Popularity of Healthcare.gov Insurance Exchange Spells Complicated Repeal Process

Even though president-elect Donald Trump has promised to repeal the Affordable Care Act (ACA) while attempting to keep the most popular provisions, he and Congressional Republicans have a long battle ahead as they search for a replacement plan.

The day after Trump was elected, consumer enrollment in the ACA’s health insurance exchange marketplace at Healthcare.gov surged, seeing 100,000 plan selections in a single day, according to a Tweet by US Department of Health and Human Services (HHS) Secretary Sylvia Burwell. That marked the busiest day of the open enrollment period to date. Open enrollment began November 1.

The Centers for Medicare and Medicaid Services (CMS), which runs the exchange marketplace, reported this week that one million people have selected insurance plans since November 1. According to CMS, enrollment rates this year are slightly higher than previous years, with 53,000 more plan selections during the first 12 days of open enrollment this year than last year. In order for insurance coverage to start on January 1, enrollees need to sign up by December 15, according to CMS.

The Road to Repeal and Replace

Trump has said that repealing the ACA is a priority of his first 100 days in office—and even though he has signaled that he wants to keep provisions such as the one that allows children up to age 26 to remain on their parents’ insurance and the one that prevents a ban on coverage for individuals with pre-existing conditions—policy experts predict a fraught process in the White House and Congress. After all, it is the Trump administration that will oversee the end of enrollment for 2017, which ends on January 31.

Insurance companies that are providing coverage in 2017 are contracted to continue doing so until the end of that year. What’s more, the process for providing coverage in 2018 is already underway, according to a report by Congressional Quarterly, which notes that those companies are already planning business strategies, product designs, and their premium costs for 2018.

As National Public Radio points out, repealing and replacing the ACA is complex and will take a while, regardless of the legislative mechanism used to do it. Dismantling the massive law can be done partially through presidential executive orders, and Congress could eliminate the law’s Medicaid expansion, medical device tax, and premium subsidies through a series of budget reconciliation actions, Modern Healthcare reported.

“I think that Congress may be less willing to just wipe the subsidies out if a lot of people are using them,” George Washington University’s Sara Rosenbaum told NPR.

Other experts told NPR that no legislator is eager to have angry, uninsured voters, and that any replacement program wouldn’t likely be in place until 2019. Rosenbaum advises consumers to keep shopping for insurance plans and not allow themselves to focus on the actions of Congress.

“If there’s no replacement in effect by the end of 2017, a Trump administration could find themselves operating an open enrollment period with lots of insurers dropping out. And any insurer that stuck around would raise their premiums significantly,” Larry Levitt, senior vice president for special initiatives at the nonpartisan Kaiser Family Foundation, told Congressional Quarterly. “It’s kind of like musical chairs; no one wants to be the one left insuring the sickest people.”

Click here to read a comprehensive review of the possible Republican ACA replacement plans, which lawmakers would have to evaluate in order to dismantle the law piecemeal or wholesale.

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