President-elect Donald Trump has promised that he’ll ask Congress to repeal the Affordable Care Act on day one of his administration. If you’re shopping for coverage on the health insurance marketplace, should you even bother signing up? If everything’s going to change shortly after your new coverage starts in January anyway, what’s the point?
It’s impossible to know exactly what changes are coming to the individual market and how soon they’ll arrive, but one thing is virtually certain: Nothing will happen immediately. Here are answers to questions you might have.
Q: How soon after Trump takes office could my marketplace coverage change?
A: It’s unlikely that much, if anything, will change in 2017.
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“It’s a complex process to alter a law as complicated as the ACA,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. It seems unlikely that congressional Republicans could force through a repeal of the law, because Democrats have enough votes to sustain a filibuster blocking that move. So Congress might opt to use a budget procedure, called “reconciliation,” that allows revenue-related changes, such as eliminating the premium tax credits, with simple majority votes. Yet even that process could take months.
And it wouldn’t address the other parts of the health law that reformed the insurance market, such as the prohibition on denying people coverage if they’re sick. How some of those provisions of the law will be affected is quite unclear.
“It will likely be January 2019 before any new program would be completely in place,” said Robert Laszewski, a health care industry consultant and longtime critic of the law.
The current open enrollment period runs through January. Shop for a plan, use it and don’t focus on what Congress might do several months from now, Rosenbaum advised.
Q: Will my subsidy end next year if the new administration repeals or changes the health law?
A: Probably not. Mike Pence, the vice president-elect, said on the campaign trail that any changes will allow time for consumers receiving premium subsidies to adjust.
Timothy Jost, an emeritus professor at Washington and Lee University School of Law in Virginia and an expert on the health law, also predicts a reasonable transition period.
Congress and the new administration are “not eager to have a bunch of angry, uninsured voters,” Jost said.
Theoretical conversations about changing the health law are one thing, but “I think that Congress may be less willing to just wipe the subsidies out if a lot of people are using them,” Rosenbaum said. More than 9 million people receive subsidies on the marketplace, according to the federal Department of Health and Human Services.
Q: Can my insurer drop out once the new administration takes over, even if the law hasn’t been repealed?
A: No, insurers are generally locked in contractually for 2017, according to experts. But 2018 could be a whole different story, Laszewski said.
Q: My state expanded Medicaid to adults with incomes of as much as 138 percent of the federal poverty level (about $16,000). Is that going to end if Obamacare is repealed?
A: It might. Trump has advocated giving block grants to finance the entire Medicaid program on the theory that it provides an incentive for states to make their programs more cost-effective. But that strategy could threaten the coverage of millions of Americans if the block grants don’t keep pace with costs, Jost said.
So far, 31 states and the District of Columbia have expanded Medicaid under the health law. Republican governors in these states might play a key role in arguing against taking the expansion money away, Rosenbaum said.
“One of the easy things they could do is just not enforce it,” he said.