What's next for Obamacare?

Lisa Zamosky



Donald Trump's victory means his campaign promise to repeal the Affordable Care Act may soon become reality, a fact that has many people worried about the future of their health insurance coverage.

Open enrollment for Obamacare health plans is underway now and will run through Jan. 31, 2017 – just a few days after Trump is sworn into office. (To have insurance in place by the first of the year you have to sign up by Dec. 15.)

Americans are already signing up for health insurance for 2017 through the exchanges. In fact, the U.S. Department of Health and Human Services recently announced that more than 2 million people have picked a plan via Healthcare.gov since the start of open enrollment – that's 167,000 more plans selected than during the period last year.

Still, the threat of repeal looms. In a recent interview with Fox News Sunday, vice president-elect Mike Pence said Trump has made the decision to focus immediately on repealing the health reform law "and beginning the process of replacing Obamacare with the kind of free-market solutions that he campaigned on."

Action to repeal major parts of the law may happen quickly, but Republicans, if successful, are likely to delay any changes to the existing system, experts say, until at least 2019 – a move that would minimize disruptions for the health care industry and the more than 20 million Americans who gained insurance under the law by maintaining the status quo while Republicans craft a plan to replace Obamacare.

It would also prevent voters from experiencing any changes to their existing health care coverage until after the 2018 mid-term elections.

These are uncertain times, and we don't yet know exactly how plans to repeal and replace Obamacare will shake out. But here's what we do know: The health care law – at least for now – remains intact, and open enrollment for 2017 health insurance coverage is underway.

For those interested in being insured next year, John Desser, vice president of public policy and government affairs with eHealth, has a suggestion: "Pretend like nothing's happened. It's all noise that affects things down the road and not insurance that starts in January."

With open enrollment in full swing, here's what you need to know.

[See: How to Pick a Health Insurance Plan.]

Where to Shop

You have a few ways to buy health insurance. Plans are sold through both the federal and state-run exchanges. You can also shop for plans on the private market – say, directly from an insurance company. But tax credits that lower the cost of health insurance are only available to you if you buy a policy sold through the federal and state marketplaces. Go to Healthcare.gov, and click on "Take the first step to apply." You'll be asked to enter your state and then be directed to the marketplace for your area to begin shopping.

If You're Eligible for Tax Credits

According to the Commonwealth Fund, nearly two-thirds of uninsured adults who said they know about the marketplaces created by the Affordable Care Act also said they haven't shopped for a health plan because they didn't think they could afford the coverage.

"What we've found is that the majority of people who remain uninsured do want health coverage, and the reason most of them say they haven't enrolled is because they assume they can't afford it," says Anne Filipic, president of Enroll America, a nonprofit that helps people sign up for health coverage. "The majority of people [who] think they can't afford it don't know about the financial assistance that's available."

About 12 million people who remain uninsured and as many as 2.5 million people already buying insurance and paying full price for their policies are eligible for subsidies they aren't taking advantage of.

Tax credits come in two forms:

  • Premium tax credits lower the monthly cost of insurance. If you earn less than $47,520 per year, or are part of a family of four with an annual income of no more than $97,200, you may qualify.

  • Cost-sharing subsidies help lower out-of-pocket medical expenses, such as deductibles and copays, and are available to people earning up to $29,700 a year ($60,750 for a family of four).

"For people who don't have coverage, it's worth looking into it because they may be surprised" that they qualify for financial help, says Rachel Garfield, Kaiser Family Foundation's associate director for the Kaiser Commission on Medicaid and the Uninsured.

In addition to subsidies, 31 states and the District of Columbia now make Medicaid coverage available to those with incomes up to just above $16,000 per year. As of now, 6.4 million people without coverage are eligible for Medicaid but haven't signed up, according to the Kaiser Family Foundation.

Even if you've previously checked your eligibility and found that you didn't qualify, go back and check again, experts advise. You can do that by logging onto Healthcare.gov, or by using the online calculators offered by Get Covered America or the Kaiser Family Foundation.

[See: Infographic: How to Read Your Hospital Bill.]

Surprise! Your 2017 Premiums Costs May Drop

The headlines going into the open enrollment period painted a bleak picture of pricey monthly premiums set to increase by an average of 22 percent in federal and state marketplaces for 2017.

But for most people buying coverage through Healthcare.gov, those headlines don't represent what they'll actually pay. Subsidies are tied to the price of the second least expensive silver plan in your area, also known as the benchmark plan, and your income. As premiums rise, so does the amount of financial help available for those who are eligible.

The results can be paradoxical. A recent study conducted by researchers at Harvard found that most people signing up for coverage through Healthcare.gov – who buy the lowest cost silver plan – will actually see their premium drop by an average of 16 percent in 2017, despite rising costs. "For a large fraction of individuals enrolled through Healthcare.gov, they could potentially save money," says lead author Dr. John Hsu, associate professor of medicine and health policy at Harvard Medical School, Massachusetts General Hospital. "Subsidies offer increasing protection in an era of rising premiums."

In parts of the country where prices increased the most, savings may be even greater. For example, in Maricopa County, Arizona, premiums will more than double next year. The Harvard study found, however, that people enrolled in the lowest cost silver plan both this year and next will see their premiums reduced by an average of 67 percent in 2017.

[See: How to Help Aging Parents Manage Medications.]

Where to Get Help

Although online tools baked into Healthcare.gov and many state and private insurance exchanges can help you pick the right health plan, choosing the best coverage for you and your family can be confusing. Add to that the complicated matter of estimating your annual income for 2017 – a projection that's required when you apply for tax credits.

"That can be challenging for people who don't have the traditional white collar job with a salary," says Sabrina Corlette, a research professor with Georgetown University's Center on Health Insurance Reforms. "Figuring that out almost requires a Ph.D. in tax law, so that can trip people up."

An inaccurate estimate can result in taking too little financial help or taking too much, which can lead to a tax bill requiring you to pay back the excess. Given the changing political environment, however, it's unclear whether the government would enforce either the repayment of subsidies or taxes resulting from going uninsured (the greater of $695 per adult or 2.5 percent of annual income).

You can tap into local, in-person help by logging onto localhelp.healthcare.gov and getcoveredamerica.org. Community organizations as well as insurance brokers certified to sell plans both on and off the government-run exchanges are able to assist.