As debate rages, consumers ask, ‘What about me?’

The roller-coaster health care debate in Congress is having an unsettling effect on consumers who count on individual marketplace health insurance for themselves and their loved ones. Many others simply don’t understand what’s at stake. Here’s a quick explainer on what it all means for consumers.

Question: I keep hearing that the Affordable Care Act, or Obamacare, mainly affects “individual” coverage. What exactly is the individual coverage?

A: Most Americans have either employer-based coverage provided through their jobs or government coverage, like Medicaid or Medicare. But 7 percent of Americans purchase their health coverage individually, or outside the workplace on the individual market. Many with individual coverage are self-employed or don’t work in jobs that offer employer-sponsored coverage.

Q: Will the health care debate cause me to lose my individual coverage?

A: Consumers with individual marketplace coverage worried by the roller-coaster health care debate should relax. As long as you continue to pay your premiums, you can count on your 2017 coverage to deliver all the benefits and all the protections guaranteed by the Affordable Care Act.

Q: What if my insurer decides to exit the marketplace in my state?

A: They must still honor all policies they signed until those policies expire or are terminated for non-payment.

Q: Do I still have to abide by the individual mandate that compels me to have health insurance or pay a fine?

A: The Affordable Care Act’s individual mandate is still the law of the land. But the Trump administration is not enforcing the provision, so the Internal Revenue Service is accepting tax filings in which people leave blank a question about their coverage status. The IRS policy coincides with an executive order issued by President Donald Trump that directs federal agencies to reduce potential burdens of the health law. Q: What’s all this talk about “death spirals?”

A: An insurance industry “death spiral” is when people begin to drop their coverage because they can’t afford it, leaving behind mostly sicker plan members whose higher medical costs then drive up premiums even more. Insurers, left with fewer and more costly enrollees, then stop offering coverage — which then increases the numbers of uninsured. That market unraveling is considered a death spiral.

WASHINGTON —

Q: Is the Affordable Care Act in a death spiral? Insurers are already exiting many counties and premiums are increasing, aren’t they?

A: No. Obamacare is not in a death spiral, say health experts. Recent research from the Kaiser Family Foundation shows individual insurer profits are growing this year. The steep price hikes that marketplace consumers incurred in 2017 were mainly due to underpricing in 2015 and 2016. And new research from the Robert Wood Johnson Foundation shows that large national carriers — Humana, Aetna, United and Cigna — accounted for more than 65 percent of the 700-plus county-level insurer departures this year. However, smaller regional plans, provider-sponsored plans, Medicaid managed care organizations and Blue Cross Blue Shield plans have grown their individual market imprints, “and they are the dominant issuers in the market right now,” the Robert Wood Johnson Foundation found.