Trump said Obamacare is dead (nope, definitely not). Then he said he supported a bipartisan plan to save subsidies (well, that’s good news). Then he said he did not support that same plan (what the…?). You might feel like you need a scorecard and a decoder ring to keep up with it all. To help, here are answers to some of the key questions.
Yes, we all heard Trump say last week of Obamacare, “It’s dead. It’s gone. It’s no longer—you shouldn’t even mention it.” He was lying.
Q: DID TRUMP GET RID OF INSURANCE SUBSIDIES FOR LOW INCOME PEOPLE?
This is a harmful piece of misinformation that’s floating around, and some advocates are even worried it will keep people from even trying to buy insurance because they’re assuming it will be too expensive. Some news outlets, in reporting on Trump’s refusal to make cost-sharing reduction payments to insurance companies, have run headlines saying Trump has eliminated subsidies for low-income people. But as this terrific piece on Medium by Lori Lodes, co-founder of Get America Covered, explains, “[F]or most people who already have health insurance through HealthCare.gov or who are thinking about getting covered, this doesn’t change anything.”
Here’s why: Under the Affordable Care Act, insurance companies that participate in the marketplace are required to offer plans with discounted deductibles and copayments to lower income people who don’t qualify for Medicaid. This is known as “reduced patient cost-sharing,” because patients end up covering less of the cost their care than they otherwise would, while their insurance covers more. The federal government then reimburses insurance companies for the money the insurance comapanies lose as a result. These reimbursements to the insurers are the cost sharing reduction (CSR) payments Trump is refusing to pay.
Here’s the critical detail: Even if they’re not paid back by the government, insurance companies still have to offer reduced patient cost-sharing. That means if you are eligible to purchase a plan with discounted deductibles and copayments, nothing Trump has done can stop you from doing so.
(By the way, if you’re interested in the legal explanation for how it’s possible for Trump to refuse to make the CSR payments when the law still requires insurance companies to offer the discounted coverage, this article in the Washington Post provides a good overview.)
Q: SINCE CONSUMERS CAN STILL RECEIVE SUBSIDIES, DO I EVEN NEED TO CARE ABOUT WHETHER THE INSURANCE COMPANIES GET PAID BACK?
FOLLOW-UP Q: BUT WHY? DON’T INSURANCE COMPANIES MAKE ENOUGH MONEY?
A: THAT’S NOT A YES/NO QUESTION.
The profit margin for insurance companies is a whole other conversation, and a legitimate one. But right now, the reality is insurers will look to get this money back or else to avoid losing it in the first place.
Since any insurer that participates in the marketplace is required to offer reduced patient cost-sharing to eligible enrollees, the only way to avoid it is to withdraw from the marketplace completely. That’s bad because it leaves consumers with less choice in plans but, so far, no insurer has withdrawn because of this.
For insurers who stay in the marketplace, the only way to make the money back is to pass the costs on to consumers by raising premiums. To state the obvious, that’s also bad—but for more reasons than perhaps most people realize.
To cover their lost revenue, insurers are looking to raise premiums on marketplace plans by 20% to 25%—and in fact many already have. The greatest burden of this increase will fall on those individuals who are buying insurance through the marketplace but don’t qualify for subsidies or tax credits.
Perhaps more surprisingly, the federal government will face costs of approximately $200 billion (according to the Congressional Budget Office) because of the decision to withhold the CSR payments. That’s because tax credits available to help low income people purchase insurance will go up in proportion with the increases in premiums. So while actually making the CSR payments has a zero effect on the budget (says the CBO), not making them will cost taxpayers $200 billion and result in millions of people being unable to afford insurance. This is why Senators Lamar Alexander and Patty Murray have been working with others on a bipartisan bill to authorize the payments (a bill Trump said he supported and then the next day said he didn’t).
Q: CAN I STILL SHOP FOR INSURANCE ON HEALTHCARE.GOV OR MY STATE MARKETPLACE WEBSITE?
Yes, we all heard Trump say last week of Obamacare, “It’s dead. It’s gone. It’s no longer—you shouldn’t even mention it.”
He was lying.
He’d prefer that no one mention it, which is why he cut funding for advertising for open enrollment, but the Affordable Care Act is still the law of the land, and all health insurance marketplaces will open for business on November 1.
If you’re going to be buying insurance through a marketplace, definitely take a look at Lori Lodes’s piece on Medium, which includes a useful cheat sheet to help you understand what type of assistance you might be eligible for based on your income.
Q: WHEN CAN I BUY INSURANCE THROUGH THE MARKETPLACE?
A: OPEN ENROLLMENT FOR INSURANCE COVERAGE FOR 2018 WILL BEGIN ON NOVEMBER 1, 2017, AND IN MOST STATES WILL END ON DECEMBER 15, 2017.
Whether you are buying insurance through healthcare.gov (the federal marketplace) or a marketplace run by your state, open enrollment will begin on November 1.
If you are enrolling through healthcare.gov, then you have just six weeks to sign up for coverage, with open enrollment ending on December 15. That’s half the time that was allowed for enrollment last year.
In addition, the federal website will be closed regularly for maintenance, so plan accordingly (see the schedule below).
If you are enrolling through a state-run marketplace, the open enrollment periods are as follows:
Credit: Kaiser Family Foundation
If you are renewing a policy rather than signing up for the first time, you should visit your state’s marketplace website in advance of November 1 to see whether the enrollment period is the same. Visit this page on healthcare.gov for links to state websites.
Have more questions about open enrollment or want to help get the word out in your state (since Trump cut the budget for advertising and marketplace assistors)? Visit getamericacovered.org for resources and toolkits.
Want to know more about what’s happening in Congress? Ask your questions in the comments below!