Obamacare repeal is dead, again. But the months of Republican attacks on the health law will still have consequences for some consumers.
For now, people who get their insurance through Medicaid can rest easy. While some states have applied to make minor changes to their programs, the demise of the Graham-Cassidy legislation on Tuesday means no major cutbacks are on the immediate horizon. But almost every health bill that Republicans proposed this year called for subjecting the program to caps, so that idea seems unlikely to disappear.
Those with employer insurance can also coast along with the status quo; there have been no policy changes affecting the price or comprehensiveness of workplace health plans. The Republican bills would have eliminated rules requiring large employers to offer health benefits and could have weakened protections against annual or lifetime limits on workers’ coverage.
But the recent political cycle means it will probably be a tumultuous season for people who buy their own health insurance. The Trump administration remains deeply opposed to the Affordable Care Act, and it has taken steps that will mean higher prices for insurance and will make it harder for consumers to get information about how to sign up.
Insurers wishing to sell policies in the individual market next year need to sign contracts with the government by Wednesday, confirming their participation and agreeing to prices. Early signals suggest that premiums are set to increase by double digits in most parts of the country.
Insurers say at least some of those increases were to account for the policy uncertainty brought by the Trump administration, which has indicated that it may hold back some routine payments to insurers and that it will reduce outreach to possible customers.
Complete market failure seems to have been averted: There is at least one insurer that has agreed to sell health plans in every county of the country. But Republican critics of the law are right that many parts of the country will have just one insurer offering plans, and that single insurer may be charging very high prices for its products.
Most Obamacare customers won’t feel the sting of higher premiums, because government subsidies limit their exposure to a percentage of their income. But there are still millions of people who buy their own insurance and earn too much to qualify for subsidies. The rocky market will be worse for them, and possibly unaffordable.
Senators in the Health, Education, Labor and Pensions committee had been negotiating over a possible bipartisan deal to help stabilize the markets. The expected package would guarantee the disputed payments to insurers and provide states with some policy flexibility in future years.
But that effort was shelved by congressional leadership as part of the failed push to pass the Graham-Cassidy health care overhaul. Now, with contract signings imminent, it is probably too late for lawmakers to improve conditions much for next year. (On the flip side, it’s probably also too late for President Trump to create substantially more havoc for markets by declining to pay the insurance subsidies, as he has periodically threatened to do.)
The Trump administration has, so far, been a reluctant overseer of the Obamacare markets. It has slashed its budget for outreach and enrollment assistance for possible customers, meaning that consumers may have more trouble finding out when and how to sign up for health insurance. Its Department of Health and Human Services keeps sending news releases cheerfully noting the law’s shortcomings. (A recent one had the subject line “It’s not working…”)
Officials also recently announced that they expect to take the HealthCare.gov enrollment website offline for maintenance for up to 12 hours on five of the six Sundays during the enrollment period, substantially longer than was needed last year.
The administration argues that people eligible for Obamacare programs are already well-informed about their options, but there is substantial surveyresearch suggesting that many may be confused or simply unaware of how the program works. That may be especially true now, given the months of news about efforts to repeal the law.
Taken together, higher prices and less outreach are likely to mean fewer people buying coverage on the individual insurance market. Insurers’ views on whether to participate in 2019 are likely to be shaped by their experience next year.
The Trump administration has tended to use the poor performance of the health care markets as a prod to legislators to move forward on repeal. But the timing of repeal’s collapse means that, even absent a legislative overhaul, the markets will suffer.
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