To say the least, it’s a time of uncertainty for the Affordable Care Act. On Friday, President Trump signed an executive action that sets the stage for the repeal of his predecessor’s signature achievement. Yet it’s unclear just what will replace Obamacare; most recently, the new administration said it will be a broader Medicaid program, controlled by states, while two GOP senators proposed allowing states who want to keep the program to do so.
So what’s likely to happen with the ACA over the next few months, and what might it mean to to you, as an enrollee or someone who’s considering becoming one? Here’s a rundown:
1. The ACA’s Coverage Mandates Remain in Effect for Now
President Trump’s executive order calls for federal agencies to "exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden," on individuals or businesses. That reflects the president’s determination to eliminate the mandates that require individuals to carry health insurance, and for businesses with more than 50 employees to offer it. But Trump lacks the authority to eliminate those requirements without congressional approval. So, for now, they remain in effect.
2. Changes to 2017 Coverage Will Be Limited
Individual Exchange Plans are approved for the entire year of 2017 by each of the state regulators. Consumers who signed up for these plans have agreements in place with the individual carriers for at least the rest of the year, provided they continue to pay their premiums. Even in the case of repeal, any changes to plan benefits and general pricing would need to be approved by the state regulators again; such changes aren’t likely to occur until 2018.
3. Subsidies Could End — and Your Costs Could Rise — Immediately
While your plan’s provisions likely won’t change this year, the premiums you pay could, if you’re among the many who get help in paying them. You’re all but insulated from 2017 rate increases if you pay the full cost for your plan out of your own pocket. However, if you’re among the majority of ACA plan-holders who currently receive tax credits to subsidize your premiums on either Healthcare.gov or one of the associated state exchanges, a repeal of the ACA could reduce or eliminate those subsidies immediately. That could make you responsible for more, or all, of your plan’s cost for the remainder of 2017.
4. It Will Likely Take Months to Replace the ACA
The path to repealing and replacing Obamacare requires congressional action, which in turn raises questions about the number of senators who would need to approve a replacement program as well as when and how GOP legislators might be able to agree on the shape of such a plan. The news website POLITICO reported that the administration hopes to put legislation in front of Congress in "March or April," but that might be optimistic, given the complexities involved.
5. Coverage and Premiums Will Likely Change in 2018
Beginning in 2018, however, the repeal of any plan requirements under the ACA could see the current crop of plans cancelled or shifted into completely different benefit structures. There is no guarantee that any plans and benefits you enjoy now will be available next year. For example, the stipulation that pre-existing conditions be covered — and not used as a reason to deny coverage — could be dropped. The same goes for the current rule that allows children to remain on their parents’ healthcare plan until the age of 26.
6. Your Employer Might Drop Coverage
The ACA mandated that all employers with 50 or more employees be required to offer health-care coverage to them, or pay an assessment to help subsidize their coverage. Repeal of the law could see changes to that requirement, thus potentially allowing companies to drop their own coverage immediately.
7. There’s No Reason Not to Enroll in Obamacare by January 31
If you’re currently without health insurance, there’s little to be lost by signing up for the program for 2017, which you must do by the end of January. While any subsidies you will receive may change if and when new legislation replaces the ACA, your coverage and premiums will be locked in at least through the end of 2017. You’re also free to cancel your plan whenever you choose to, if and when a better option arises for you.
Also, by signing up you’ll avoid any possibility of a penalty for failure to carry coverage; while it’s all but certain that the new administration will want to eliminate the individual mandate, it’s less clear when and if they can get congressional approval to do so. (It is, however, possible, if not likely, that the government will alter or eliminate the mandates by the time any non-coverage penalties for 2017 come due — which will be next year, when you complete your 2017 tax return.)