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What Obamacare may look like in 2018

Health care bill
Health care bill 05:45

The Senate health care bill is on life support, and proposed alternatives from U.S. Sen. Ted Cruz, R-Texas, and Sen. Lindsey Graham, R-South Carolina, are also under fire. So the fate of the GOP's plans to repeal and replace Obamacare is hardly clear, even at this late date. But what does that mean for consumers wondering about their insurance plans right now?

No matter what happens in Congress this year, health care exchanges will stay in place in 2018. The deadline for insurers to file with state regulators on what plans they'll offer and for what price hit last month. While regulators and other researchers are still combing through the data, glimpses so far show that 2018 may well be tough for many Obamacare consumers. 

It's important to remember the vast majority of Americans get insurance from their employers. But more than 12 million buy insurance through the Affordable Care Act's exchanges. And most of those consumers receive a federal tax credit to help pay premium costs.

GOP health care bill struggles 03:48

If you're one of those people, you're likely worried about what the future will look like when open enrollment begins this Nov. 1. Here's a first look at the road map.

Choices continue to be limited. At last count, 44 out of 3,143 U.S. counties were at risk of having no insurer in their marketplace, according to a late June analysis from the Kaiser Family Foundation. That would leave a little more than 31,000 enrollees without an exchange option. Perhaps more dramatic, an estimated 1,200 counties are expected to have just one insurer available on the exchange.

The exodus has been public at times. Last month, Anthem (ANTM) announced it was exiting Ohio, leaving about 20 counties in that state without an exchange insurer. Many other major insurers, such as United Health (UNH), have made other big exit announcements in the past year.

Kaiser noted that the numbers in its recent study are likely to change. Data for 2018 participation won't be finalized until the fall, and other insurers may move into those abandoned counties before open enrollment begins.

At the same time, another recent analysis from the Johnson Woods foundation shows that the number of insurers offering exchange coverage or individual market policies outside the exchanges hasn't really changed much since the exchanges began in 2014, negating the idea that the ACA is responsible for the decline in coverage. 

Of course if you're someone facing just one or no choice on your exchange, that's little comfort. But it does help put the shortage of health resources in rural areas in high relief.

Premiums are rising. Although not yet as dramatic as increases last year, exchange consumers can expect to pay more in premiums in 2018. A study by health care consultants Avalere conducted early in June found that premiums would be on average 18 percent higher for the most popular silver exchange plans. 

In some states, that average can be much higher, depending on how many ill people participate in the exchanges, low overall enrollment, the uncertainty about the future of the ACA and whether the federal government will continue to pay cost-sharing reductions.

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States are stepping in. On Tuesday, Alaska announced it received approval from the federal government for its plan to help stabilize its exchange by creating a program to cover claims for people with high-cost conditions. Maine and Minnesota are also making moves to shore up their exchange insurers. In New York, the governor recently announced that any insurer leaving the exchanges would be banned from the state's list of Medicaid providers. 

Keep an eye on your state's efforts to boost exchanges going forward. With Alaska's recent success, experts expect other states to follow suit.

What you can do. Consumers have a lot of waiting and watching until open enrollment starts in earnest. For now, it's best to keep tabs on what's happening in your area. Are insurers leaving? Might your plan be in jeopardy? 

If you live in a county with little choice, you may want to start checking for insurers that offer individual policies outside of the exchanges. You won't qualify for subsidies, but in most cases you'll continue to get the coverage you're accustomed to. That's because in 2018 most insurers must still offer plans that meet current federal standards.   

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