So now what? Options for consumers as health law drama fades

The Republican health plan designed to replace the Obama-era health law known as the Affordable Care Act would not have taken full effect for a few years — and now it’s dead. But many people still face questions about getting insurance for next year, including on the government run exchanges.

WILL I HAVE PLANS TO CHOOSE FROM?

It depends on where you live. Choices are dwindling, but chances are at least one insurer will sell in your market. That company may offer several plans.

Generally, big cities will have more choices than rural areas where there may not be enough customers to attract insurers.

As of now, there are 16 counties in a region of Tennessee around Knoxville that have no insurers committed to sell coverage on the exchange next year. About a third of the nation’s 3,100 counties are down to just one insurer.

Insurers have been pulling back, and more are expected to leave, but health care researchers are not predicting mass defections.

“For most consumers, (2018) will look a lot like ‘17,” said Dan Mendelson, president of the consulting firm Avalere.

Customers can try to find coverage outside their exchange, but then they won’t be able to use tax credits to help pay the bills, which may be particularly painful since many markets have seen prices soar.

ARE THERE FIXES IN STORE?

Last month, the Health and Human Services Department, which runs exchanges in many states, proposed some adjustments to try to stabilize these marketplaces.

For example, insurers want greater scrutiny of people who sign up for coverage outside of the open enrollment period. Customers are supposed to be allowed to do so only if they have a life-changing event like the birth of a child, a marriage, or the loss of a job that provided coverage, but insurers have found that people are just waiting to sign up when they need care.

Another proposed adjustment would let insurers design cheaper plans tailored to younger people who may not need lots of health care but want to be protected in the event of a big injury or sickness. That could be very helpful, because insurers say they have struggled to attract younger and healthier customers to the marketplaces to balance out the claims they pay from those who use their coverage.

Those changes are expected to be finalized in the next month or so.

WHEN WILL INSURERS MAKE THEIR DECISIONS ON 2018?

Some have said they want to see the final version of the proposed federal adjustments before deciding where and what kinds of coverage they will offer.

But insurers generally have to decide by this spring whether they will participate in order to leave enough time for regulatory approvals and marketing before enrollment starts next fall.

Aetna, the nation’s third largest insurer, has set an April 1 deadline for deciding on 2018. The company has already pared its marketplace participation down to 4 states this year from 15 because of heavy financial losses.

Customers won’t know for certain who is selling on their exchanges until early next fall. While insurers have to apply to sell coverage on their exchanges generally by late spring or early summer, they can drop out later.

IS THE AFFORDABLE CARE ACT ‘IMPLODING’ AS PRESIDENT TRUMP HAS SAID ON TWITTER?

No. The marketplaces are not expected to dissolve next year, even though choices have dwindled.

While there’s debate over the law’s tax burdens and its impact on government budgets, the federal plan has covered more than 20 million people.

About 11 million are covered through an expansion of Medicaid, the health program designed to help poor Americans. Another 12 million buy private insurance through the law’s marketplaces, most with help from subsidies based on income.