What does Trump’s vow to kill Obamacare mean for open enrollment?

Nov. 10--During his campaign, President-elect Donald Trump promised to repeal Obamacare on his first day in office.

Now that Trump has won the election, that promise takes on a more direct meaning for more than 10 million Americans currently receiving their health coverage from a plan they purchased through a state or federal health insurance exchange. More than 1.3 million Californians -- an estimated 123,910 of them in San Diego County -- have until Jan. 31, 2017 to decide if they want to stick with their current plans or fine a different options that suit them better.

Already anxiety-producing because some plans have posted double-digit premium increases for 2017, Obamacare's fourth open enrollment suddenly has a new dimension: Current enrollees must decide how to interpret Trump's vow to undo the Affordable Care Act.

The health law currently provides subsidies to more than 87 percent of those on plans sold through Covered California, the state's Obamacare health insurance exchange. Were these subsidies to evaporate in 2017, most would not be able to afford their plans' monthly premiums.

It is not clear whether or not a Trump administration would try to wipe out those subsidies right away, though Congress already attempted a similar move in 2015 which President Barack Obama refused to sign.

So, should current Affordable Care Act enrollees hold off on making a plan selection for 2017 out of a fear that subsidies will go away next year?

One of the nation's most widely-cited experts on health law says no.

Timothy Jost, an emeritus professor at Washington and Lee University School of Law who has been a student of and regular commentator on the ACA, said Wednesday that there is no reason why anyone should decline to enroll for next year even though the law is in Trump's crosshairs.

He said it is not likely that politicians would immediately cancel subsidies without providing some other option or, at the very least, a grace period for those already enrolled. When they tried to defund the subsidies last year, he noted, the attempt included a grace period of at least one year. If no such grace is forthcoming and the new administration simply makes subsides go away, that wouldn't mean, Jost said, that current beneficiaries would be stuck paying unsubsidized premiums for the rest of the year. All health insurance plans, he noted, are month-to-month arrangements. There is no penalty for letting them lapse unpaid other than the loss of health coverage.

"People should go ahead and sign up during open enrollment. The worst-case scenario is that you have to drop your policy later in the year," Jost said.

Meanwhile, health care systems, which spent years gearing up to serve the larger number of insured Americans under the ACA, are preparing for the possibility that health coverage for some of the patients they serve may look very different soon.

Chris Van Gorder, chief executive of Scripps Health in San Diego, said that he believes any potential change can be weathered, though doing so may be painful for organizations that have not left themselves enough flexibility to embrace changes in sources of government payment.

Just as Jost noted in an analysis of Trump's options published Wednesday, Van Gorder said he does not see a the ACA evaporating overnight once a new president is sworn in, regardless of what statements have been made in campaign stump speeches. Some of the health law's attributes, like guaranteeing coverage to those with pre-existing conditions, he said, are simply too popular.

"I don't believe they are going to repeal the ACA in its entirety. But I think they'll want to tweak it fairly dramatically. This health care problem we have has been seen as belonging to the Democrats for many years, now it belongs to the Republicans," Van Gorder said.

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