The roller coaster ride that is Obamacare’s future continued this week with the latest version of a health care proposal, this one a bipartisan effort to make short-term fixes to the insurance marketplaces created by the Affordable Care Act.
On Tuesday, Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., said they had reached a deal to shore up Obamacare insurance markets by guaranteeing federal subsidies for low-income insurance customers for two years.
For most of the day, it seemed a deal was at hand. But Wednesday morning, President Trump tweeted that he didn't like it, and Republican support began evaporating. At this point the plan is in limbo, though Alexander says he is still pushing to pass it, or some version of it.
Although the proposal could change, here's what you need to know about how the version released Tuesday could affect you, if Congress and the president ever agree to pass it.
It probably doesn't affect your insurance
Only about 7% of the population buys insurance on their own, instead of getting coverage through an employer or government program like Medicare or Medicaid. Contrary to what most people think, those are the only ones whose insurance is affected by changes to the Obamacare marketplaces. Yet, only one-fifth of the 2,505 adults surveyed this month by the nonpartisan Kaiser Family Foundation were aware that the marketplace issues do not affect everyone.
Premiums could be lower
The proposal would continue through 2019 payments to insurance companies to offset the discounts they're required to give lower-income customers on deductibles and co-payments for marketplace plans.
Without the payments, which the Trump administration discontinued this month, insurers need to raise premiums about 20% to cover those discounts. Many priced their 2018 plans assuming the payments would not be made, and it could be too late to reprice them before the open enrollment period begins in November.
So if the payments are resumed, and insurers end up collecting more in premiums than needed, they may have to give some of the money back. That could happen in the form of refunds to customers, or to the government, which subsidies premiums for most marketplace plans.
More people could choose low-cost plans
The deal would let anyone in the individual market buy plans with low monthly premiums and very high deductibles — more than $7,000 for this year's catastrophic plans.
Currently, only adults up to age 30 and those who qualify for a hardship waiver can buy them. Increasing that option could draw healthier people into the insurance pool, which could eventually decrease the cost for sicker customers.
But those who purchase a catastrophic plan have to cover most of their routine medical expenses before the insurer steps in.
States could come up with new options
It could become easier for states to get around the Affordable Care Act's insurance rules. States could not undermine protections for people with pre-existing conditions or eliminate essential health benefits, according to an analysis by health care experts Billy Wynne and Timothy Jost.
But the proposal would let states make changes as long as insurance options have "comparable affordability," instead of the current requirement that plans be "as affordable as" ACA coverage.
An example of the changes that could be made, according to a summary provided to GOP lawmakers, is higher co-payments for opioid prescriptions combined with lower co-payments for cholesterol-reducing drugs.
"Applying a test of 'comparable affordability' could allow for more trade-offs, providing greater affordability for some and less for others," tweeted Larry Levitt, senior vice president at the Kaiser Family Foundation.
More people could have a choice of insurance provider
Uncertainty about policy — particularly whether the federal government would continue to reimburse insurers for the cost-sharing subsidies — prompted many insurers to stop participating in the marketplaces.
It's too late for insurers who have withdrawn for 2018 to jump back in. But continuing the payments through 2019 could prevent more from leaving, and potentially lure some back. If the marketplaces aren't stabilized, the major trade group for the industry warned this week, "there may not be an individual insurance market to improve."
More people could get help understanding a confusing situation
The deal would restore some of the funding the Trump administration cut for consumer outreach. That's important because the majority of people who are either uninsured or currently using the marketplaces don't know the key dates about open enrollment for 2018 plans, according to the Kaiser Family Foundation poll.
Few said they've heard or seen any ads about how to get insurance. The Trump administration cut the advertising budget for the enrollment period and slashed grants for the "navigators" who walk people through the process. The administration also shortened the sign-up period. But enrollment may need to be delayed, or extended, if lawmakers want to give insurers time to adjust rates in response to the changes.
Taxpayers could come out ahead
The insurance subsidies that the plan would continue through 2019 end up saving the government money overall, according to the nonpartisan Congressional Budget Office. That's because if insurers raise premiums to offset the loss of the payments, the government ends up paying more in the premium tax credits available to people earning up to 400% of poverty.
Ending the payments to insurers would increase federal deficits by $194 billion over 10 years, CBO projected in August.
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