Premiums under Obamacare will increase from 12 percent to 32 percent next year unless the federal government steps in, according to a study that examines the fallout from President Trump's attempts to chip away at the program.
The nationwide analysis, released Thursday by California's insurance exchange, said repeal of the Affordable Care Act's "individual mandate" to hold insurance is the main driver, jacking up rates by 7 percent to 15 percent in 2019 and up to 10 percent in the following two years, as younger and/or healthier people decide not to get coverage.
Mr. Trump's decision to slash the enrollment period and the promotion of Obamacare's exchanges will contribute to price increases, as people fail to sign up, while his twin moves to offer plans that don't comport with the 2010s coverage requirements will have a relatively modest impact, boosting rates by the low single digits.
Consumer behavior itself, such as the mix of enrollees and their use of health services, is likely to increase premiums by 7 percent in each of the next three years.
Milliman, which conducted the analysis, said the cumulative effect is that premiums could rise by more than 90 percent through 2021.
Expected rate increases will vary wildly across the nation, analysts warned, but said states that promote their markets or take steps to regulate prices down would fare better than others.
Taxpayer-funded subsidies will blunt rising costs for most people on Obamacare's exchanges, but several million Americans will take it on the chin.
"The challenges to our health care system are threatening to have real consequences for millions of Americans," said Peter V. Lee, executive director of Covered California. "The prospect of 30 percent premium increases in 2019 and hikes of over 90 percent over the next three years threatens access to coverage for millions of Americans."
Obamacare's defenders say Republican tweaks from Washington are destabilizing the exchange markets after a relatively steady year of enrollment on the exchanges.
Signups appear to dip slightly this year, from 12.2 million in 2017 to an estimated 11.8 million, despite Mr. Trump's antipathy and his claims that his predecessor's signature law was already "dead."
The administration and congressional Republicans say Obamacare's economics were wobbly even before Mr. Trump came along, after lackluster enrollment resulted in double-digit price increases and the exodus of major insurers from the program.
The White House says middle-class Americans are desperate for cheaper options. It's pushing a parallel set of regulations that would open the door to plan options that aren't governed by Obamacare's coverage standards or its prohibition on charging a sicker person more than a healthy one.
Mr. Trump wants to allow people in similar trades to band together and buy "association plans" across states lines, and let people hold short-term insurance plans for a full year, instead of just three months.
Sen. John Barrasso, Wyoming Republican, introduced a bill that would let people renew those short-term plans.
Democrats fear that will result in a splintered market in which only the sickest customers stay in Obamacare, driving up consumer and taxpayer costs.
Health and Human Services Secretary Alex Azar said Thursday the administration supports letting customers renew the short-term plans.
"We think they're low-cost options," he said. "If it's right for that person in their situation, we would like for them to have renewability."