Obamacare enrollment deadline looms amid questions about replacement

Signups for Affordable Care Act plans gained steam earlier this month with more than 4 million people choosing 2017 plans on the federal exchange through Dec. 10, according to data out Wednesday.

The pace continued this week despite vows by Republican officials that the law will be repealed soon after Congress returns in January and in time for the Trump administration. Health and Human Services Secretary Sylvia Burwell tweeted that more than 325,000 people signed up on the federal exchange HealthCare.gov on Monday and about that many chose plans on Tuesday.

HHS has been promoting the law aggressively ahead of the first deadline Thursday for the last open enrollment for Obamacare as we now know it.

“Momentum is building,” Burwell said Wednesday. “As we approach the December 15th deadline for consumers to get coverage that begins January 1st, we’re seeing hundreds of thousands of consumers each day signing up for coverage they want and need."

Reports of the law's demise may not be all that premature, but that still doesn't affect the requirement that everyone have insurance for 2017 — or what's known as a hardship exemption. The plans sold on the federal and state exchanges were already priced and posted at the time of the presidential election.

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Despite the penalties for not having coverage, some people are willing to take a chance and pay the penalty because they can't afford the high premiums and deductibles.

A higher penalty might have led more people to sign up, but "given the price of the coverage, a bigger penalty would have seen a bigger backlash," says Paul Howard, director of health policy at the free market Manhattan Institute.

"If you’re a younger and/or healthier person looking at what happening in Washington, you may wonder whether it will be more affordable in 2018," says Howard. "Do you sit it out?"

That would be a big mistake, says Larry Kocot, a former Centers for Medicare and Medicaid Services official, now with consulting firm KPMG.

"To anyone considering whether they need to have insurance — absolutely, you should have insurance," says Kocot.

Only about a quarter of those who signed up through Dec. 10 — 1.1 million people — were previously uninsured.

The new numbers don't represent actual enrollments as no one has paid a premium yet. Kocot says many of those who quickly signed up against for insurance for 2017 may be those who wisely shopped around after being notified by their insurers about rate increases.

Rates in some states increased by as much as 50%-75% for 2017, in part due to departure of some large insurers from the exchanges.

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Some of insurance broker Trish Freeman's clients are seriously considering dropping their coverage "and taking the chance of going uninsured," she says.

"If they are lucky, no one in their family will need to spend over $5,000 to $6,000 in health care between January and December of 2017," says Freeman, who is based in Gonzales, La. "But what happens if someone tears an ACL? Has a hernia? These surgeries can be upwards of $12,000-$15,000."

Valerie Balcombe of Indio, Calif., bought insurance on the Covered California exchange and gets a tax credit, so is "grateful for the assistance."  Still, she tore her meniscus last month and has to stay on crutches or a cane because she's paid so little toward her $6,250 deductible this year.

"Basically we have insurance we can afford, but we can't afford to use it when we need it," says Balcombe.

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Lisa Day is sticking with her existing insurance plan, which was grandfathered in and doesn't meet the ACA requirements. But while it is just catastrophic coverage with no preventive care, the Seattle-area real estate agent says, "I consider myself lucky."

She's saving about $300 a month, but laughs that she doesn't have maternity coverage: "Note, I am 60 years old."

Most people can find plans for less than $75 per month in premiums thanks to the tax credits that about 85% of consumers are eligible for, HHS emphasizes. But those eligible for little or no financial help find it can be painful.

"My clients who do not get a tax credit seem to be dropping like flies — especially the healthy ones," says Freeman. "These families just can’t afford the super-high premiums."

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