What will happen to my Obamacare?

The estimated 14 million people who are expected to buy health insurance coverage through the ACA exchanges this fall are likely wondering: What happens now?

The future of Obamacare has been hotly speculated since last Tuesday, even by the president-elect himself. The most recent evidence comes from Sunday’s CBS 60 Minutes interview, during which Donald Trump left open the possibility of keeping the Affordable Care Act at least partially intact.

All in all, it seems the short-term future of the exchanges will remain stable through the current open-enrollment period. Exchange participants who sign up now on Healthcare.gov will remain covered by the insurer they choose at least until January of 2018, says Joel Ario, formerly at the Department of Health and Human Services and now managing director of Manatt Health. Perhaps because of that, the day after the election saw record signups for the exchanges.

For those of you in the midst of open enrollment -- which can be cumbersome -- don’t give up. Go through the hoops and get your exchange coverage for the coming year. Yes, premiums may be higher, and yes, you may have to change your provider network of doctors and other health care professionals. But by all means stay covered.


President-elect Trump has said he’s willing to support a major tenet of the ACA -- that insurers may not reject participants because of a preexisting condition. That’s great news. But here’s a caveat. Trump has implied on his website and elsewhere that people with a preexisting condition can’t be rejected only if they have continuing coverage, explained Ario.

What does that mean? As far as experts can tell, if you have any gaps in your health insurance coverage -- say you were temporarily unemployed or took time off to care for children or elderly parents and decided not to buy coverage -- when you go back to buy coverage and you have a preexisting condition you may be rejected.

Trump and others have proposed reinstating “risk pools” to take care of sick people without coverage who decide to get insurance, arguing this is a tried-and-true solution. But in the past, risk pools have been problematic. Coverage for people with preexisting conditions is often prohibitively expensive partly because the pool lacks healthy, infrequent health care users to help subsidize the more needy patients.

For anyone -- healthy or with a preexisting condition -- who wants to avoid this quagmire, Ario recommends signing up for Obamacare now. Yes, premiums have jumped in many locations, but for now, expensive coverage may be better than no coverage. And for the next year at least, government subsidies for qualified exchange patients can help ease the burden of those high premiums.

ACA open enrollment for coverage starting Jan. 1, 2017, ends on Dec. 15, 2016.