If Obamacare goes away, coverage will stay – for the moment

President-elect Donald Trump and GOP lawmakers have made overturning the Affordable Care Act a top priority, as record numbers of people are signing up for “Obamacare” coverage. Their coverage will likely remain in place for at least the year, experts say. (Photo by Alex Proimos/Creative Commons)

WASHINGTON – More than 100,000 people rushed to sign up for Obamacare on the day after the election, despite President-elect Donald Trump’s promise to repeal the Affordable Care Act in his first 100 days in office – or perhaps because of it.

But health policy experts say that whatever Trump and the Republican Congress do or do not do to Obamacare after they take office next month, those who have enrolled in the marketplace are “more than likely” to keep their coverage for 2017.

That’s because coverage is good for a year even if opponents could halt the program on Day One – and published reports indicate Republicans in Congress may not be interested in cutting people off cold turkey, but in quickly enacting a repeal that would gradually phase out the law.

“There are obviously changes in store for the healthcare law,” said Cynthia Cox, an associate director of health reform and private insurance at the Kaiser Family Foundation. “What those changes look like and how the Republican Congress will go about making those changes is something that is still up for debate.”

Cox said that while repealing the legislation could cause consumers to lose coverage in the long run, “the most likely scenario is that the people signing up now are going to be able to keep their coverage through 2017. We would expect to see changes come about in 2018 or 2019 … but we don’t have a crystal ball and there’s a lot of ideas out there being considered.”

In Arizona, the number affected would be in the hundreds of thousands at least. The Department of Health and Human Services reported that almost 12.7 million people were able to get coverage through one of the Affordable Care Act’s marketplace plans in 2016, and 203,066 of them lived in Arizona.

But advocates say the number who would feel the effects of an Obamacare repeal would be much higher.

DJ Quinlan, spokesman for the Alliance for Healthcare Security, puts the number in Arizona closer to 400,000. That includes not just people getting coverage directly but those who were able to get coverage because of other parts of the law, such as its ban on denying patients with pre-existing conditions, or its provision letting children stay on a parent’s policy until age 26.

“The fact is that those who are in favor of ACA repeal have not released a plan,” Quinlan said. “We believe that it is highly irresponsible to repeal the ACA without having an immediate replacement.”

He said patients won’t be the only ones hit if there is no plan to replace the Affordable Care Act – doctors and hospitals would be hurt, too.

“Here in Arizona, we have benefited tremendously by the additional federal funding that allowed expansion of the state’s Medicaid program,” Quinlan said.

But critics of the legislation, like Sen. John McCain, R-Arizona, have called it an “unsustainable system that places an unfair financial burden on families and small businesses.”

Criticism has been especially sharp in Arizona, where customers faced the steepest premium increases in the nation – 116 percent, according to estimates from Department of Health and Human Services – when this year’s open enrollment period began Nov. 1.

The state also saw most of its health insurance providers pull out of the market, leaving the vast majority of customers with no option but to shop with the one remaining provider in their county.

Supporters have said that premium increases being seen in Arizona now are likely a response to unrealistically low premiums in the last few years that made it too costly for insurers to stay in the market. They also note that most people would not be hit in the pocketbook by higher premiums because, under the law, they can receive a subsidy to help pay for their coverage.

But that has not dampened calls to repeal and replace Obamacare, although Trump’s plans for a replacement remain unclear.

Cox said that whether action to upend Obamacare comes through legislation in Congress or through action taken by the president – it could take some time.

“There’s not a lot of time to get consensus even within the Republican Congress,” she said. “There are many ideas as to what the replacement is going to look like.”

Cox said that due to what is likely to be a lengthy process of replacing the ACA, people who are enrolling or are currently enrolled are “more than likely” to keep their coverage for the next year.

Lydia Mitts, a senior policy analyst at Families USA, agreed that for those enrolling or currently enrolled in Obamacare, “nothing is going to happen overnight.”

“We could see ourselves going back to an era where women could be charged more than men, where people with pre-existing conditions could be denied coverage,” Mitts said. “Or maybe they would be afforded coverage but insurers completely ran the show and could say, ‘We’ll give you coverage but we’re not actually going to cover your pre-existing conditions.'”

But the mere threat of repeal appears to have driven people to sign up. HHS Secretary Sylvia Burwell said in a tweet that on Nov. 9 – just days into the open enrollment period and the day after the election – more than 100,000 people had signed up for coverage that day. And last week, Burwell tweeted that the pace of enrollment is 400,000 signups ahead of the same point in last year’s open enrollment period.

Mitts said regardless of what happens next year or in years to come, “this law is still the law of the land and insurers have committed to providing health insurance.”

Cox echoed that. She advised consumers to shop on the marketplace before open enrollment ends on Jan. 31 and to continue “to make their decisions based on what the current law is.”