and auto repair business. His alleged goal was to ensure former President Trump remained in office.

7 hours ago - Health

Fauci: COVID vaccine rollout needs to prioritize people of color

Anthony Fauci. Photo: Alex Wong via Getty Images

Infectious disease expert Anthony Fauci highlighted the need to address racial disparities in the COVID-19 vaccination process, per an interview with The New England Journal of Medicine on Wednesday.

What he’s saying: "I think that's the one thing we really got to be careful of. We don't want in the beginning ... most of the people who are getting it are otherwise, well, middle-class white people."

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