After a year in which Obamacare's fate hung by a thread, 2018 is likely to feature fewer mortal threats. But the next 12 months could still be a tumultuous period as insurers, customers and elected officials react to major changes to the law by the Trump administration and the Republican Congress.
Republicans tried without success throughout 2017 to repeal and replace Obamacare, but there's little indication they plan on pursuing another serious push next year.
President Donald Trump told supporters after the last health bill failed that Republicans had the votes to pass repeal in 2018 once a hospitalized senator — who was neither hospitalized nor a decisive vote — returned, but it was a face-saving bluff. Now with Sen.-elect Doug Jones, D-Ala., set to take office and midterms getting closer, the math is even harder.
"I think we'll probably move on to other issues," Senate Majority Leader Mitch McConnell, R-Ky., told NPR last week.
Instead, the Affordable Care Act, which Trump has pronounced "dead," "finished," "gone," and, as he put it earlier this month, "essentially repealed," continues to chug along.
About 8.8 million people have signed up for 2018 coverage through HealthCare.gov, only a modest decline from the previous year despite a 90 percent cut in advertising by the administration and an enrollment period that was half as long. Insurer profits improved, suggesting companies have learned to price plans better. Millions more continue to get care through the law's Medicaid expansion.
"The ACA is living and breathing right now, which was hardly the expectation a year ago when Republicans took control of the federal government," Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, said in an e-mail.
But the law's insurance exchanges are also fragile and face big changes next year.
The new tax bill eliminates the individual mandate, a key pillar of the ACA. Trump's White House is pursuing new regulations that could undermine Obamacare plans with cut-rate alternatives. Some states are struggling to attract insurers, a problem that's carried over from the Obama era.
Republicans are still debating whether to give the ACA a bipartisan tune-up or purposefully "let Obamacare fail," as the president has put it. And nobody is sure what surprises the year might bring.
"The individual insurance market is one big question mark right now," Levitt said.
End of the mandate
While they fell short of full repeal, Republicans did manage to make a major change to Obamacare by passing a tax bill that eliminates the individual mandate, a penalty for people who go without insurance that was created by the Affordable Care Act.
At the time it was passed, the mandate was considered a critical part of the law's protections for people with preexisting conditions. The goal was to push more young and healthy customers into the system to offset the cost of sicker patients insurers would now have to take on. Without the mandate, the Congressional Budget Office estimates that 4 million more people will go without insurance in 2019 and 13 million after a decade, while insurance premiums shoot up 10 percent annually.
Health experts are watching the mandate change closely, but they're not sure how much it will affect the insurance market. Some analysts already viewed the mandate as too weak to achieve its intended effect and insurers may have already priced in the assumption that they'll have fewer healthy customers than expected when the ACA passed.
Deep Banerjee, an analyst at S&P who tracks the insurance industry, said he expected higher premiums without the mandate and potentially some loss of customers and insurers, but not "mass exits" from the market.
Continue Reading: Obamacare survived 2017. What about 2018?
Republicans tried without success throughout 2017 to repeal and replace Obamacare, but there's little indication they plan on pursuing another serious push next year.
President Donald Trump told supporters after the last health bill failed that Republicans had the votes to pass repeal in 2018 once a hospitalized senator — who was neither hospitalized nor a decisive vote — returned, but it was a face-saving bluff. Now with Sen.-elect Doug Jones, D-Ala., set to take office and midterms getting closer, the math is even harder.
"I think we'll probably move on to other issues," Senate Majority Leader Mitch McConnell, R-Ky., told NPR last week.
Instead, the Affordable Care Act, which Trump has pronounced "dead," "finished," "gone," and, as he put it earlier this month, "essentially repealed," continues to chug along.
About 8.8 million people have signed up for 2018 coverage through HealthCare.gov, only a modest decline from the previous year despite a 90 percent cut in advertising by the administration and an enrollment period that was half as long. Insurer profits improved, suggesting companies have learned to price plans better. Millions more continue to get care through the law's Medicaid expansion.
"The ACA is living and breathing right now, which was hardly the expectation a year ago when Republicans took control of the federal government," Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, said in an e-mail.
But the law's insurance exchanges are also fragile and face big changes next year.
The new tax bill eliminates the individual mandate, a key pillar of the ACA. Trump's White House is pursuing new regulations that could undermine Obamacare plans with cut-rate alternatives. Some states are struggling to attract insurers, a problem that's carried over from the Obama era.
Republicans are still debating whether to give the ACA a bipartisan tune-up or purposefully "let Obamacare fail," as the president has put it. And nobody is sure what surprises the year might bring.
"The individual insurance market is one big question mark right now," Levitt said.
End of the mandate
While they fell short of full repeal, Republicans did manage to make a major change to Obamacare by passing a tax bill that eliminates the individual mandate, a penalty for people who go without insurance that was created by the Affordable Care Act.
At the time it was passed, the mandate was considered a critical part of the law's protections for people with preexisting conditions. The goal was to push more young and healthy customers into the system to offset the cost of sicker patients insurers would now have to take on. Without the mandate, the Congressional Budget Office estimates that 4 million more people will go without insurance in 2019 and 13 million after a decade, while insurance premiums shoot up 10 percent annually.
Health experts are watching the mandate change closely, but they're not sure how much it will affect the insurance market. Some analysts already viewed the mandate as too weak to achieve its intended effect and insurers may have already priced in the assumption that they'll have fewer healthy customers than expected when the ACA passed.
Deep Banerjee, an analyst at S&P who tracks the insurance industry, said he expected higher premiums without the mandate and potentially some loss of customers and insurers, but not "mass exits" from the market.
Continue Reading: Obamacare survived 2017. What about 2018?
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