With the conclusion of open enrollment coming Sunday, health insurance sign-ups on the state's MNsure exchange are continuing to match last year's pace even as health plan selections have been down across most other states.

As of Jan. 2, 116,795 people had selected a health plan for 2019 via MNsure, which is roughly even with the year-ago tally at a similar point during open enrollment for 2018 coverage.

The federal government's HeathCare.gov website, which serves as the exchange in more than 30 states, saw open-enrollment sign-ups fall by more than 300,000 people, or about 4 percent, to 8.4 million, according to a government report this month.

One possible explanation for the difference is that Minnesota and several other states that run their own health exchanges have maintained spending on outreach and enrollment efforts, whereas the federal government has cut back spending, said Cynthia Cox, a health policy researcher at the Kaiser Family Foundation.

"The state-based exchanges have been more likely to do better in terms of maintaining or increasing enrollment," Cox said. "That makes it seem like outreach and enrollment is playing a role."

MNsure is a government-run website where individuals can buy nongroup insurance policies, a type of coverage popular among people under age 65 who are self-employed or don't get health insurance from their employer.

Minnesota launched the health insurance exchange in 2014 to implement the ACA, which provides income-based tax credits to many who buy coverage through one of its insurance exchanges.

The exchanges are an option for people who buy individual coverage that's sold by private health insurers.

The ACA banned carriers from denying coverage to people based on pre-existing health conditions, and coupled the requirement with tax penalties for individuals who don't have health insurance.

A tax bill signed into law in late 2017 by President Donald Trump eliminated enforcement of the ACA's "individual mandate" for people to buy coverage.

On Monday, the health policy journal Health Affairs published a study suggesting the lack of enforcement on the individual market in California could prompt some relatively healthy consumers to not buy insurance. A survey of individual-market enrollees in California in 2017 found that 19 percent said they would not have purchased insurance had there been no penalty, researchers said, adding that premiums would increase by 4 percent to 7 percent if those enrollees were not in the risk pool.

MNsure officials, however, said they haven't seen a big change in consumer behavior in Minnesota due to the lack of enforcement on the individual mandate. Enrollment trends in Minnesota have been helped, they said, by outreach and enrollment efforts by MNsure as well as premium declines of 7 percent to 27 percent.

After three years of big premium jumps, Minnesota's individual market for 2019 is seeing a second year of flat or declining premiums. The average benchmark premium across Minnesota in 2019 for a 40-year-old nonsmoker is $326 per month, a decline of 15 percent from the comparable rate this year, according to the Kaiser Family Foundation.

Minnesota is one of seven states that's outperforming the federal government's exchange in terms sign-ups for 2019 vs. last year, said Cox, the researcher at the foundation. While sign-ups at the federal exchange are down overall, there are some states using the federal government's HealthCare.gov website that have seen sing-up increases, she said.

If the lack of enforcement on the individual mandate is playing a role in sign-up numbers, Cox said, it might be a bigger factor among people who buy individual policies outside the exchanges, since many who use an exchange receive tax credits that cover a large chunk of the cost. She noted that sign-ups on the exchange for New Jersey have been down even though the state enacted its own mandate for individuals to buy coverage. Numbers aren't yet available for sign-up trends in the off-exchange individual market.

Open enrollment closed in December for states that use the federal exchange. At MNsure, open enrollment will draw to a close at the end Sunday, with extended call center hours planned for Friday and Saturday. On deadline day, MNsure expects to field calls until midnight.

Last year, MNsure reported 123,334 sign-ups for coverage during open enrollment for 2018 coverage. MNsure's budget for 2019 anticipates flat enrollment.

Christopher Snowbeck • 612-673-4744 Twitter: @chrissnowbeck