WASHINGTON — Rising premiums and shaken faith among insurers have cast a cloud over sign-up season for President Barack Obama’s health care law, and now it’s crunch time again.

Tuesday is the deadline for millions of uninsured procrastinators to sign up in time for coverage to begin on Jan. 1. As the health insurance expansion enters its third year, their decisions are critical to its economic viability. A surge of younger, healthier customers could hold down premiums in a market that’s struggling to grow.

“Medical costs of enrollees have been higher than expected and total enrollment remains low,” said Caroline Pearson, a

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