Is Obama’s health overhaul losing steam?

That’s about as many as are covered now through the law’s online markets for subsidized private health insurance.

“Almost 60 percent are confused about how premium tax credits work or don’t know they’re eligible”, said Sylvia M. Burwell, secretary of the U.S. Department of Health and Human Services, during a morning telephone briefing for the media. Nearly 8 in 10 have an income that may qualify them for financial assistance. That’s far lower than Congressional Budget Office estimates that topped 20 million. The huge difference quickly raised questions about whether advances in health insurance coverage under President Barack Obama’s law may sputter or stall, leaving millions still uninsured.

But by year-end 2016, enrollment will be lower compared to the number of people who signed up for coverage during open enrollment. But she called 10 million “a strong and realistic goal”.

The exchange-based plans are sold by private insurers including Aetna Inc, Anthem Inc and UnitedHealth Group Inc. Republicans want to repeal the Affordable Care Act, but haven’t spelled out details of how they’d replace it. As documented by government studies and independent surveys, that’s a historic accomplishment. But things seem to be changing.

Premiums are expected to go up next year by a bigger amount than this year. And money is a problem.

Holding them back, Burwell said, are concerns about the cost of coverage and a lack of information about available financial aid, which is set on a sliding scale.

In addition, between 2.8 million and 3.9 million uninsured individuals will opt for coverage during the 2016 open enrollment, while between 900,000 and 1.5 million individuals who now have coverage outside the exchanges will select an exchange plan in 2016.

The insurance markets are now two years old, but they don’t quite appear to have stabilized. Such plans first took effect at the beginning of 2014.

The administration said that it believes that it will see customers drop coverage for a variety of reasons. And almost 970,000 households had their subsidies “adjusted” because of problems documenting their incomes. We are working hard to improve the customer experience with upgrades to our site and more tools to help people find what they are looking for.

Enrollment for 2016 coverage on the exchanges starts on November. 1, about three months before voters in each party begin choosing their candidates in Iowa, New Hampshire and South Carolina.

About 17.6 million people have gained insurance coverage through the exchanges and through the expansion of Medicaid plans for the poor since early 2014.