WASHINGTON (USA TODAY) — Republicans’ last-ditch effort to rewrite the Affordable Care Act collapsed Thursday after Senate Majority Leader Mitch McConnell, R-Ky., acknowledged it lacked the votes to pass.
It’s unclear whether the bipartisan attempts to fix some of Obamacare’s problems —which were derailed by the latest repeal bill — can now be successful.
Here’s what that means for you:
Who is affected?
Despite all the attention Obamacare has gotten this year, the lack of action by lawmakers won’t affect most Americans' health care coverage. The problems are centered in the health insurance marketplaces created by the ACA for people who don’t get coverage through an employer or a government program like Medicare or Medicaid. Only about 7% of the population buys insurance on the individual market. An average of 10 million a month have been getting those plans through the subsidized marketplaces this year.
Will people still be able to buy Obamacare insurance?
As insurers filed their initial coverage plans for 2018 earlier this year, there were dozens of counties without an insurer. But other providers stepped in to fill those gaps. That could still change before 2018 enrollment begins in November. Wednesday is the deadline for insurers to finalize their contracts with the federal government. (States that run their own marketplaces have their own set of rules.)
Still, the nonpartisan Congressional Budget Office projected this month that, over the next decade, fewer than half of 1% of people live in areas where no insurers will want to participate.
Will people have a choice of insurers?
Nearly half of counties could have only one insurance provider, the Centers for Medicare and Medicaid Services said last week. Because many of those counties are rural, the share of people using the exchanges would could lack choice is closer to one quarter. Still, participation by insurers has declined.
How much will the insurance cost?
Prices won’t become public until later this fall. But CBO projects the average premium for a benchmark plan — those used to determine a consumer’s subsidy — will be about 15% higher than this year. (The average benchmark premium for a 45-year-old is now about $4,800 a year.)
Most people are insulated from premium increases because of the premium subsidies available to those earning up to about $48,000.
People earning up to about $30,000 can also get help paying for deductibles, co-payments and other out-of-pocket expenses. But the Trump administration has not said how long it will continue to reimburse insurers for providing these discounts. That’s a main reason premiums are going up and insurers’ participation is going down.
So will the subsidies continue?
The administration has been making the payments to insurers on a month-to-month basis. This doesn’t directly affect the customer, however, because the law requires insurers to provide the assistance. What remains to be determined is how long insurers will be compensated. A challenge to the payments brought by congressional Republicans after the ACA’s passage is pending in federal court.
How could a bipartisan bill help?
Most of the focus of bipartisan efforts to improve the individual insurance markets has been on funding and flexibility. Democrats want to continue the cost-sharing reduction payments and want to provide new funds to help offset the costs of the sickest customers. Republicans want to make it easier for states to change insurance regulations and to allow more people who either can't afford or don't want full insurance to buy plans that cover only about half of medical costs.
Could lawmakers still agree on a bipartisan set of fixes?
Maybe. Democratic Rep. Josh Gottheimer of New Jersey and GOP Rep. Tom Reed of New York, co-chairmen of a bipartisan group called the House Problem Solvers Caucus, said Monday the only way to get something passed is if both sides come together. “Now is our moment,” Gottheimer said. But there’s still plenty of opposition. Many Republicans don’t want to look like they’re “bailing out” insurance companies or shoring up Obamacare. And Democrats are worried about changes they worry could undermine patient protections.
Tennessee GOP Sen. Lamar Alexander, who had been working with Sen. Patty Murray, D-Wash., on a bipartisan bill, said Tuesday he'll resume trying to find a consensus on a limited plan that could help make insurance more available and affordable in 2018 and 2019.
What else could affect the Obamacare marketplaces?
The administration has shortened the open enrollment period to less than half the time people have had to sign up. Officials also significantly reducing spending on advertising and on paying “navigators” to help people enroll.
As a result, CBO projects that while participation will increase next year, it won’t go up as much as previously expected. And because the dropoff is likely to be heaviest among the young and healthy, insurers are likely to seek higher rates for 2019.
What about Medicaid?
The failure of the GOP repeal bills means the ACA’s funding for states to expand Medicaid eligibility continues. Of the 19 states which haven’t gone along, CBO expects many could still wait for more funding predictability. But within a decade, 70% of people made newly eligible by the ACA will live in states that have expanded Medicaid, CBO predicts.
Some states could be induced to expand by the Trump administration’s eagerness to waive some Medicaid rules. But advocates for the poor could challenge any actions like work requirements that they think go beyond what’s allowed without changing the law.
Contributing: Herb Jackson.