The election results will not change anything about open enrollment in Obamacare health insurance for 2017 coverage, local, state and federal officials say.
The Affordable Care Act is still the law of the land and until it’s not, consumers are being urged to continue enrolling on the government-run marketplace as usual.
Plans for 2016 will be enforced until Dec. 31 and plans for 2017 appear to be secure under the existing law. It’s 2018 and beyond that becomes more of a question mark, the experts say.
“Our message to consumers and to all our navigators and assisters is that nothing has changed. Be calm and enroll,” said Allen Gjersvig, director of navigator and enrollment services at the Arizona Alliance for Community Health Centers.
“The chances of anything changing for the 2017 marketplace plans is very, very low. I can’t say zero because extraordinary things have happened this year. … But essentially it’s baked, it’s set, and it’s being served, even though it doesn’t start until Jan. 1.”
Open enrollment on the marketplace, created by the 2010 Affordable Care Act, began Nov. 1 and goes through Jan. 31. The enrollment is for coverage in 2017. People who want coverage by Jan. 1 should enroll by Dec. 15. Last enrollment season, 11 million Americans got their insurance through the federal and state marketplaces.
The marketplace is where working-age people who don’t get health insurance via their employer or through a government program may purchase health plans and qualify for federal subsidies to help pay for them. Many people refer to the insurance available on the marketplace as Obamacare as it was passed during President Obama’s first term as president.
Some states created their own marketplaces, but Arizona uses the one operated by the federal government.
New President
President-elect Donald Trump has said that one of the first things he wants to do when he gets into office is repeal the Affordable Care Act. Many Republicans have echoed his concerns about the law.
Trump’s reforms include allowing individuals to deduct the full amount of premiums for individual health plans from their federal tax returns, providing block grants to finance state Medicaid programs, and allowing insurers to sell insurance across state lines.
On Wednesday, the day after the election, more than 100,000 Americans signed up for health insurance via the marketplace, which is also known as the health exchange.
U.S. Department of Health and Human Services director Sylvia Burwell tweeted that it was the highest number of plan selections since this season’s open enrollment began.
“Consumers want affordable coverage, and are naturally apprehensive about the unknown,” said Dr. Daniel Derksen, a professor in the public health policy and management program at University of Arizona’s Mel and Enid Zuckerman College of Public Health.
“Until things are sorted out by the new administration and Congress, many want to be sure they have coverage.”
Federal officials held a national call with enrollment assisters and navigators Thursday to emphasize that people continue to need and want affordable coverage for 2017.
Their message is that affordable coverage is still available, that the vast majority of consumers who purchase plans on the marketplace are eligible for subsidies, and that signing up is both cost-free and easy.
“For now, the prudent path would be for consumers to understand their current options, and do what is best for their own coverage and for their families,” Derksen said. “It would be very difficult, for many reasons, to leave 11 million without a viable alternative.”
Help is available
The Pima Community Access Program, which helps people enroll in health insurance, is instructing its enrollment assisters and navigators to continue helping consumers enroll in health coverage as usual.
“The main message is we the assisters are here to help,” executive director Michal Goforth said.
Gjersvig of the Arizona Alliance for Community Health Centers said what happens in 2018 is “a completely different discussion,” but that for 2017 consumers should be OK. Fines for not having insurance in 2016 and 2017 are also expected to remain.
The Affordable Care Act is not just about the 11 million Americans, including 31,000 Pima County residents, who get their health insurance via the marketplaces. Gjersvig’s organization estimates more than 600,000 Arizonans have coverage as a result of the law, when people who purchased marketplace plans and gained coverage through other provisions like Medicaid expansion are included.
The law, among other things, allows young adults to stay on their parents’ health insurance plans until they are 26; prohibits health insurance companies from denying coverage to people due to pre-existing conditions, and requires marketplace plans to cover FDA-approved contraceptive methods without charging a co-payment or co-insurance.
Gjersvig said he’s heard about a lot of women wanting to get IUDs in the wake of the election, for example, because that form of contraception is currently covered by plans under the law. But women should not worry about coverage changing so quickly, he said.
“It will take time for Congress to separate the stuff they want to keep from the stuff they don’t want to keep,” Gjersvig said. “This isn’t going to happen tomorrow.”
An analysis by the Commonwealth Fund, a nonprofit that promotes access to high quality health care, says Trump’s proposals would result in higher out-of-pocket spending for individuals than the current law. Because the proposed reforms do not replace the Affordable Care Act’s financing mechanisms, they would increase the federal deficit by $0.5 billion to $41 billion, the analysis says.
But analyzing those proposals may be shortsighted.
“Trump has no policy track record. You only have his campaign words to go on,” Gjersvig said. “We really have to wait.”
Tucson insurance broker Raymond Magnuson has had some clients call this week with questions about the election results.
One couple, for example, was worried about their Medicare coverage. But Magnuson said he’s heard nothing in Trump’s proposals that talk about weakening Medicare, which is government insurance for people over 65.
Enrollment problems
The real problems with Obamacare insurance this enrollment season have nothing to do with the election, Magnuson said.
“As I tell my clients, keep trudging along,” Magnuson said. “Regardless of how the election went, this is a horrible year for plans in Pima County. People have to change plans, change doctors.”
While Pima County consumers had a choice of 28 plans on the marketplace last enrollment season, this year they have three — two plans for people of all ages, and one so-called “catastrophic” plan that’s available only to people under 30.
“The real bottom line as we sit here today is before we really start to worry about Trump, let’s at least wait until he’s sworn in and not president-elect but president,” Magnuson said.
Derksen says he would not want to see the U.S. go back to the era when 48 million people were uninsured. That number is now hovering around 28 million, experts say. But Derksen says there are ways to improve the health system moving forward.
“It will mean taking on the corporate interests that fuel cost growth untethered to accountability in terms of value and improved health outcomes,” he said
“On that front there are many battles worth waging that would really help — holding insurers accountable, forcing the pharmaceutical industry to justify skyrocketing charges for lifesaving drugs, and addressing at long last the liability/malpractice crisis that adds so much cost to delivering health services.”
