Obamacare open enrollment ends Tuesday — possibly forever

Jan. 30--Tuesday will be the last day of open enrollment for health insurance this year under the Affordable Care Act -- and possibly the last day ever for Obamacare enrollment if Republican opponents of the health law have their way.

For millions of Americans, open enrollment is the time to go online to re-up or switch insurance plans -- or to sign up for coverage for the first time to avoid penalties. The fourth open enrollment period under the ACA started Nov. 1.

As of Jan. 14, 8.8 million consumers nationally, including 413,000 Pennsylvanians, had selected plans for 2017 through the federal marketplace website, healthcare.gov, according to the U.S. Centers for Medicare and Medicaid Services.

The numbers closely match those of last year, suggesting that talk of repealing the ACA has had little effect on consumers' behavior, said Katherine Hempstead, a senior adviser for health care at the Robert Wood Johnson Foundation, a philanthropic group focused on public health.

"It seems like consumers are acting normal so far," she said, "as if nothing is going on, which is kind of interesting."

In one of her final official statements before stepping down two weeks ago, former Heath and Human Services Secretary Sylvia Burwell struck a defiant tone.

"It's clear that marketplace coverage is a product Americans want and need," she said in a news release. "Strong demand is especially striking in light of the unique headwinds created by discouraging rhetoric from ACA opponents."

Many Lehigh Valley marketplace customers have found that they have to pick new insurance plans this time. That's because a number of insurance companies withdrew from the marketplace.

During the last enrollment period, eight insurers offered 41 plans in the insurance region that encompasses the Lehigh Valley. This time around, the number of insurers locally is down to three -- Geisinger, Capital BlueCross and Highmark -- offering six plans.

The good news is that for many customers, the brunt of higher prices is being absorbed by government subsidies. For example, the initial price of a second-lowest-cost silver plan for a 27-year-old Pennsylvanian with an income of $25,000 would be $327 a month, according to HHS. But after an advance tax credit of $185, it would drop to $142.

Plans are rated by quality of coverage as bronze, silver, gold or platinum. The Internal Revenue Service uses the second-lowest cost silver plan as its benchmark to calculate tax credits.

Cathy Cortijo, an enrollment assistant with Neighborhood Health Centers of the Lehigh Valley, said lots of people are interested in taking advantage of the final days of open enrollment.

"I am getting a slew of phone calls," she said. "You always get people who wait until the last minute."

Before the ACA, many people who wanted insurance had limited options because carriers could reject them or charge them higher rates for pre-existing conditions. By the end of the 2016 enrollment period, which closed in February, nearly 13 million consumers nationwide had signed up for insurance through either the federal marketplace or state-based exchanges.

Millions of others have been covered through an ACA-enabled Medicaid expansion. Additionally, many young adults have been able to remain on their parents' insurance, since the law also raised the age limit for parental coverage.

All told, the number of people without insurance has dropped by 31 million people to 27 million under the health law, according to a report published this month by the nonpartisan Congressional Budget Office.

President Donald Trump and GOP leaders of both the Senate and the House who say they'll repeal former President Barack Obama's signature achievement and promise to replace it with something better, though they've yet to put forth specifics.

Change in any form, however, could take awhile, said Hempstead. She said Republicans may buy time by voting for repeal legislation that keeps much of the ACA intact for an additional year or two or even longer.

Some of the customers Cortijo has helped enroll in marketplace coverage suffer from chronic illnesses such as diabetes and cancer, she said. "It's really really sad when you have people who have serious health conditions and they don't qualify for Medicaid," she said. "So we need something in place for sure."

Last week the Trump administration canceled about $5 million in ACA ads that were to have run over the final few days of the open enrollment period. Normally, this would be a busy time for marketplace sign-ups, especially for the younger, healthier customers insurance companies need to subsidize the cost of care of their older, less-healthy customers.

Kevin J. Counihan, the former chief executive of the marketplace, issued a statement accusing the Trump administration of trying to "sabotage open enrollment."

Without a definitive change in the law, people who are eligible for financial assistance but still don't get insurance will continue to face penalties.

Some people in 2014 were forced to forfeit $95 -- or 1 percent of their income, depending on which was higher -- from tax refunds filed the following spring.

The cost went up to $325, or 2 percent of income, for the 2015 tax year, and to $695, or 2.5 percent of income, for the 2016 tax year. Deductions for uninsured children, which are half those of adults, can result in even larger penalties for families.

After the open enrollment period ends Tuesday, only people who experience a qualifying life event, such as a job loss, will be eligible for coverage through the marketplace.

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OBAMACARE HELP

--Online: Go to HealthCare.gov or CuidadoDeSalud.gov.

--By phone: Call 1-800-318-2596. Assistance available in 150 languages.

--In person: Find local help at localhelp.healthcare.gov

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