Enrollment in plans through Nevada’s health insurance exchange this year is lagging behind last year’s numbers as state officials face additional challenges including the expansion of health plans with skimpier coverage, telemarketing scams, misinformation about a new federal rule change and the repeal of a health insurance mandate penalty.

As of Dec. 1, Nevada’s health insurance exchange had enrolled 31,068 people into qualified health plans, 4,380 fewer than it had at this point last year. Heather Korbulic, the head of the exchange, said she is “deeply concerned” about the numbers though they are “trending in the right direction” as Nevada heads into the final week of its open enrollment period, which ends Dec. 15.

Two weeks ago, the exchange had enrolled 3,508 people, or 15.6 percent, fewer than it did at this point last year. While the most recent numbers released by the Centers for Medicare and Medicaid Services on Thursday show that gap has widened in terms of raw numbers, the margin has actually shrunk in terms of a percentage point difference, which now stands at about 12.4 percent.

“We’re getting closer, but I anticipate that our enrollment may be down for all the reasons we’ve been talking about going down,” Korublic said.

Korbulic believes that the expansion of two types of health insurance plans that aren’t required to provide the full suite of benefits required by Affordable Care Act-compliant plans, known as short-term limited duration plans and association health plans, are having some kind of an impact on exchange enrollment this year. But of the two, Korbulic believes the short-term limited duration plans are likely having the most effect since only one association health plan is offering coverage to sole proprietors.

A proposed Trump administration rule on public benefits has also been having a “chilling effect” on immigrants afraid to take federal subsidies to pay for insurance plans on the exchange, despite the fact that the rule does not apply to those subsidies, she said. On top of that, Congress repealed the tax penalty associated with Affordable Care Act’s individual mandate to purchase health insurance, which means some consumers may be choosing to forego coverage this year.

“Ultimately what concerns me is consumers that are choosing to be uninsured and the implications that has not only for them and their finances but for our community and our economy,” Korbublic said. “That’s more concerning to me than anything.”

The Division of Insurance has also been sounding the alarm about telemarketers and websites falsely advertising plans with limited coverage as compliant with the Affordable Care Act. Though consumers will no longer face a penalty for failing to be covered by an ACA-compliant plan, state officials are warning consumers that they may end up with thousands of dollars in medical bills if they purchase a skimpier plan.

“Consumers should only take these calls as reminders to shop for health insurance, but should never provide any information over the phone. There have been consumers who have fallen for this scam and have been left with thousands of dollars in unpaid medical bills because of gaps in coverage,” Insurance Commissioner Barbara Richardson said in a statement, directing people to both the state’s health insurance exchange and the federal enrollment websites.

Korbulic said an improving job market may also be a factor in lower enrollment this year, with people getting covered by private insurance through their employers. But she said it will be difficult to determine where exactly the exchange has lost enrollment numbers until the state receives the official breakdown of numbers from the federal government in March.

As a state-based exchange operating on the federal platform, Nevada has more control over open enrollment than other states operating fully on the federal platform do, including its marketing efforts, which Korbulic said are performing better this year than any other year. But she added that the transition to a state-based marketplace, which the exchange aims to have up and running by Nov. 1, 2019 for next year’s open enrollment, will give the state full control over its data, meaning an increased ability to recruit and retain customers.

“Essentially all of that combined really does lend itself to the narrative that we’ve been building and the story of why it’s important for us to move to a state-based exchange,” Korbulic said.