President Trump's plan to eliminate the subsidies that help insurance companies absorb the cost of covering people with lower incomes is now before a federal judge. In the meantime, the clock is ticking down to the next open enrollment period under the existing health law - known as Obamacare.
After several attempts to repeal and replace Obamacare failed in Congress, Trump launched an attack this month against subsidies for insurers, calling the payments "bailouts."
Until the U.S. District Court in San Francisco issues its ruling, it's not clear what will happen to those subsidies. But Trump's administration has already taken steps that could weaken the health insurance marketplaces Obamacare established for each state:
- The Trump administration has drastically shortened the amount of time people will have to sign up for insurance on federally-run health exchanges, from three months to six weeks.
- The administration has also slashed its budget for publicizing the next open enrollment period, which starts Nov. 1.
- Funding for navigators — real people who can help consumers sort through insurance options — took a 41 percent cut this year, according to the New York Times.
All these policy shifts have created some confusion as to exactly what kind of coverage is still available. With less than a week to go before the next open enrollment period under Obamacare, here's what you need to know.
For now, the insurance marketplace in New York State is pretty healthy.
More than a dozen companies will be selling private insurance plans on New York's exchange, called the New York State of Health. This is the marketplace for people who don't have insurance through their jobs and need to buy their own coverage. (Think people who run their own business.)
Steve Wood is an insurance expert with ACR Health — one of many agencies that can help sign people up for coverage in New York State. For now, Wood says competition on New York's insurance marketplace is keeping costs low. Premiums are expected to be slightly cheaper than last year, by about 5 percent.
"So that's the first time in I don’t remember when, that insurance premiums actually go down!" Wood said. "Generally, insurance has historically always gone up [by] 5 to 20 percent every year."
If you can't afford insurance, you still have options.
Coverage can be really expensive if your job doesn't pay much — or if you're out of work. That's where Medicaid and something called the New York Essential Plan come in. Between these two programs, a single adult living in New York and earning up to $23,000 a year can get free or very cheap insurance. We're talking $20 per month, at most.
More people qualify for this program than they might realize, says Emily Williams, another insurance expert with ACR Health. New York accepted federal funding as part of the "Medicaid expansion," which allowed the state to relax its income cutoffs. Medicaid now covers a huge range of people in the North Country, from recovering addicts seeking inpatient treatment to elderly people in nursing homes.
The program accepts new members year-round, Williams said. ACR Health has reached out to people who lost their jobs in big manufacturing layoffs to let them know Medicaid might be an option.
"I’ll say there is still a stigma against Medicaid in certain circumstances. But that’s what we’re here for, to educate people that it has expanded," Williams said. "Working people have Medicaid! I wish I could get Medicaid because it’s wonderful, essential, comprehensive health coverage."
Obamacare doesn't look the same in every state.
For now, New York's insurance marketplace is stable. But you don't see that in every state.
It all goes back to the way Obamacare was enacted. Governors had some flexibility to decide which reforms they wanted to adopt — whether they wanted to operate their own state insurance exchange or leave that work to the federal government, for instance, or whether they wanted to expand Medicaid eligibility. (Every state had to abide by the "individual mandate," which requires people carry insurance or face a financial penalty.)
Gov. Andrew Cuomo went all in with Obamacare reforms. But he's acknowledged in recent months that if the law and its associated funding goes away, New York will be facing a $3.7 billion budget gap.
No matter what, Obamacare (or parts of it) may stick around.
Since the repeal fight picked up this year, Cuomo and other governors have started looking for ways to preserve parts of Obamacare. Studies from Gallup and other polling groups show that the healthcare law — which wasn't always popular — is starting to gain traction with Americans.
Here in northern New York, ACR Health's Emily Williams said many of her clients are coming around to the Affordable Care Act — a full seven years after it was signed into law. "We have noticed now, that more people now in 2017 are more in favor of the ACA than four years ago, "Williams said. "They realize that they need it and they benefited from it."