Little change for Obamacare clients WHO IS AFFECTED?
Even with the failure to repeal and replace the Affordable Care Act, some uncertainty remains
Republicans’ last-ditch effort to rewrite the Affordable Care Act collapsed Tuesday after Senate Majority Leader Mitch McConnell, R-Ky., acknowledged it lacked the votes to pass. Bipartisan attempts to fix some of Obamacare’s problems also have stalled. Here’s what that means for you:
Despite all the attention Obamacare has gotten this year, the lack of action by lawmakers won’t affect most Americans’ health care coverage. The problems are centered in the health insurance marketplaces created by the ACA for people who don’t get coverage through an employer or a government program such as Medicare or Medicaid. Only about 7% of the population buys insurance on the individual market. An average of 10 million a month have been getting those plans through subsidized marketplaces this year.
WILL PEOPLE STILL BE ABLE TO BUY INSURANCE?
As insurers filed their initial coverage plans for 2018 earlier this year, there were dozens of counties without an insurer. But other providers stepped in to fill those gaps. That could still change before 2018 enrollment begins in November. Wednesday is the deadline for insurers to finalize their contracts with the federal government. (States that run their own marketplaces have their own set of rules.)
Still, the non-partisan Congressional Budget Office projected this month that, over the next decade, fewer than half of 1% of people live in areas where no insurers will want to participate.
WILL PEOPLE HAVE A CHOICE OF INSURERS?
Nearly half of counties could have only one insurance provider, the Centers for Medicare and Medicaid Services said last week. Because many of those counties are rural, the share of people using the exchanges who could lack choice is closer to one quarter. Still, participation by insurers has declined.
HOW MUCH WILL THE INSURANCE COST?
Prices won’t become public until later this fall. But CBO projects the average premium for a benchmark plan — those used to determine a consumer’s subsidy — will be about 15% higher than this year. The average benchmark premium for a 45-year-old is projected to be $4,800 a year.
Most people are insulated from premium increases because of the premium subsidies available to those earning up to about $48,000. People earning up to about $30,000 also can get help paying for deductibles, co-payments and other out-of-pocket expenses. But the Trump administration has not said how long it will continue to reimburse insurers for providing these discounts. That’s a main reason premiums are going up and insurers’ participation is going down.
WILL SUBSIDIES CONTINUE?
The administration has been making payments to insurers on a month-to-month basis. This doesn’t directly affect the customer, however, because the law requires insurers to provide the assistance. What remains to be determined is how long insurers will be compensated. A challenge to the payments brought by congressional Republicans after the ACA’s passage is pending in federal court.
WHAT ABOUT MEDICAID?
The failure of the GOP repeal bills means the ACA’s funding for states to expand Medicaid eligibility continues. Of the 19 states which haven’t gone along, CBO expects many could still wait for more funding predictability. But within a decade, 70% of people made newly eligible by the ACA will live in states that have expanded Medicaid, CBO predicts.
Some states could be induced to expand by the Trump administration’s eagerness to waive some Medicaid rules. But advocates for the poor could challenge any actions such as work requirements they think go beyond what’s allowed without changing the law.