President-elect Donald Trump vowed to “repeal and replace Obamacare” during his campaign, but the threat of dismantling the program is having little effect on those choosing to sign up for the Affordable Care Act.

Through Nov. 1, the first date of open enrollment, through Dec. 19, 6.4 million Americans had selected an insurance plan. Federal officials say that number represents an increase of 400,000 over the same period last year.

Total plan selections from Nov. 1 through the extended deadline of Dec. 19 include 2.05 million new consumers and 4.31 million returning consumers actively renewing their coverage. Consumers whose coverage will be automatically renewed for Jan. 1 are not yet included in these totals.

In Alabama, 122,711 people signed up during that period, which is also a 1 percent increase over prior year.

Dec. 19 was the deadline to have insurance begin on Jan. 1, though the final deadline for 2017 coverage is Jan. 31. Healthcare.gov handles Affordable Care Act sales for the 39 states that do not operate their own exchanges, which includes Alabama.

Department of Health and Human Services Secretary Sylvia Burwell said while open enrollment is trending ahead of last year’s numbers, efforts are underway to market the ACA to new consumers. For example, the IRS plans to send letters to potential consumers urging them to sign up for insurance as opposed to paying the penalty.

“We want uninsured Americans to know one thing — they have not missed their chance for coverage,” Burwell said Wednesday during a call with media outlets.

She added the “doomsday predictions” about the marketplace were wrong, though she did refer to 2017 as a “transition year.” Providers have brought their rates up in line with their costs, which has proven incredibly costly for the four states — Alabama, Texas, Mississippi and Florida — that rejected the Medicaid expansion.

Alabamians who receive insurance through the ACA will pay significantly more next year, however. A decision by Humana and UnitedHealthCare to exit the Alabama exchange leaves only Blue Cross Blue Shield as the only provider.

Blue Cross Blue Shield announced earlier this year that premiums would rise rise 36.1 percent in 2017, following a 28 percent increase from 2015 to 2016.

According to a report in Wednesday’s Los Angeles Times, 17 percent of Alabamians skipped health insurance in 2015 because of the cost. The rate was 18 percent in Texas and 19 percent in Mississippi, the report said.

The future of health care

It’s unclear how a Trump presidency would affect health care for Americans. Republicans plan to repeal “Obamacare” early next year, then take up to several years to replace it.

Burwell said call center representatives have talked to 30,000 people who have asked if they should still sign up, considering Trump’s pledge to repeal and replace.

“The answer is ‘yes,’” she said. “Even though we have had some headwinds … the Affordable Care Act is the law of the land.”

Burwell explained that a congressional decision to repeal the Affordable Care Act would result in 30 million Americans losing coverage. She said it could also destabilize the individual market and cause it to collapse.

Still, the cost of the program continues to escalate. An analysis released Dec. 15 by the Center for Health and Economy says taxpayers will fork over nearly $10 billion more next year to cover double-digit premium hikes.

The study estimates the cost of premium subsidies under the ACA will increase by $9.8 billion next year, rising from $32.8 billion currently to $42.6 billion.

The average monthly subsidy will increase by $76, or 26 percent, from $291 currently to $367 in 2017.

Currently more than 8 in 10 consumers buying private health insurance through HealthCare.gov and state markets receive tax credits from the government to help pay their premiums. Those subsidies are designed to rise along with premiums, shielding consumers from sudden increases. But the bill ultimately gets passed on to taxpayers.

Shortly before Election Day, the administration revealed that premiums for a midlevel benchmark plan on HealthCare.gov would jump by an average of 25 percent next year.

Democratic appeal

Democratic governors Wednesday warned top Republicans in Congress that repealing the Obama health care law would stick states with billions of dollars in costs for providing medical care to residents made newly uninsured.

The Democratic Governors Association sent a letter to House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. The letter explained states could face nearly $69 billion in costs for uncompensated care over the next 10 years if the health law is repealed. States traditionally shouldered a hefty share of such costs.

Party leaders have promised an orderly transition between the repeal of the ACA and implementation of a new system. It’s unclear what that would involve, but presumably some of the law’s popular provisions — such as subsidies and protection for those with pre-existing medical conditions — would be kept in place.

Repealing the law “would be a financial and health disaster for states,” the governors wrote. “Repeal would throw millions of our residents off their health coverage, shift enormous costs to state governments — blowing a hole in state budgets — and cause economic uncertainty for our states’ businesses, hospitals, and patients.”

— Associated Press reporter Ricardo Alonso-Zaldivar contributed to this report.