Donald Trump
President-elect Donald Trump says he wants to repeal and replace Obamacare, but analysts say people signing up for 2017 coverage should be able to keep it through 2017.
(Paul Sancya, Associated Press)
WASHINGTON, D.C. -- Just as open enrollment for Obamacare in 2017 wraps up in January, a newly elected president and Congress will try to unravel the insurance program. So should you bother signing up at all?
And if you like your coverage at the start of 2017, will you be able to keep it through 2017?
Yes and probably yes, say healthcare authorities.
"Our position is the same as it was in 2016: You signed a contract and you paid your bills. You should get a service," said David Hopcraft, communications director for the Ohio Department of Insurance, a state regulatory agency that for now must operate as if nothing about the Affordable Care Act, or Obamacare, has changed.
Current enrollment followed lengthy state and federal regulatory reviews. Insurers, hospitals and doctors signed multi-million-dollar contracts through 2017. It'll be hard for Congress and Donald Trump, once he assumes the presidency Jan. 20, to change the law in a way that simply upends the contracts before 2017 is through.
Analysts at the Georgetown University Health Policy Institute said the same thing, in a blog post: "Yes, for coverage through 2017. The ACA is current law and in general, insurers participating on healthcare.gov are required by federal and state law to continue providing coverage throughout the year."
Most of the big changes, which could include an end to taxpayer subsidies for many individuals and families, won't be felt until 2018, said both U.S. Sens. Rob Portman, an Ohio Republican, and Sherrod Brown, an Ohio Democrat.
"You don't want to pull the rug out from under people who, through no fault of their own, find themselves in a situation where they're relying on the subsidies or for that matter people who are in businesses that are relying on the mandates and the kind of coverage that's required" right now, Portman said.
"So I think we need to be careful. Same with Medicaid expansion. I think there has to be that assurance."
Here's why nothing will likely change until 2018.
Insurance doesn't happen overnight:
Open enrollment on the federal marketplace, which Ohio participates in, and in independent state insurance exchanges, began Nov. 1. People who sign up by Dec. 15 and pay premiums, whether directly or through the federal subsidies, can be insured starting Jan. 1, and their coverage will probably continue through 2017 as long as they pay premiums every month.
Open enrollment continues through Jan. 31 but coverage for those who sign up after Dec. 15 won't start until January or February.
Months before open enrollment began, insurers were calculating their risks, projecting costs and calculating 2017 premiums. They negotiated payment rates and provider networks with hospitals and doctors. They traded financial information and projections with state insurance departments through summer. The states then sent the information to the U.S. Department of Health and Human Services, or HHS, for final approval.
And the insurers made assurances with all of the above, and now are entering into contracts with consumers that say they'll provide insurance in 2017.
There are ways out of contracts, though that can lead to lawsuits. And Congress would probably deal with some of this as it tries to unwind parts of Obamacare. But until it digs into the details, nothing changes.
"If there was some sort of major change to the law, that might allow them to back out," said Cynthia Cox, who analyzes health reform and insurance at the Kaiser Family Foundation. "But I think, and most people that I talk with think, that the most likely scenario is that people who sign up for insurance for 2017 will be able to keep coverage in 2017."
So many details to work out:
A straight repeal of Obamacare would result in 22 million to 23 million people losing health coverage this year and next and about 24 million people after 2019, according to projections last year by the Congressional Budget Office. But since Trump won election last week, he has said he'd like to keep a provision that assures health coverage for people with preexisting medical conditions. He'd like to keep another that lets adult children stay on their parents' health plans to age 26.
There are ways this might happen while the core of Obamacare - the demand that you have insurance or pay a penalty, and the allowance of taxpayer subsidies to help many people pay premiums - is eliminated.
Yet details are relatively skimpy, as they almost always are when ideas and legislation are proposed. House Speaker Paul Ryan has provided more information. Yet even past proposals from Ryan and fellow GOP lawmakers -- about expanding health savings accounts, allowing health coverage to travel with the individual regardless of his employer, creating state-based high-risk insurance pools - lack the level of detail needed for analysts to fully assess, especially if parts are mixed and matched with the provisions Trump says he'd keep.
Republican ideas to let insurers sell across state lines and to stop trial lawyers from filing large medical malpractice suits, for example, would accomplish "about 2 percent" of what they claim they want, says Brown, the Ohio Democrat and an ardent Obamacare supporter.
"I think they're shocked that they actually have to do something now other than vote repeatedly to repeal Obamacare, because they have no real idea how you replace this stuff," Brown said. "They were the dog chasing the car and they caught the damn car and they don't know what to do with the car."
Industry doesn't know what to expect:
Some in the healthcare-provider industry expect change a bit sooner, but they admit they're guessing.
"We expect the repeal and replace of the ACA to occur quickly once President-elect Trump takes office," said John Palmer, spokesman for the Ohio Hospital Association.
"Considering Trump's remarks during 60 Minutes on Nov. 13, it would be a simultaneous timing of repeal and replace. However, this is a volatile situation and we'll be monitoring and analyzing new developments as they occur with the ACA reform."
Uncertainty can be unnerving, not only for individuals who fear they'll lose insurance but for the healthcare industry, too. "And anyone who tells you right now that they know what is coming is probably not being completely truthful," said Reginald Fields, communications director for the Ohio State Medical Association.
Fields said the association, which represents physicians and medical practice managers, hopes improved access to medical care remains a staple of whatever Trump and Congress do. Physicians also hope the reforms eliminate some of Obamacare's red tape, so doctors can "spend less time on administrative burdens and more time seeing patients," Fields said.
But what about consumers?
Kristine Grow, a spokeswoman for America's Health Insurance Plans, the industry's lobbying group, told USA Today, "We also have a commitment to continuous coverage. Consumers should be covered and patients should be protected -- and sudden disruptions would jeopardize both."
Don't worry (yet), says Obama administration:
Open enrollment for Obamacare policies is proceeding for 2017, and about 1 million people signed up in the first two weeks of November, according to HHS.
"The American people are demonstrating how much they continue to want and need the coverage the Marketplace offers, and we are encouraging all Americans who need health insurance for 2017 to visit HealthCare.gov or their state Marketplace and check out their options," HHS Secretary Sylvia Burwell said in a statement.
In an appearance at the White House on Monday, Burwell noted that nothing has changed yet. "Rest assured," she said, "the Affordable Care Act is the law of the land."