Friday, December 15 is the final day of Obamacare open enrollment. This has been a tumultuous year for Obamacare (aka the Affordable Care Act), to put it lightly, with multiple efforts by the GOP-led Congress to repeal or otherwise gut the seven-year-old health law. But Obamacare is still the law of the land, Americans are still required to carry health insurance in 2018, and Friday is the last chance to sign up for health coverage through Healthcare.gov.
Here’s what you need to know about the final day of Obamacare open enrollment—and about where the law may stand next year.
The vast majority of Americans can find affordable plans
The political hurricane surrounding Obamacare since the 2016 election has led to plenty of confusion among consumers. For one, there’s been a flurry of headlines about Congress’ efforts to gut the Affordable Care Act, and all the uncertainty (and the Trump administration’s open antipathy toward the law) has also caused major Obamacare insurance plan providers to pull out of certain markets and raise premiums.
But the Obamacare exchanges are heavily subsidized, and for the vast majority of Obamacare plan holders, premium spikes are made up for by corresponding increases in federal tax credits to help pay those premiums. The lower your household income, the more subsidy credits you get. (Those earning more than 400% of the Federal Poverty Level, or about $48,000 for an individual and $98,000 for a family of four, don’t qualify for the tax credits and would have to either bear the brunt of premium increases or pay the Obamacare tax penalty for not having health insurance, which is still in effect for 2018.)
In a strange twist, many consumers shopping for health insurance during the current Obamacare enrollment period can actually get even cheaper coverage thanks to President Trump’s decision to cut off certain subsidies paid to insurance companies. (For an explanation of why, read this open enrollment guide.) Experts urge consumers to shop around and select the plan that’s best for them. For instance, mid-level “Silver” plans come with extra subsidies that reduce poorer consumers’ out-of-pocket medical costs,—so that may ultimately be a better option for a low-income family that knows it has more medical needs than buying a “Bronze” plan with cheaper premiums but higher deductibles (and no extra out-of-pocket cost-reducing subsidies). But healthier Americans with few medical needs could get a lower-tier plan for free, as the nonpartisan think tank the Kaiser Family Foundation notes.
It’s also important to recognize that there’s no need to buy health insurance if you’re already covered by your employer, Medicare, Medicaid, or some other government program. Plans sold under Obamacare are individual health insurance plans, which is just a tiny slice of the overall insurance market. For those who do need an individual plan, you can access the federal market as well as the enrollment websites for state-run Obamacare markets through Healthcare.gov.
Click here to subscribe to Brainstorm Health Daily, our brand new newsletter about health innovations.
The Obamacare tax penalty is still in place
You may have (correctly) heard that the GOP tax plan making its way through Congress would repeal the ACA’s individual insurance mandate, which states that nearly all Americans (other than those who qualify for an exemption) must either carry health insurance or pay a tax penalty. But the Obamacare tax penalty is still currently in place—and you could face a financial hit that’s actually more expensive than simply buying a plan if you lack coverage in 2018.
Just how steep is the fine? For tax year 2017, it’s either 2.5% of your total household income, or $695 per uninsured adult and $347.50 per uninsured child (up to a maximum of $2,085)—whichever figure is higher.
The Trump administration hasn’t really advertised Obamacare
President Trump has taken multiple steps to roll back Obamacare, including by issuing executive orders that undermine its regulations and cutting off payments to health insurers. The administration has also taken a very lackadaisical approach to publicly promoting the open enrollment period, even slashing outreach funding by 90%.
Healthcare.gov’s Twitter account, for its part, has been sending out a stream of reminders throughout the open enrollment period.
The same cannot be said for the Trump administration’s top health officials—a substantial departure from the Obama administration’s prominent public information campaigns and unusual considering the federal government is still tasked with enforcing the law. For instance, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma, who oversees Medicare, Medicaid, and Obamacare, has only retweeted signup reminders from the Healthcare.gov social media account in the last several days and hasn’t sent any of her own. Acting Health and Human Services (HHS) Secretary Eric Hargan hasn’t said anything about open enrollment at all on his Twitter account during the signup period, which began on November 1.
Obamacare signups are expected to fall
This year’s Obamacare open enrollment push got off to an impressive start, with the pace of signups easily lapping last year’s. The final week is seeing a similar surge—but, unlike previous years, 2017 open enrollment is just six weeks rather than three months. And that means the overall number of enrollees is expected to dip compared with last year.
Another 4 million Americans would have sign up for 2018 health insurance plans in the final days in order to meet last year’s federal marketplace total of 9.2 million.
Millions could lose health insurance under the GOP tax plan
The massive GOP tax plan being discussed in Congress would repeal Obamacare’s insurance mandate. That would lead to 13 million fewer Americans with health insurance in 2027 compared to current law, according to the nonpartisan Congressional Budget Office (CBO). The mandate repeal, if passed, could also cause already-jittery insurance companies to either exit more Obamacare markets or defensively raise premiums as healthier people who feel like they don’t need coverage fall out of the risk pool. Still, it wouldn’t exactly kill the Affordable Care Act altogether.
The most important piece of advice health experts have for consumers shopping during this open enrollment period: Shop around and choose a plan that best meets your needs.