Still need health insurance coverage? You still have options. Call today.

Health Insurance Premiums Down Nationwide for 2019

The Trump administration is taking credit for a recent 1.5 percent drop in 2019 premiums for the second-lowest silver plan under Obamacare. This is the benchmark health care coverage level that subsidies are based upon. This year, the largest premium reduction is in Tennessee, with a 26.2 percent decrease. Seema Verma, Administrator for the Centers for Medicare and Medicaid Services (CMS), says that efforts by the administration to stabilize prices led to the reduction. The big picture is more complicated, however.

This year, the same plan experienced a 37 percent rate hike, and last year the premiums rose 25 percent. The latest drop is actually a slight downward adjustment to overall increases in premiums for those covered under the Affordable Care Act (ACA) for the past two years. Insurers say that uncertainty about previously approved government cost-sharing reimbursements and enforcement of the individual mandate were factors in the increases. The nonpartisan Kaiser Family Foundation determined that premiums would have risen only slightly during both years if not for changes in policies affecting the ACA.

At one point in 2017, it appeared that several counties would not have access to an insurance provider under Obamacare. The CMS took steps to stabilize the insurance market, including reducing burdensome and overlapping regulations. Allowing reinsurance programs in several states was another step that gave insurance providers more confidence in the ACA. Reinsurance provides state and federal funding assistance for exceptionally high claims that erode insurance companies’ profits. ACA premiums will decrease in 2019 for states that have reinsurance programs, but they’ll still be higher than they were before 2018.

This year, the Trump administration has eliminated the penalty for those who go without health insurance. The original legislation was designed to allow insurers to charge lower premiums due to the high numbers of insured. In addition, short term health plans have been expanded under new regulations, allowing people to purchase these plans for up to nearly a year. One drawback here is that almost none of these plans cover pre-existing conditions, and most of them don’t cover substance abuse treatment, pregnancy and childbirth care, or prescription drug costs. Critics are also concerned that short term coverage could draw people away from major medical plans that need high enrollment to keep rates down.

Insurers lost money in the beginning under the ACA, but increased enrollment each year was expected to make up for the initial cost to insurance providers. Aside from withholding cost-sharing funds, the administration also cut funding for Obamacare marketing and outreach by 90 percent. Surprisingly, the overall number of enrollees grew to 8.7 million even without this support. The large rate jump last year was meant to accommodate the cancellation of cost-sharing reimbursements for insurers, and participating insurers began to turn a profit.

To benefit from lower premiums, some people will have to change to a different network or set of healthcare providers. States are required to ensure adequate networks and reasonable availability of providers. For the benchmark silver plan, the actual cost may not decrease as subsidies go down along with lower rates.

The decrease in rates applies to the 39 states that participate in the federal exchange site at The District of Columbia and 11 states run their own exchanges. Although rates have increased in some states as they’ve gone down in others, there’s also a trend for premiums to have less variation from one state to another, making them more equitable.

The profitability for insurance providers should help keep insurers in the marketplace, which in turn should keep current customers coming back – while attracting new business to the table. Per Seema Verma, 23 more insurers are participating on the exchanges for 2019, and those already participating are expanding their geographic reach. Although small, the 1.5 percent reduction in average premiums nationwide represents a big change from the increases we’ve gotten used to, and it could be a positive sign for the future of the ACA.

New HRA Rules Could Boost Choice for Employers and Their Workers

Quite a few of the healthcare policy decisions made by the Trump administration have been mired in partisanship and acrimony, but this is certainly not the case with a proposed rule recently published on the Federal Register. The rule in question involves the expansion of health reimbursement agreements, known as HRAs, that would benefit Americans by means of an employer-based system for reimbursing out-of-pocket healthcare expenses.

HRAs had been put on ice by the Obama administration years ago, but an executive order signed by President Trump in 2017 directs the IRS as well as the Health and Human Services department to look for ways to expand them. 

The current proposal seeks not only to refresh HRAs but also to create a new type of benefit for employees who want to cut down on the medical spending that comes out of their own pockets. In the proposed new version of HRAs, small business owners stand to benefit the most, although there may be some advantages for large companies to consider. Before we get into the proposed changes to HRA rules, it helps to know how they work.

The Employer Role in Funding HRAs

As the situation currently stands, employers are tasked with the heavy lifting of HRAs because they are expected to set aside cash for workers, which they can then use throughout the year. In essence, this funding works like a feature of group health insurance coverage, and it can be used to cover qualified medical expenses that would not normally be covered by existing policies. To an extent, HRAs act like external supplements that make health insurance more comprehensive. Qualified expenses may even include overt-the-counter items.

HRAs only work in conjunction with the group health insurance programs that employers offer. They’re not available to individuals on the private market due to Affordable Care Act restrictions against products that don’t include coverage for essential health benefits. In other words, HRAs don’t count as minimum essential coverage, so they’re not available as standalone products outside of an employer setup.

Proposed Changes to HRA Rules

Here are some of the proposed improvements to HRA programs:

Excepted benefits: Under this proposal, a separate HRA could be set up by employers to let workers pay for dental and vision plans as well as short term health insurance policies. This improvement would be capped at $1,800 per year. This measure could be considered a progressive overhaul of ACA rules because of the flexibility it would offer to American workers.

Individual health insurance purchase: Employees could use HRA cash to purchase their own health insurance, but doing so would require them to obtain plans that provide major medical coverage, and the employer would be barred from offering traditional plans. All HRA offerings would be voluntary, as would participation in an employer-sponsored HRA.

Allowing expenses beyond the HRA cap: Should employees spend more on healthcare than the HRA allows per year, business owners could approve a reasonable payroll deduction program to cover these expenses, but only if those expenses are related to paying for major medical insurance premiums. It should be noted that this provision is voluntary for both employers and employees.

A significant aspect of the HRA rule proposal is that Republicans are now focused on giving Americans more flexibility in terms of choosing health insurance options. The days of seeking a full repeal of the ACA are over, particularly in light of the midterm elections that secured a Democrat majority in the House. What lawmakers are working on now represents reasonable rather than political improvements that take into consideration all aspects of the health insurance industry, particularly as it applies to working Americans.

Public comments are welcome on the proposed rule until December 28. If the rule becomes finalized, changes would take effect for plan years starting January 1, 2020.

New CMS Rule Would Require Drug Companies to List Price in TV Ads

One in five Americans will go without the health care he needs because he can’t afford it. To decrease the out-of-pocket cost for patients, the federal government wants to make drug companies include in television ads the price of drugs and biological chemicals covered by Medicare and Medicaid. Pharmaceuticals companies, who say the law interferes with their right to free speech, want to implement their own plan. Currents laws require commercials to list side effects but not cost.

The new regulation, an offshoot of the American Patients First Blueprint, would require drug companies to show the cost of a 30-day supply for chronic illnesses, like diabetes, or a routine round of medication, like antibiotics for infections. The information would show up on the top of the commercial, and the Department of Health and Human Services would monitor offenders. Drugs that cost under $35 per month would be exempt. 

Other initiatives of the “blueprint” include improving competition among drug companies, offering incentives to companies that lower drug prices, encouraging price negotiations and lowering costs to consumers. The Centers for Medicare and Medicaid Services is deciding if the rule will apply only to television or if it will also be a requirement for social media, radio, newspapers and magazines.

Health and Human Services (HHS) Secretary Alex Azar also wants to transfer some drugs paid for by Medicare Part B to Medicare Part D, the private drug portion of Medicare that allows more competition than the federally funded Part B. While that might lower costs for some patients, it could also cause a backlash from pharmaceutical companies who want to protect their profits. The new rule would not apply to over-the-counter medications covered by Medicare.

Even with prescription drug coverage, patients must pay full price for any drug that is not on their formulary – the official list of covered drugs provided by an insurance company – and list prices determine which drugs go on the formulary list. According to HHS, the 10 most commonly prescribed drugs in the United States range from $550 to $11,000 per month. People need to know the cost before it’s time to pay.

HHS Secretary Azar says that putting cost-related information on an independent website is not the same as listing it on advertising. Drug companies argue that disclosing the price of expensive treatments might discourage people from seeking the care they need.

The proposal to include pricing in TV ads has received bipartisan support. A poll by the Kaiser Family Foundation reported that 76 percent of Americans approve of the plan. There is also agreement among legislators and patients that rebates, which are payments made to employers, state and federal government, and other pharmacy benefit managers, require examination and transparency. Experts say few of the benefits from rebates change out-of-pocket costs for consumers. 

New Waivers for States Could Signal Flexible, Affordable Health Insurance Markets

On October 22, the Centers for Medicare & Medicaid Services (CMS) announced that states would be given authority to relax some of the guidelines for insurance under the Affordable Care Act (ACA). Framed as giving states “the flexibility to lower premiums and increase choices” for consumers, it’s also a weakening of ACA regulations that are designed to keep the insurance exchange healthy and premiums affordable. But it could spell innovation in states where ACA regulations have strangled the private market.

The new guidelines are called State Relief and Empowerment Waivers. To understand what these changes mean for the individual, it’s necessary to look at the fact sheet provided with the announcement. One change is that states will no longer be required to maintain a certain number of people insured by Obamacare plans when applying a new health insurance system under the waiver. Instead, states are allowed to provide other options to consumers, and these alternatives will compete for enrollment with ACA coverage.

A guarantee of coverage still exists under the Affordable Care Act, but some health analysts believe that populations may lose access to affordable health insurance, particularly if states move toward high-risk pools for people with chronic health problems. 

One theme that runs throughout the CMS statement is assurance of coverage for those with pre-existing conditions – it occurs three times in the text. However, there’s no mention of the concurrent authorization to raise rates for that coverage. The press release only mentions protecting those with pre-existing conditions and giving them access to the same level of care. 

Another worrisome change is the power given to states to decide who will get insurance subsidies. According to CNN, experts believe that older, sicker individuals or low-income citizens may actually end up with fewer choices as short-term plans lure young, healthy people away from the ACA marketplace. It should be noted, though, that enrollment in short term plans has been historically low compared with full major medical benefits. Some analysts believe that the Trump administration’s bolstering of short term plans will have minimal impact on the private market.

The new guidelines also put the emphasis on providing access to healthcare coverage to as many people as possible instead of covering as many people as possible. States will now have the flexibility to design alternatives to the ACA, consider improvements and implement new models. The goal with these initiatives would be to increase health insurance coverage by facilitating “competitive private coverage.”

Rules are being relaxed in order to give consumers more choice and better options for meeting individual needs, not to mention tightening federal spending on healthcare. 

The impact of these changes won’t be felt immediately, and 2019 open enrollment won’t be affected. Depending on the number of states applying for waivers and their specifications, changes could start happening by early 2020.

Mega Merger for Aetna and CVS 

After drawn-out legal proceedings with the Justice Department, CVS Health and Aetna have finally agreed to a gigantic $69 billion merger deal. provided that the companies divest part of the business prior to officially merging. This merger is the most recent in a spate of huge health insurance and health provider buyouts and mergers, which included the $52 billion buyout of pharmaceutical benefits company Express Scripts by Cigna, one of the largest health insurers in America. 

This merger is one of the largest in history, as CVS is the biggest retail pharmacy and the second-biggest individual prescription drug plan provider in the United States. Aetna is the third-largest health insurance company in the U.S. and the fourth-largest insurer of individual prescription drug plans.

Though Aetna and Cigna have unsuccessfully attempted two healthcare mergers with Humana and Anthem before, which were both blocked by the Department of Justice between 2016 and 2017, this acquisition signals a consolidation of health care services under larger umbrellas. To some, the consolidation is worrying. 

The Justice Department has cleared the merger of any antitrust concerns, but advocacy groups still believe that the reduced competition this merger creates could lead to reduced quality of healthcare products and services. The merger is under intense scrutiny from antitrust lawyers and the Federal Trade Commission to ensure that proper regulations are put in place.

The Justice Department’s tentative approval was conditional on Aetna divesting one section of its business: its Medicare Part D prescription business. Aetna’s Part D business focused on providing individual Medicare prescription drug plans in 16 Medicare Part D regions in the United States. These 16 regions covered parts of 22 different states, and Aetna contributed to a large share of all prescription drug plans in those regions. 

In the Department of Justice’s reasoning for demanding that Aetna divest its Part D business, there appears to be a concern for anticompetitive effects due to CVS and Aetna both providing plans in many of those areas. If Aetna and CVS were to merge and not divest these plans, then the lack of competition in these regions could drive innovation down and prices up. Currently, Aetna and CVS have agreed to these terms and Aetna is in the process of unloading its Part D business.

Aetna and CVS maintain a positive outlook on what this merger could accomplish for consumers. They predict that CVS stores could become the go-to spot for prescriptions and basic medical treatment, as the merger provides for both under one comprehensive plan and CVS’s 10,000+ stores provide convenient access points for these services. 

The enhanced connectivity of a single company may also be able to deliver more affordable care. However, the integration of companies this large may take more time than expected. With thousands of employees around the United States, streamlining the transition may prove challenging. 

Health Insurers Find Stable Footing in 2019

According to a recent report from S&P Global Ratings, 2019 should be a strong year for health insurers. The financial analyst firm predicts that the American health insurance market is likely to remain stable over the course of the year.

Conditions are generally favorable for those doing business in this sector at the moment. For one thing, the American job market has been growing. As more people get hired, more people opt into employer-sponsored health insurance. This, in turn, boosts the number of customers covered by insurance companies.

There’s also significant business available for insurers in the area of government-sponsored health coverage since private health insurance companies can participate in federal or state-based health insurance exchanges. S&P noted that these markets are seeing greater stability now than in the earlier years of the Affordable Care Act. According to some predictions, 2018 will be the highest year of earnings for marketplace insurers. One sign of the health of the exchanges is that new participants have been joining the marketplace’s insurer lineups in recent years.

Are Better Times Ahead For Carrier & Consumers?

Operating managed Medicare or Medicaid plans is another way that many insurers choose to participate in the realm of government-sponsored healthcare. As Baby Boomers are turning 65, Medicare enrollment numbers are going up, and many of those enrollees are opting for Medicare Advantage plans. These private alternatives to traditional Medicare offer robust benefits without a robust price tag. Managed plans are also becoming a common trend among state Medicaid programs.

As a result of the favorable health insurance market, the majority of health insurers under S&P’s purview received a rating of “A” or better at the end of 2018. Despite the positive news, the analyst firm notes that there are some issues looming that could reduce the future stability of the market.

The continued viability of the ACA is one such concern. On the one hand, because Democrats gained control of the House of Representatives during the November 2018 midterm elections, the probability of a congressional ACA repeal seems unlikely to happen in the near future.

On the other hand, the Trump administration may continue to attempt changes to the ACA through other means. Furthermore, in light of a late 2018 ruling from a federal judge, the constitutionality of the healthcare law will once again end up before the Supreme Court.

Also of concern is the fact that healthcare costs around the country continue to rise. Climbing costs could affect insurers’ financial stability. And several mergers of large companies have led to the creation of even larger healthcare giants, which will impact the healthcare industry – for better or worse, it remains to be seen. Near the end of 2018, Cigna Corp. and Express Scripts finalized their deal, and Aetna and CVS Health did the same.

Involvement in government-sponsored healthcare can involve a good deal of red tape. While major healthcare companies often have the manpower and departments to handle this, smaller insurers may find themselves struggling to stay ahead. Federal and state exchanges have seen the entrance of many new insurers over the last few years, which has given consumers greater choice. It’s possible, though, that some of the smaller players, unable to keep up, will once again exit over the next few years.

It’s also possible, however, that the natural response to these company mergers may simply be that collaboration across healthcare entities increases. This could lead to greater efficiency and productivity.

In the short term, S&P analysts predict that payment-and-delivery reform will be a key focus for insurance companies this year. Attempting to follow through with the ACA’s provisions regarding value-based payments may be an additional source of increased collaboration between healthcare entities.

Another Area Affected By Government Shutdown: Food Inspections

The federal government’s shutdown is touching the lives of more than its furloughed employees. From issues reported at national parks to potential delays in processing upcoming tax returns, the shutdown is creeping into the lives of every American. Now the Food and Drug Administration (FDA) is reporting that they have suspended routine food inspections.

What’s Been Affected So Far

FDA director Dr. Scott Gottlieb said the agency has halted routine safety inspections of seafood, fruits and vegetables and other foods due the federal government’s shutdown. The FDA oversees nearly 80 percent of the food supply in the United States. Their inspectors visit about 160 food processing and manufacturing plants per week. More than 30 percent of those are considered to be at high risk of causing food-borne illnesses. According to statistics from the Centers for Disease Control and Prevention, food-borne diseases are responsible for well over 100,000 hospital visits each year in the U.S., with some 3,000 deaths reported annually.

Not all inspections have ceased. The agency said 100 percent of foods imported from other countries continue to be inspected and that critical functions, such as monitoring outbreaks of food poisoning, have not been affected. Sampling of some frozen foods has also continued. The Department of Agriculture handles inspections of meat and poultry products and they report that 89 percent of their food safety employees are still on the job, though they are not being paid. Also, restaurants are overseen by local health agencies and are not affected by the federal shutdown.

Officials Aren’t Overly Concerned — Yet

While admitting the situation is not ideal, officials say there is not a big need for public concern at this point. Director Gottlieb said the FDA is working to bring back about 150 employees to inspect foods that represent higher risks to the public, such as cheese products, infant formula and fresh produce. He’s hopeful this could happen as early as next week.

Sarah Sorscher, from the Center for Science in the Public Interest, said the FDA’s suspension of routine food inspections isn’t an immediate cause for concern, but will be if the shutdown continues. “That’s more and more issues they’re potentially not catching,” she said. In addition to missed inspections, a long-term shutdown could impede the agency’s ability to implement new food safety standards, according to Sorscher.

Officials remain optimistic that an agreement between political leaders will be reached to end the shutdown and stress that there’s no need for the public to worry about the safety of their at this point. However, it’s a story that bears watching if the shutdown continues.

Beware the Trade-Offs for “Medicare for All”

In 2017, Senator Bernie Sanders introduced legislation that would expand Medicare into a universal health insurance system for the country. The bill, known as Medicare for All, was supported by at least 15 Democratic senators and would provide universal health coverage without any premium costs for consumers.

Senator Sanders believes that the healthcare system in America needs to be completely overhauled. Over the past five years, premiums have doubled and deductibles have gone up 40 percent. Many insurance plans have small networks that only offer a limited number of providers and hospitals. When the closest hospital is outside the network, this can lead individuals to run up extensive bills if there is an emergency.

How Would It Work

According to Sanders and his supporters, Medicare for All would build on the Affordable Care Act, which allowed millions of Americans to obtain health insurance. But proponents of universal healthcare believe that the federal government could do more. There are still 29 million Americans without health insurance, and millions remain underinsured because they can’t afford the high copayments and deductibles their policies require.

Medicare for All would separate health insurance from employment. It’s billed as a healthcare proposal that would spur innovation and allow people to live healthier lives. Employers would no longer spend time focusing on how to provide health insurance to their employees and spend more time focusing on growing their business.

The plan would create a federally administered single-payer healthcare system, covering inpatient and outpatient care, including long-term, primary and specialty care. Prescription medications, vision, dental, hearing, mental health and substance abuse coverage would also be included under this proposal.

Estimated Costs

In July 2018, the Mercatus Center at George Mason University reported that the program would cost the federal government around $32 trillion over a 10-year period. Sanders suggested when he introduced the bill that most Americans would support a tax increase if it meant household healthcare costs would be reduced. Critics of the idea say that the estimated cost would be difficult for the federal government to absorb. The Mercatus Center is not alone in its estimates as the Urban Institute came up with similar figures in 2016.

Other Countries

Canada currently has a single-payer system that has been implemented successfully, which many proponents of Medicare for All use to demonstrate how the program could work in the United States. Canadians pay about the same in income taxes as Americans. However, in a 2017 comparison of 11 high-income countries, Canada’s healthcare system ranked ninth and the United States ranked last. In addition, Canada covers most medical needs, but people often purchase a second, private plan for unmet health needs like prescription drugs. In Britain, the government owns hospitals and employs specialists via the National Health Service. There are often long waits for care in Britain, which is addressed by a small private system that caters to wealthier people who want faster access to treatments.

The problem in comparing the United States to other industrialized nations with universal healthcare systems is that it’s much bigger from a population standpoint. Implementing a federal single-payer program would not only cost more but require a complete overhaul of the way the system works now.

As an example, hospital rooms in the U.S. are generally private or shared with one other person. In England, patients are more likely to be put in a ward, which could hold up to 24 beds divided into smaller sections based on level of care. European hospitals tend to be housed in older buildings that may not have started out as healthcare facilities, so planners conserve space and architectural integrity with a different setup than Americans are used to. A nationalized healthcare system would require American providers to rethink how they plan, build and administer hospitals – and this is just one instance of change.

Cost Negotiations

Proponents argue that a single-payer system could actually save money through healthcare cost negotiations. The federal government would be able to negotiate prescription drug and other healthcare costs. This means the $32 trillion could be cut somewhat if healthcare costs can be reduced. Administrative and pharmaceutical costs are much higher in the United States than they are in other high-income countries. Doctors also earn significantly more here as well, partly because there are more specialists – only 30 percent of practitioners in the U.S. are generalists – and specialists demand higher pay for their skills.

Under the Medicare for All plan, doctors would be paid about 10 percent less. It’s significant to note that a similar program proposed in Vermont was not pursued by the governor because it would mean an 11.5 percent increase in payroll taxes on businesses as well as a 9.5 percent income tax increase.

Gaining Momentum

Since Sanders presented the bill, the idea has been gaining momentum, even though he has yet to explain how his proposal would be financed. One New York Times poll found that 51 percent of Americans and 74 percent of Democrats supported the idea of a single-payer system. But a 2017 poll by the Kaiser Family Foundation found that support for the program dropped significantly when respondents were told taxes may increase or that the government could have more control over healthcare. There is also some confusion among Americans about how universal healthcare would work. Many polled believed they could keep their current health insurance under a single-payer plan, something that is not true.

There are still many variables that must be addressed regarding Medicare for All. There has been no discussion about what would happen to jobs at private insurers, although some believe those jobs could be repurposed into positions with the federal government. As Democrats start throwing their hats into the ring for the 2020 presidential election, healthcare will take center stage as a leading platform issue.

How Many People Would Lose Coverage if the ACA Gets Repealed?

The Affordable Care Act (ACA) has been integrated in stages for nearly seven years, with most of the policies in effect having been executed over the last three. Repealing and replacing it is a monumental task.

Republicans have already designed many alternatives in the last few years, but none of them made it past the Senate majority or President Obama. However, with the combination of a Republican Congress and President-elect Trump, the ACA’s days may be numbered.

Trump met with President Obama shortly after the election and made a statement regarding key provisions of the ACA that he now intends to keep. Preserving the policy that allows young adults to stay on a parent’s health insurance plan until age 26, and the ban on denying coverage to those with pre-existing conditions, means a full repeal has been set aside. But the Affordable Care Act will be completely transformed, and many people stand to lose their current health plans.

Total Uninsured

Prior Republican legislation indicates a two-year time frame to establish Trumpcare’s system of tax credits and health savings accounts (HSAs) for individuals, the modernization of Medicaid and the creation of a free-market enterprise for health insurance and pharmaceutical companies. These plans are designed to encourage competition and lower costs throughout the health care industry. Options for replacement should be offered by 2019.

In late 2015, the CBO estimated that about 22 million people would have lost health insurance after the end of 2017 if the GOP’s legislation HR 3762 had been enacted. These would have been people covered through Medicaid and the insurance marketplaces.

The Committee for a Responsible Federal Budget followed in 2016 with an estimate of almost 21 million people losing their insurance coverage. They believe Trump’s replacement plans would cover just 1 million of the 22 million individuals expected to sacrifice benefits under the ACA repeal.

The Rand Corporation shows that the combined effect of Trump’s proposals would leave 20.3 million uninsured. It’s clear that around 20 million people would lose their current health benefits under the law if the ACA gets repealed, and Trump does not appear to have an adequate explanation for how those affected would be covered under his version of national health care.

Medicaid Enrollees

Lower-income individuals would be more affected than others when the Medicaid expansion is repealed along with the ACA. It covers 15.7 million additional people with incomes below 138 percent of federal poverty level, a provision added in 2013. A Republican administration will focus on getting people off of Medicaid subsidies and into private plans with tax credits to help cover the premiums.

Trump wants to replace current funding for low-income individuals to each state using block grants or per-capita allotments to supplement their own programs. This transition will not likely happen until 2018 or 2019.

Marketplace Consumers

If the estimates overall are roughly 22 million, and 15.7 of them are subsidized by Medicaid, that leaves about 6.3 million marketplace enrollees without their current coverage once the exchanges get dismantled under Trumpcare. However, there are many unknown variables regarding the replacement plans and the success of tax cuts, credits and deductions applied to the purchase of health savings accounts. The details of changes to Medicare and Medicaid could have wide-ranging effects on estimates in either direction.

Avik Roy, president of the Foundation for Research on Equal Opportunity, along with several economists, came up with vastly different numbers based on three different but very specific proposals for repeal and replacement. The Patient CARE Act would only reduce coverage by 3 million people, A Better Way would reduce coverage by 2 million, and Roy’s own proposal claims to increase the number of insured by 9 million.

The particulars of Trumpcare can greatly change the outcome; we might end up somewhere in between. For the 20 million or more Americans who count on the ACA for coverage, their future depends on those particulars.

Avoid Serious Risks And Enroll Before The January 31 Deadline

The Department of Health and Human Services (HHS) has announced from Nov. 1, 2015 through Jan. 20, 2016, an estimated 8.8 million people had enrolled in Obamacare/ACA insurance in the 38 states that rely on the federal exchange and another 2.7 million that use state-run exchanges (and the District of Columbia). Open Enrollment ends on January 31 and if Americans miss this deadline there are stronger penalties and risks than in previous years.

4 Risks To Not Enrolling By January 31:

Tax penalties – By not enrolling by 11:59 p.m. on Jan. 31, you could face IRS-imposed tax penalties. Some consumers may avoid these if they qualify for hardship exemptions. But if found liable, you’ll pay the greater of:

  • $695 per adult and $347.50 per child, for a maximum of $2,085 per family; the 2015 penalty was $325 per adult and $162.50 per child
  • 5 percent of your income above the tax filing threshold; the 2015 penalty was 2 percent

Read more here: Obamacare tax penalty.

Inability to purchase coverage – Not enrolling may prevent you from being insured later on. You may be able to enroll outside of the OEP, during a Special Enrollment Period (SEP), if you experience special life changes, known as Qualifying Life Events (QLEs); e.g., childbirth, loss of coverage, relocation. However the government has recently announced new restrictions that will make it more difficult to enroll for an SEP.

Short-term health insurance – Consumers may have to turn to short-term (or temporary) policies, which are meant for shorter periods (1-12 months). But they only cover emergencies, whereas traditional plans provide preventive care, physicals and immunizations. They do not meet the ACA’s benefit standards, so you could still face tax penalties. Short-term plans are not eligible for government subsidies. Pre-existing conditions are not covered, and you may be liable for coverage gaps if you switch to a traditional plan.

Out of pocket – Paying all medical expenses yourself can be very expensive. In 2014, uninsured low- and middle-income, nonelderly adults were twice as likely as those who gained coverage or had coverage to have problems paying medical bills. They were more likely to use up savings, have problems paying for necessities, borrow money or have medical bills sent to collection.