The fate of the Affordable Care Act has been an open question as the GOP works on an alternative. But what that might look like is becoming a little more clear.

Ahead of next week’s Congressional recess, House Republican leaders gave members a 19-page paper that provides the most detailed look yet at plans to repeal and replace the ACA, also known as Obamacare.  

House Speaker Paul Ryan said that legislation to repeal and replace Obamacare will be introduced in the House when Congress comes back from its break on February 27th.

The House road map lays out many of the same elements previously put forward by GOP senators and Tom Price, the new Secretary of Health and Human Services. Those include resurrecting high-risk insurance pools, expanding health savings accounts, and giving people tax credits based on age (not income as the ACA does) to help pay insurance premiums. It would also sharply reduce federal funding for state Medicaid programs, which provides healthcare for millions of low-income Americans.

But beyond those broad strokes, there is little consensus on whether the new plan would replace the existing law at the same time as it is repealed, or whether there will be interim “repairs” to it.

That uncertainty has consumer advocates worried.

“Repealing the Affordable Care Act without a comprehensive replacement plan would mean real, serious consequences for American families,” says Laura MacCleery, vice president of policy and mobilization for Consumer Reports. “Congress should focus on what’s needed most to help consumers: measures that lower healthcare prices, improve quality, and make it easier for consumers to navigate and understand coverage choices.”

CR on Thursday laid out the standards it says any replacement plan must have.

“This is the high bar we will hold any alternative to and we’ve yet to see a plan that comes close to meeting these requirements,” MacCleery says.  

Consumers are worried too. In our recent nationally representative Consumer Voices survey, 55 percent of respondents expressed concern that they or their loved ones may not be able to afford insurance.


Join Consumer Reports' efforts to preserve access to affordable health insurance.
 

What Could Change Soon

Other changes to the Affordable Care Act are expected to come more swiftly, through regulatory actions taken by government agencies such as the Centers for Medicare and Medicaid Services (CMS) or executive actions taken by President Trump.

Some of these are aimed at stabilizing the marketplace for insurers, who complain that their ACA plans have been losing money. Humana, for example, recently said it would drop out of the ACA for 2018, and Aetna and Molina threatened to do the same.

Given the uncertainty about the ACA's overall future, it's unclear whether those new regulatory actions, which are expected to take effect in mid-June, will be enough to convince insurers to remain in the ACA, says Karen Pollitz, senior fellow at the Kaiser Family Foundation.

But those regulatory actions could have a more serious impact on people trying to sign up for an ACA plan, by limiting enrollment periods and driving up costs.

Here are answers to how these proposed changes might affect you:

Q: Will anything change if I'm already enrolled in an ACA plan for 2017?
A: No. But if you're not yet insured and wanted to sign up later in the year, that might be harder to do.

While open enrollment in the ACA officially ended at the end of January, there are exceptions for people who, for example, have a baby or lose a job.

Insurers don't like those special enrollment periods, which they say discourage people from signing up until they become sick.

If the proposed CMS rules are approved in June as expected, there will be more rigorous pre-enrollment verification of changes in circumstance and some limits affecting people who get married and want enroll their spouse.

Q: Is it going to be harder to enroll for insurance for 2018?
A: You might have less time to sign up.

CMS proposed shortening the open enrollment period to 45 days from the current 90 days. For 2018, that means sign-up would run from November 1st through December 15th. Last year, the enrollment period ran from November 1st through January 31st.

Also, if you are enrolled but fall behind in payments, you could lose your insurance more quickly. Currently, if you fall behind on your premiums, you have a three-month grace period before your coverage can be terminated. Under the CMS rule, insurers could terminate your coverage after one month of nonpayment.

Q: Will my insurance cost more more?
A: Probably. 

Under current rules, insurance must cover a set minimum percentage of a consumer’s medical costs. The most popular ACA plan is the Silver tier—about two-thirds of people on the exchanges elect that option. While it's unclear what the insurance marketplaces will look like next year, under the proposed CMS rule, the amount of guaranteed coverage in a Silver plan would drop from about 70 percent to as little as 66 percent.

That means patients would pay a bigger share of their medical bills or may have higher deductibles, Pollitz says.

Q: When will I know if my current insurer is going to stay in my market?
A: The companies must say in the spring what they will offer, how much they will charge, and in which states they will operate. Though exact deadlines vary, most states have an early May deadline.

Q: What will happen if my insurer decides it doesn’t want to offer a plan in my state anymore?
A: That depends on what a replacement plan for Obamacare looks like. Republicans say any plan they pass will include a transition period.

Q: If I didn't sign up for health insurance last year, will I still have to pay a penalty?
A: Yes, but maybe not right away.

The government uses your tax return to see whether you have health insurance, by asking you to check a box verifying coverage. In the past, the IRS said it would reject all 2016 tax returns if that section was left blank. 

But the Trump administration recently issued an Executive Order that allows government agencies to relax rules around the healthcare law. So while you are still required to pay the penalty if you don’t have insurance, your return will be processed without it, and it's up to the IRS to follow up with the penalty.

Q: If I get health insurance through my employer or Medicare, will I be affected?
A: The CMS changes only apply to individual health insurance plans on the ACA. But the Affordable Care Act mandated many changes to employer health insurance and Medicare.

For example, it required that a set of services, like preventive screenings and vaccinations, be covered at no cost to the consumer. Whether those requirements will continue will depend on what the Republicans settle on for an Obamacare replacement.

“It’s not clear where we will end up. Nobody knows and the Republicans don’t know yet,” says Ron Pollack, founding executive director of Families USA, a nonprofit focused on consumer healthcare issues.

“But based on what we know now, it means that people are going to be paying a whole lot more for their insurance and it’s going to be harder for some people to get insurance at all.”