Obamacare After the Mandate

This time last year, open enrollment season for health insurance was at the center of the national political conversation. The Affordable Care Act – aka the ACA, aka Obamacare – had barely survived a repeal attempt in Congress, and no one knew how the ACA exchanges would fare with the Trump administration's shortened sign-up window and vastly reduced advertising budget. The good news: National enrollment numbers for 2018, down just 3.7% from 2017, indicated the ACA marketplace might just survive the Trump era.

Now the bad news: As the exchanges open Nov. 1 for 2019 coverage (www.healthcare.gov) until the end of enrollment on Dec. 15, the prevailing mood around the ACA is starkly different. With the midterms soaking up most activist energy, little is left over for helping those who need health insurance. Also, Republicans have dismantled two important provisions of the law – the individual mandate to purchase insurance and some limits on insurers' ability to sell bare-bones plans. Both changes have the potential to entice consumers away from the exchanges, which could eventually undermine the law's core protections for women, people with pre-existing conditions, and anyone who might get sick or injured.

Despite these reasons for future worry, the 2019 ACA exchange market in Central Texas appears to be stable. Kori Hattemer, head of the Insure Central Texas program at local nonprofit Foundation Commun­i­ties, says the four insurers on the exchange last year are all back – Blue Cross Blue Shield, Ambetter, Oscar, and Sendero Health Plans, which decided not to exit the market in September after public outcry ("Sendero's Path Forward," Sept. 28). "If anyone signs up for a Sendero plan, they'll have coverage for all of 2019, and their plan won't change during the year," Hattemer says. She expects prices on Healthcare.gov to mirror last year; premiums are projected to decrease by 1.5% nationwide, a welcome change after years of substantial increases.

This year, with no tax penalty for skipping out on insurance, many may be tempted to roll the dice on their chances of staying healthy. Consumers should be aware that going uninsured can expose them to far greater costs for even routine medical care than those negotiated with insurers. Hattemer is optimistic that most ICT clients, for whom the program provides impartial expert in-person help obtaining insurance, will be back this year.

"We found that a lot of people who come in to get health insurance through us actually didn't come in because of the mandate," she says. "They came in because they needed health insurance for themselves or their families." ICT is aiming for 5,000 sign-ups this year, just below their 5,300 total from last year.

Some consumers may have heard about the repeal and surmised that the ACA itself is dead; it isn't. Nor do insurers seem particularly concerned for now about a "death spiral" of healthy patients leaving the exchanges – hence the falling premiums. But those who opt out this year won't have another chance to sign up until next Novem­ber, unless they have a major life change such as marriage or a new job. Outside the exchanges, it's difficult for many consumers on the individual market to find a high-quality plan at any price.

Under the ACA as written, insurers may issue short-term health plans to help people bridge transitions in their lives for up to three months. These plans did not have to meet the "essential health benefits" criteria of the ACA, such as covering pre-existing conditions, maternity, mental health, surgery, hospitalizations, and prescriptions. Thanks to a Trumpian regulatory change, these bare-bones plans can now last all year, allowing insurers to sell (potentially) useless crap under the aegis of the ACA. There's talk of allowing these plans to be sold on the exchanges as soon as 2020, but for now they're not on Healthcare.gov or eligible for ACA financial assistance.

Nor does ICT recommend these plans. "If people purchase short-term plans thinking that they'll get the same kind of protection and the same kind of coverage they get through marketplace plans, they can end up having a health care need that isn't covered," Hattemer warns. Her team is well-versed in helping people with conditions like cancer, diabetes, and HIV find insurance that is affordable, comprehensive, and the best match for their needs. "Our team is specially trained in knowing what providers are in-network, what medications are in-network for certain plans," she says. "We've done all the research on what each of the plans cover and can help people select the one that's going to provide the coverage that they will need."

If you are new to Healthcare.gov and wary of the cost, make sure you know what financial assistance is available. The exchanges have gotten a bad rap through a near-decade of right-wing disinformation, but many folks like what they see once they get help navigating the market.

"A lot of people go on Healthcare.gov and look at the plan prices and think that it's too expensive, or someone in their family or in their social circle will say that the plans aren't affordable," says Hattemer. "Actually, most people get help paying for their health insurance through the marketplace. We really encourage everyone to come in and meet with us and not just assume that it will be unaffordable."

For free help signing up on www.healthcare.gov, visit or call one of ICT’s drop-in locations:

North: 5900 Airport, 737/717-4001, Mon.-Thu., 9am-7pm; Fri.-Sat., 9am-4pm; Sun., 1-5pm

South: 2600 W. Stassney, 737/717-4000, Mon.-Wed., 10am-7pm; Thu., 10am-4pm; Fri.-Sat., 9am-1pm