During the campaign, Donald Trump and Republicans in Congress vowed to immediately “repeal and replace” the Affordable Care Act, yet now that dismantlement is possible, people across the U.S. are rushing to lock in coverage. More than 300,000 chose plans from Nov. 9-11.
For years the backers of the Affordable Care Act have fretted over how best to stimulate insurance enrollment on the exchanges so the law could work as designed. They might have finally found a way from the unlikeliest of sources: the election of Donald Trump as president.
During the campaign, Trump and Republicans in Congress vowed to immediately “repeal and replace” the health-care law known as Obamacare, calling it a failure. Yet now that dismantlement is possible and maybe even likely, people across the nation are rushing to lock in coverage for next year.
A record 100,000 Americans signed up the day after the election.
Washington state has not seen a major surge, largely because so many people already had been insured here through the ACA, state officials say.
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“We’re running a little above forecast, but we haven’t seen a huge spike like in other areas,” said Michael Marchand, spokesman for the Washington Health Benefits Exchange.
More than 750,000 people have gained health coverage in Washington since the ACA took effect, said Marchand. The bulk of those — about 600,000 — were covered through the law’s expansion of Medicaid, which serves low-income people. The other 150,000 enrolled in individual health plans.
Enrollment for 2017 began Nov. 1, a week before the election. It will end Jan. 31, 11 days after Trump is inaugurated. At times he has promised to completely repeal the ACA on his first day in office, although most experts say that is unlikely and probably not even possible.
Advocates and even some critics of the Affordable Care Act are urging people to go ahead and sign up for a plan for next year despite the fiery campaign rhetoric.
“It is virtually certain that people who sign up now will remain insured through the end of 2017,” said Dr. J. Mario Molina, president and CEO of California-based Molina Healthcare, a Fortune 500 company that has had a strong presence on the exchanges. His is one of three insurance carriers offering plans on the exchange in Houston and said sign-ups have been “brisk” since Wednesday.
On Monday he said he was sympathetic to the nervousness among those wanting policies. About 11 million people currently get their coverage through the exchange.
“They have good reason to be worried,” Molina said, noting the irony that it took the election of someone who wants to kill the law to get people to sign up for it.
After reporting that 100,000 people signed up for a plan under the ACA the day after the election, U.S. Health and Human Services Secretary Sylvia Burwell tweeted, “Best day yet.”
The system, which relies on insurance marketplaces and expanded access to Medicaid, has recorded historic gains over the last three years, as some 20 million previously uninsured Americans have gained health insurance since 2013.
In the same period, the nation’s uninsured rate dropped to the lowest level ever recorded.
The flood of people signing up since enrollment began Nov. 1 surpassed 1 million on Saturday, outpacing enrollment from last year, new data show.
More than 300,000 people selected plans Nov. 9-11, the health agency reported. That postelection period also coincided with stepped-up outreach efforts.
“The American people are demonstrating how much they continue to want and need the coverage the marketplace offers,” Burwell said in a statement Wednesday.
There were 53,000 more sign-ups during the first 12 days of open enrollment this year than last, according to the health agency.
Trump and congressional Republicans have said they will replace the system in a way that ensures people don’t lose coverage.
But the GOP has not advanced any alternatives that would protect the millions of people who now depend on the law.
Many of these Americans have low incomes and rely on Medicaid, which has been expanded in 31 states through the health law.
But about 11 million get commercial health plans through HealthCare.gov and similar state-based insurance marketplaces that were created through the law.
And more than 80 percent of these consumers receive government subsidies to offset the cost of their premiums.
The current enrollment period, the fourth through the health law, runs through January for 2017 coverage.
Part of the anxiety is being fueled by the fact no one knows what the replacement piece of repeal and replace will look like, with some wanting a quick and complete gutting and others preferring a slower, piecemeal approach.
“I’m not sure they know,” Molina said about Trump and Congress.
In recent days Trump has softened his stance on the ACA and said he favors keeping certain parts, such as allowing young adults to remain on their parents’ policies until age 26 and prohibiting insurers from denying anyone for a pre-existing condition.
The latter could prove the thorniest since he and others have also vowed to discard the individual mandate, which forces nearly all to buy health coverage. The requirement for universal coverage was baked into the law to expand the risk pool and make it possible to cover people no matter their health. It may be difficult to achieve one without the other.
Adding another layer of confusion was a reference on Trump’s presidential transition website late last week to a return of high-risk pools, a solution that U.S. House Speaker Paul Ryan has favored.
High-risk pools, once in place in various states with varying success, were a way to offer coverage typically at a much higher price to people who otherwise could not get insurance. Talk of their return set off concerns over the protection for people with pre-existing conditions.
“That’s not going away without a fight,” said Mimi Garcia, Texas state director for Enroll America.
Molina cautioned against reading too much into any one piece of the puzzle too soon. He speculated that any wholesale changes, even if the law is repealed, would probably not be abrupt and any Republican replacement law could take a year, maybe two, to take effect. He said he believes changes will come from Congress rather than the White House.
“The biggest problem is that Trump has said so little about health care. We have to be confident that he will work with smart people to come up with a plan,” Molina said. “I don’t think they want 25 million people to go back on the rolls of the uninsured. It wouldn’t be in the Republicans’ best interest to pull the rug out for all of those people.”