ACA markets open this week amid uncertainty

WASHINGTON — Health insurance marketplaces created by the Affordable Care Act begin accepting 2018 applications Wednesday amid mounting concern that the Trump administration’s repeated attacks on the law will dramatically depress enrollment.

The marketplaces — a centerpiece of the law commonly called Obamacare — continue to provide coverage for some 10 million people. And they remain the only option for many low- and moderate-income Americans who don’t get health benefits through an employer or a government program such as Medicare or Medicaid.

But across the country, the president’s persistent criticism of the law and Republican congressional efforts to repeal it have fed widespread confusion among consumers.

“Most people think the plans are gone,” said Katy Caldwell, executive director of Legacy Community Health, a large network of clinics serving lowincome patients in and around Houston.

Caldwell said patients routinely now say they are expecting to be uninsured in 2018. “We’re afraid people think they can’t enroll next year,” she said.

In one recent national survey, more than 40 percent of uninsured working-age adults were either unsure or unaware that the requirement that people have insurance is still in effect, the nonprofit Kaiser Family Foundation found. Americans who do not have coverage may be subject to a tax penalty.

The Trump administration has at times appeared intent on stoking the uncertainty.

Two weeks ago, the president publicly suggested the health care law had been repealed.

“Obamacare is finished. It’s dead. It’s gone,” Trump said at a mid-October Cabinet meeting.

The president’s comments followed a series of moves that many state regulators, consumer advocates and health insurers say are undermining the markets.

Trump in October abruptly cut off federal payments that reimburse insurers for reducing out-of-pocket costs for lower-income Americans.

Uncertainty over the payments has prompted many insurers to significantly raise their 2018 rates, in some cases by as much as 30 percent, according to a recent Kaiser Family Foundation analysis.