A little more than 1.9 million people signed up for health insurance in the first three weeks of the Affordable Care Act open enrollment for 2019 coverage. That compares with almost 2.3 million during the first three weeks of open enrollment last year, which included an additional day. Americans are signing up for coverage through the federal marketplace at a slower rate this year, but the Centers for Medicare and Medicaid Services numbers don't include enrollment in states that operate their own exchanges, or those who will be automatically enrolled in plans during the last week of open enrollment, which ends Dec. 15 in most states. (Shelby Livingston, Modern Healthcare)