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The Senate GOP legislation to replace the Affordable Care Act appears all but dead for now, but Republican efforts to repeal the law are not, injecting even more uncertainty about the future of health insurance into an already shaky market.

That uncertainty poses immediate threats as consumers—and insurance companies—are left lingering in healthcare limbo.

The confusion over whether the ACA ultimately survives means “some people will have fewer choices, higher premiums, and bigger out-of-pocket costs," says Chris Sloan, a senior manager at Avalere Health, a healthcare consulting firm.

And the longer uncertainty about healthcare reform lasts, the bigger the impact on consumers, he says.

Here's how you could feel the pain:

Fewer Plans to Choose From

One of the key areas of uncertainty centers on subsidies that, under the ACA, help consumers cover out-of-pocket costs such as deductibles and co-pays for office visits and prescription drugs.

Under the current system, insurance companies cover those costs upfront, then get reimbursed by the federal government—to the tune of about $7 billion per year.

Insurance companies depend on those reimbursements—called cost-sharing reductions, or CSRs—saying that without them they can't make money on the plans they sell through the ACA exchanges.

President Donald Trump wants the Senate to repeal the ACA and deal with a replacement later. In the meantime, the Trump administration has agreed to reimburse insurers for those expenses only on a month-by-month basis. And without long-term assurance, many insurers say that continuing to offer ACA plans is too financially risky, prompting many to say they may have to drop out.

Higher Premiums

The uncertainty about CSR reimbursement also means that insurers that do offer plans for 2018 will probably charge higher premiums.

For example, Blue Cross and Blue Shield of North Carolina is asking for a 22 percent increase in premiums but said if CSRs were funded, it would need to raise rates only 8.8 percent.

Overall, among the companies whose rate increase proposals for 2018 plans are public so far, insurers are asking to boost premiums an average 34 percent, according to Charles Gaba, who is tracking the rate filing data at ACAsignups.net.

While those are steep increases, it's important to note that under the ACA, most consumers—about 85 percent—receive substantial subsidies that help defray the costs of their premiums, Eibner says.

If Senate repeal efforts are ultimately successful, those subsidies would go away so the premium increases being implemented now would be even more painful down the road.