Last year’s final enrollment numbers under President Barack Obama’s health care law fell just short of a target the administration had set, the government reported Friday.

The numbers are important because the insurance markets created by the president’s 2010 health care law face challenges building and maintaining enrollment. The marketplaces offer subsidized private insurance to people who don’t have access to job-based coverage.

The report from the Health and Human Services Department said about 8.8 million consumers were still signed up and paying premiums at the end of last year.

HHS Secretary Sylvia M. Burwell had set a goal of having 9.1 million customers by then.

Political uncertainty isn’t the only threat to the Affordable Care Act’s future. Cracks also are spreading through a major pillar supporting the law

Health insurance exchanges created to help millions of people find coverage are turning into money-losing ventures for many insurers.

The nation’s largest, UnitedHealth Group Inc., could lose as much as $475 million on its exchange business this year and may not participate in 2017. Another major insurer, Aetna, has questioned the viability of the exchanges. And a dozen nonprofit insurance cooperatives created by the law have already closed, forcing around 750,000 people to find new plans.

More insurer defections would lead to fewer coverage choices on the exchanges and could eventually undermine the law, provided the next president wants to keep it.

With billions in taxpayer dollars at stake, the Obama administration has taken a “passive” approach to identifying potential fraud involving the president’s health care law, nonpartisan congressional investigators say in a report released Wednesday.

While the Government Accountability Office stopped short of alleging widespread cheating in President Barack Obama’s signature program, investigators found that the administration has struggled to resolve eligibility questions affecting millions of initial applications and hundreds of thousands of consumers who were actually approved for benefits.

The agency administering the health law — the Centers for Medicaid and Medicare Services — “has assumed a passive approach to identifying and preventing fraud,” the GAO report said. In a formal written response, the administration agreed with eight GAO recommendations while maintaining that it applies “best practices” to fraud control.

A federal appeals court in Atlanta on Thursday upheld a contraceptive mandate included in the president’s health care law but is delaying the implementation of its ruling until the U.S. Supreme Court can weigh in on the issue.

A three-judge panel of the 11th U.S. Circuit Court of Appeals ruled 2-1 to reject challenges to the mandate in a single opinion addressing two separate cases, one filed by nonprofit organizations affiliated with the Catholic Church in Georgia and the other by Catholic broadcaster Eternal Word Television Network in Alabama.

The organizations had argued the mandate and a related rule against those entities would violate the Religious Freedom Restoration Act of 1993, which prohibits the government from imposing a substantial burden on a person’s religious practice.

Hundreds of thousands of people lose subsidies under the health law, or even their policies, when they get tangled in a web of paperwork problems involving income, citizenship and taxes. Some are dealing with serious illnesses like cancer. Advocates fear the problems, if left unresolved, could undermine the nation’s historic gains in health insurance.

Coverage disruptions due to complex paperwork requirements seem commonplace in the health law’s system of subsidized private insurance, which currently covers about 12.7 million people.

The government says about 470,000 people had coverage terminated through Sept. 30 last year because of unresolved documentation issues involving citizenship and immigration. During the same time, more than 1 million households had their financial assistance “adjusted” because of income discrepancies. Advocates say “adjusted” usually means the subsidies get eliminated.

As more requirements of the health care law take effect, income tax filing season becomes more complex for small businesses.

Companies required to offer health insurance have new forms to complete providing details of their coverage. Owners whose payrolls have hovered around the threshold where insurance is mandatory need to be sure their coverage — if they offered it last year — was sufficient to avoid penalties.

Even the most tax-savvy owners may find that do-it-yourself doesn’t work when it comes to fulfilling the law’s requirements. Many don’t know about the intricacies of the new health care regulations associated with the law that affect employers, says Lydia Glatz, an accountant with the firm MBAF in Fort Lauderdale, Florida.

“Most small businesses and mom-and-pop operations,” Glatz says. “They’re more involved in running their day-to-day business.”

Most uninsured Americans are sitting on the sidelines as sign-up season under the federal health law comes to a close, according to a new poll that signals the nation’s historic gains in coverage are slowing. The survey released Thursday by the Kaiser Family Foundation finds that:

– Only 15% of the uninsured know this year’s open enrollment deadline, which is Sunday.

– More than 7 in 10 say they have not tried to figure out if they qualify for the two main coverage expansions in the law, Medicaid and subsidized private health insurance.

– Only 1 in 100 know the minimum penalty for being uninsured is going up to $695 in 2016.

About 1.4 million households that got financial help for health insurance under President Barack Obama’s law failed to properly account for it on their tax returns last year, putting their subsidies at risk if they want to keep coverage. The preliminary figures were released by the IRS late Friday afternoon, a time when the government often reports unfavorable developments.

Going into President Barack Obama’s last year in office, progress has stalled on reducing the number of uninsured Americans under his signature health care law, according to a major survey out Thursday.

The share of U.S. adults without health insurance was 11.9% in the last three months of 2015, essentially unchanged from the start of the year, according to the Gallup-Healthways Well-Being Index. The ongoing survey, based on daily interviews with 500 people, has been used by media, social scientists, and administration officials to track the law’s impact.

A federal budget proposal brought good news Wednesday for Minnesota’s medical device companies by freezing for two years a tax on products like pacemakers and ventilators that they have long opposed. The package of tax cuts and spending cued up for final votes in Congress this week would suspend the 2.3% excise tax on those devices, ultrasound machines and more that took effect in 2013 as part of the funding mechanism for President Barack Obama’s health care law.