By Tony Pugh

McClatchy Washington Bureau

WASHINGTON, D.C. — As the fourth and possibly final enrollment period for health insurance under the Affordable Care Act ends Tuesday, outreach workers nationwide are pulling double duty: assisting enrollees and trying to overcome actions by the Trump administration that have made their work more difficult.

Procrastinators have until 11:59 p.m. Tuesday to enroll in a 2017 health plan in the individual marketplace. Those who miss the deadline for personal reasons like relocation, getting married or having a baby can qualify for an extension.

Nationwide, more than 8.8 million Americans used HealthCare.gov to sign up for coverage through Jan. 14. That’s about 100,000 more than last year at the same time.

Then, the Trump administration issued a confusing executive order strongly suggesting that his administration won’t strenuously enforce the health care law’s individual mandate, which requires most Americans to obtain health insurance or pay a penalty.

The order was immediately misconstrued, said Sorien Schmidt, North Carolina state director of Enroll America, the private Affordable Care Act advocacy group.

“When the executive order was signed, (people) thought that might mean the Affordable Care Act was no longer available to them,” Schmidt said of consumers her organization assisted. “For an individual who believes that and doesn’t check any further, it could mean that they give up the opportunity to enroll.”

Trump followed the executive order by pulling $5 million in radio, television and online advertising about the HealthCare.gov enrollment and deadline. Schmidt said she has already noticed fewer HealthCare.gov enrollment and deadline reminders than in previous years.

In South Florida, where nearly 600,000 people in Miami and Fort Lauderdale had signed up for a plan on HealthCare.gov through Dec. 31, enrollment counselors with the Epilepsy Foundation of Florida said Trump’s actions had taken the wind out of their efforts just as they were hitting one of the busiest months.

Enrollment signups for January dropped 64 percent from January 2016, said Karen Egozi, chief executive of the Epilepsy Foundation.

“We’ve seen a big impact,” she said. “We’ve seen almost like a halt. … This is usually our big month … and we’re getting people calling and canceling appointments.”

Egozi said the drumbeat of “repeal and replace” has left many consumers uncertain about whether they should even bother signing up for 2017 coverage.

“People are very confused,” she said. “It’s just a combination of everything, and people are holding back.”

In Washington, DSPolitical, a Democratic-aligned political technology firm, decided to produce its own digital outreach ads, targeting web users who need health insurance, said Jim Walsh, the company’s CEO. The company launched a GoFundMe account on Sunday seeking public contributions to fund the effort.

“We just couldn’t stomach it,” Walsh said of Trump’s decision to pull the HealthCare.gov ads. “Our team, once we heard about it on Friday, spent all day Saturday coming up with a plan which we launched on Sunday.”

“We wanted to do something, whatever we could to, at least, take advantage of the fact that there’s at least one day left to sign up,” Walsh said. “And even if Republicans decide to cancel the Affordable Care Act, if one person’s (coverage) could actually be saved by some small effort that we could make, we wanted to do it.”

Not all outreach groups have noticed a change since the Trump actions. Melissa Camp, director of navigation at Insure Georgia, a state navigator group based in Macon, said Trump’s executive order and ad pull haven’t caused much of a stir.

“Most people don’t even mention it,” Camp said. “Occasionally we get a question, but we haven’t had much response to it.”

Camp said the group’s enrollment activity may be down slightly from last year, but that could reflect the fact that more people can enroll on their own and don’t require as much assistance.

“We’re confidant that the new administration will do what’s right for the people, not only in Georgia, but the United States,” Camp said.

“We are going by the law as it currently stands and we will continue to work according to the law until we are told to do something differently,” Camp added.

Schmidt said the thought that this could be the last open enrollment under the Affordable Care Act was bittersweet.

“It makes me very sad that the hundreds of thousands of North Carolinians who get this help, might be without it next year,” she said.