Obamacare enrollment in Illinois is falling, and the Trump administration wants to scrap it. Here are 5 things to know.

March 26-- Mar. 26--Fewer Illinois residents signed up for health insurance through the Obamacare exchange this year -- as questions continued to swirl about whether the law would continue to stand.

About 312,280 Illinois residents selected health plans through the exchange for this year, according to data released by the federal government Monday afternoon. That's down from about 334,979 last year -- a decline of nearly 7 percent. Nationally, enrollment fell by about 3 percent, to 11.4 million.

Illinois residents signed up for coverage even as the Trump administration made a number of changes, and court challenges to the law persisted. The Trump administration, for example, now says it supports a Texas judge's ruling that Obamacare is unconstitutional -- a significant hardening of the administration's position against the law. House Democrats, meanwhile, say they have a plan to improve and strengthen the health care law.

Here's what you need to know about sign-ups in Illinois and the status of Obamacare.

1. Why did fewer people in Illinois sign up?

The number of Illinois residents signing up for exchange plans has been dropping since 2017 -- the same year that President Donald Trump took office, pledging to undo the Affordable Care Act, also known as Obamacare. Most people in Illinois get health insurance through their employers or government programs, such as Medicare and Medicaid, but others buy plans through the exchange at Healthcare.gov.

This year's decline was likely because of lower demand for exchange plans, thanks to a strong economy in which more people have access to insurance through their employers, the federal Centers for Medicare & Medicaid Services said in a news release.

Others, however, have said uncertainty surrounding the law in recent years has most likely deterred some consumers from purchasing exchange plans. They also say changes to the requirements surrounding the law may have contributed to the decline in enrollment.

It's possible the "drop in enrollment is result of continued action by Trump administration to undermine the Affordable Care Act," said Kathy Waligora, interim executive director at EverThrive Illinois, referring to a number of changes the administration has made to requirements surrounding the law.

Still others blame high prices for driving Illinois residents away from the exchange.

2. Has the cost changed?

Prices remained relatively steady in Illinois this year for plans purchased through the exchange, according to federal data. In Illinois, average monthly premiums are about $646 this year, compared with $644 last year -- though most people get tax credits to offset those costs.

Nearly 84 percent of Illinois residents who have exchange plans this year also get the tax credits, bringing their average monthly premiums down to $140, compared with $135 last year.

Illinois' largest health insurer, Blue Cross and Blue Shield of Illinois, dropped its average rates for many plans slightly this year. The drops, however, followed years of double-digit increases, which may still be keeping some people from buying exchange plans, according to the Centers for Medicare & Medicaid Services.

"This small decline in premiums in 2019 moves in the right direction, but, for unsubsidized people, premiums remain considerably higher than before the (Affordable Care Act's) main requirements were implemented in 2014," the agency said in a news release.

3. What changes has the Trump administration made?

Since Trump took office, the administration has made a number of changes to requirements surrounding the law. The administration has said the changes are intended to give consumers more options, but proponents of Obamacare say they could lead to fewer people with health insurance. Trump made changes after Congress was unable to fully repeal the law.

For one, starting this year, individuals will no longer have to pay penalties for going without health insurance. They also have new options for buying coverage outside the exchange, such as short-term plans that can be used for longer periods of time than in the past. Short-term plans are generally cheaper than exchange plans but may not offer as much coverage.

Also, the federal government has dramatically cut funding meant to help enroll people in exchange plans. Illinois got 78 percent less federal money last year to hire workers to help enroll people in exchange plans.

4. Where does the law now stand?

Despite all the changes and uncertainty, Obamacare remains in place. Over the years, it has faced a number of court challenges, and the U.S. Supreme Court has upheld its provisions several times.

It's still being challenged in court, however. A federal judge in Texas ruled in December that the law should be invalidated. That case is now in appeals court, and on Monday the federal government filed a notice saying it now supports the original ruling to scrap the law entirely -- a significant change from last June when the administration said some parts of the law could still stand.

Illinois is one of a number of states defending the Affordable Care Act as part of the case.

5. What would happen if the law were struck down?

The appeals court must still make a ruling, and if that ruling were against the health care law, it would most likely be stayed until an appeal is concluded, said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. The ruling would most likely go to the U.S. Supreme Court, so a final decision may be some time away.

"It's hard to imagine, certainly, anything happening this year," Corlette said, of the law being invalidated.

But if the law were eventually struck down in its entirety, it could affect millions of people in Illinois.

Also, the law doesn't just govern exchange plans and the 312,280 people in Illinois with them. States also expanded Medicaid -- a health insurance program for the poor -- to more people under the law. More than 590,000 additional adults in Illinois had Medicaid coverage as of October because of that expansion, according to the Illinois Department of Healthcare and Family Services.

The law also affects people with coverage through their employers. The law allows young adults to stay on their parents' health insurance plans until the age of 26. It also bars insurers from imposing lifetime and annual coverage caps and from denying coverage to people with pre-existing conditions.

Proponents of erasing the law say doing so could lead to more options at better prices for consumers, while opponents worry that fewer people will be able to get comprehensive insurance and will suffer more financially if they're sick.

lschencker@chicagotribune.com

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