What’s next for Obamacare?

April 2, 2014

The open enrollment period for 2014 is mostly done. The Obama administration is trumping its 7.1 million sign-ups, and the Republicans are still grumbly. But soon, people are going to start talking about what's next for the law, policy and politics-wise. Here's a roundup of things to keep in mind.


A boy waits in line at a health insurance enrollment event in Cudahy, Calif., on March 27. More than 1 million people have signed up for Obamacare in California, according to the Los Angeles Times. (REUTERS/Lucy Nicholson)

2014

Even though open enrollment for private insurance plans in the exchange is over, there's no deadline for signing up for Medicaid. States that expanded Medicaid will likely continue pushing the uninsured to sign up. States still waffling about Medicaid expansion have until Nov. 14 to apply for federal funding. States that could expand Medicare between now and then include Pennsylvania, Virginia, Utah and Missouri.

Michigan, which passed a bill to expand Medicaid last December, is accepting new applicants as of yesterday.

On April 15, the high-risk insurance plans first created in 2010 are set to expire after being extended three times. The people on these plans were supposed to sign up in the exchanges before yesterday.

Come May and June, the insurance companies taking part in the exchange will set their rates for the upcoming year. According to MIT economist Jonathan Gruber, “If insurers come and say, 'We’re going to raise rates 5, 7, 8 percent,' then that’s a huge victory. That’s … a typical annual growth in insurance premiums; it says it’s basically a stable market.” If rates increase by more than 10 percent, government regulators may review them.

On July 1, a 10-state pilot program is scheduled to begin involving wellness programs that offer insurance discounts -- up to 30 percent -- for participation.

After that, it's mostly silence until Election Day, at least on the policy front. On the political end of things, expect to hear about Obamacare every day until Nov. 4, especially if you live in a state with a close Senate race. Republican candidates and the outside spenders who support them have made Obamacare opposition the crux of their campaign. Even while the law is in stasis, Americans are going to be hearing about health care constantly.

Prepare yourself now for the endless stories that will be written about how the midterms were a referendum on the Affordable Care Act, because that's the next thing up for the law after the polls close. And, if Republicans win the Senate (which could definitely happen), be ready for the new majority to discuss how to dismantle the law before the rest of the program rolls out. They already have some ideas.

Eleven days later, open enrollment for 2015 starts. At that point, we'll have lots of data about the previous year's rollout -- how many uninsured people signed up and paid for their plans in each state, how many people signed up for Medicaid, how many people signed up in person versus on HealthCare.gov, how many people switched from employer plans to the exchange, etc. That will help improve on the 2014 open enrollment. (There are considerably fewer ways it could go worse than ways it could get better). Some of the nonprofits that helped conduct sign-ups have already published pointers for next year.

2015

Tax time! If you were uninsured in 2014 and didn't buy a plan in the exchanges or sign up for Medicaid, you'll have to pay the penalty when filing your taxes.

Many of the delays forced by Obamacare's rocky rollout are also scheduled to kick in by Jan. 1, 2015. The Basic Health Plan, which is supposed to offer low-cost health insurance to the people who make too much for Medicaid but can't afford the insurance offered on the exchange, is supposed to be available next year. Employees at small businesses should also be able to choose between multiple insurance options, something that couldn't be implemented for 2014 because of "operational challenges."

The employer mandate will begin on Jan. 1, 2015 for businesses with over 100 employees, which must provide insurance for 70 percent of their full-time employees or face a fine of up to $2,000 per worker. Open enrollment for 2015 will end on Feb. 15, 2015. Expect many stories about the first year of the Obamacare individual mandate to be written. Democrats will say it performed well. Republicans will say it didn't. There will be charts.

On Oct. 1, 2015, federal matching funds for the Children's Health Insurance Program will go up by 23 percent. This will help states pay for insuring children without coverage.

2016

We're likely to hear a lot about the Affordable Care Act during the presidential election, whether it's successful or not. If it's successful, the Democratic presidential primary will be full of promises to not mess with Obamacare -- and even improve it! -- and if it fails to meet expectations, or even if it does meet expectations, Republican primary candidates will likely discuss alternatives to the two-year old system.

On Jan. 1, 2016, the employer mandate kicks in for businesses with 50 to 99 employees. People who decided they liked their old plan and wanted to keep it will have to buy insurance in the marketplace in 2016, at least in the states that decided to allow that in the first place. Many states that were worried about premium prices made people sign up for new insurance plans this year.

States that want to form "health-care choice compacts," which allow insurance providers to sell plans in any states that choose to participate in the compact, will be able to do so in 2016.

2018

One of the more controversial aspects of the Affordable Care Act has been saved for last. A 40 percent excise tax will apply to "Cadillac" health-insurance plans -- i.e. the ones that provide the most extensive benefits -- in 2018. Many insurance providers have already started upping co-pays or decreasing benefits to stave off the tax. Supporters of the tax contend that it will help prevent unnecessary doctor visits, help keep health-care costs under control and rectify any unequal tax benefit offered by very generous employer insurance plans. Detractors say that the plans are likely more expensive because they service an older population, or people with dangerous, medical condition-prone occupations — like miners, and that so many employers are going to change plans that no one is going to end up paying the tax. We're going to hear a lot of debate about this in the upcoming years.

2020

The "doughnut hole" in Medicare Part D prescription drug coverage will close in 2020. Before the Affordable Care Act kicked in, Medicare enrollees needed to pay 100 percent of prescription drug costs after they reached a threshold of $2,850. After reaching $4,550 -- the yearly out-of-pocket spending limit, catastrophic coverage would kick in. In 2020, enrollees will only pay 25 percent of prescription drug costs while in the coverage gap. Between now and then, however, more seniors may fall into the doughnut hole than had before -- since the Affordable Care Act passed, prices have dropped for people on Medicare, but total spending on the prescriptions has remained the same. People will hit the threshold, and have to pay more money for their drugs (although less and less every year) until 2020.

Must-reads:

"Bobby Jindal, with an eye on 2016, to unveil plan to replace Obama health-care law" — Robert Costa and Amy Goldstein, The Washington Post
"Newly Enrolled, but Not Counted by Insurance Exchanges" — Katie Thomas, The New York Times

Jaime Fuller reports on national politics for "The Fix" and Post Politics. She worked previously as an associate editor at the American Prospect, a political magazine based in Washington, D.C.
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