8 Answers to Key Questions After the GOP Pulls Its ACA Replacement Plan
Donna Rosato
All the concerns about what would happen if GOP plans to repeal the Affordable Care Act became law have been replaced by a new one: What happens now that Republicans have scrapped the legislation after failing to get the votes they needed?
“We're going to be living with Obamacare for the foreseeable future,” House Speaker Paul Ryan said in a press conference Friday. “It's going to remain the law of the land until it's replaced.”
Many consumer advocates had said the bill was a bad one and would hit older Americans particularly hard. “The American Health Care Act was pulled from the floor because it is a hugely flawed bill that would do nothing to lower healthcare costs for Americans,” said Laura MacCleery, vice president of policy for Consumer Reports.
But there's still a lot of confusion about what this all means, especially for the millions of people who get their health insurance through the marketplace exchanges created by the Affordable Care Act, said Michael Miller, director of strategic policy at Community Catalyst, a nonprofit health advocacy organization.
“As the law currently stands, there have been no changes. But we’ll have to see how the Trump administration moves forward,” said Anne Filipic, president of Enroll America, a nonprofit, nonpartisan organization focused on enrolling people in healthcare coverage. “Even though the ACA remains, the administration can do real damage to the law.”
Here are answers to eight questions you might have.
What's Next For The ACA
What will Republicans do next? Both Ryan and President Trump say they will move on to other legislative priorities, including tax reform and infrastructure funding.
But even without congressional action, the Trump administration has a lot of leeway to make changes to the health insurance market through administrative action. The Department of Health and Human Services, which administers the ACA, has already proposed several rules aimed at chipping away at the law, as described below.
Will anything change if I'm already enrolled in an ACA plan for 2017? No. “Keep paying your premiums and use your coverage,” Filipic advises.
But if you're not yet insured and want to sign up later this year because of a special circumstance, that might be harder to do, in part because of some of the HHS rule changes, expected to be approved in June.
While open enrollment in the ACA ended at the end of January, there are exceptions for people who, for example, have a baby or lose a job. But one proposed rule change makes it harder for people to qualify for those exceptions, by requiring more rigorous pre-enrollment verification and placing limits on people who get married and want enroll their spouse.
Will I be able to sign up for ACA insurance in 2018? Yes, though you might have less time to sign up.
HHS has proposed shortening the open enrollment period to 45 days from the current 90. For 2018, that means sign-up would run from November 1 through December 15. Last year, it ran from November 1 through January 31.
Also, if you are enrolled but fall behind in payments, you could lose your insurance more quickly. You now have a three-month grace period before coverage can be terminated. But under the proposed HHS rule, insurers could terminate coverage after one month of nonpayment.
Will my insurance cost more next year? Probably, though maybe not as much as they would have under the GOP plan.
The average premium for the most popular Silver plans is 17 percent higher in 2017 than the year before, according to HealthPocket, a technology company that analyzes and compares health plans.
But according to the Congressional Budget Office, under the GOP plan individual health plans would have been 15 to 20 percent higher than under the ACA, on average, and even higher for older people.
Another proposed change could drive up your deductibles and out-of-pocket costs. Under current rules, Silver plans must now cover 70 percent of your expected medical bills. But HHS is proposing lowering that to 66 percent, so you could be responsible for a larger share of your overall costs.
When will I know if my insurer will offer plans in my area next year? Insurance companies are still deciding whether to participate on the exchanges and if they do, what they will offer, how much they will charge, and in which states they will operate.
HHS has extended the deadline for filing their policies and rates for review until June, but uncertainty about the ACA’s fate has kept some big insurers on the fence. Anthem, Aetna and Molina Healthcare warned earlier this year that they couldn't commit to participating in the ACA exchanges in 2018. So far, only one player, Humana, has officially said it won’t participate in the exchanges in 2018.
What will happen if my insurer decides it won't offer a plan in my state anymore? Elizabeth Carpenter, a senior vice president at healthcare consultancy Avalere Health, says another insurance company could enter the market. Or you could go off-exchange and buy insurance on the private market.
But make sure you understand what you are buying and how comprehensive it is. “There may be cheaper private insurance available but the quality and cost may not be great,” says Miller from Community Catalyst. If you go off exchange, you can't get tax credits that can help pay your premiums. And if there is no exchange plan offered in your area, those who choose to go without insurance won't be penalized.
If I get insurance through my employer or Medicare, will I be affected? Not likely. The ACA mandated many changes to employer health insurance and provided additional funding for Medicare, but no changes are planned for job-based insurance or Medicare.
If I have questions about my ACA health insurance, where can I go for help? You can get information at HealthCare.gov. It also has a tool you can use to find in-person assistance organizations by zip code. You can get other information and find resources about the ACA at Enroll America and Families USA, a nonprofit, nonpartisan healthcare advocacy group.
