(Photo by Joe Raedle/Getty Images)

The lobbying organization for the nation's health insurers finally stepped into the debate over the future of American health care on Tuesday, calling for a stable transition as President-elect Trump and Republican policymakers fulfill their promise to repeal and replace the Affordable Care Act.

Details about when and how the healthcare law, commonly known as Obamacare, would be repealed -- or how broad and sweeping a repeal would really be -- have remained largely unanswered. That has created deep uncertainty about the long-term future of health insurance for millions of Americans, right in the midst of the open enrollment period, when people sign up for 2017 health coverage in the exchanges set up by the law.

"Millions of Americans are selecting and purchasing individual health plans now – and will continue to do so through January 2017," America's Health Insurance Plans says in its list of priorities, which was described by a spokeswoman as a framework for the conversations it is having with policymakers. "Millions more have enrolled in Medicaid.  Making sudden, significant changes now or mid-year will jeopardize the coverage they depend on."

If a replacement of the law is not immediate, policymakers will depend on health insurers to continue to participate in the exchanges. The white paper from America's Health Insurance Plans provides, for the first time, a clear bullet-point list of their recommendations and priorities.

To maintain stability after a possible repeal, the insurers recommended preserving two programs that have been blasted by Republicans in the past: cost-sharing reductions and reinsurance. House Republicans have sued the Obama Administration over the legality of the cost-sharing reductions, the payments to insurers that help defray out-of-pocket costs for low-income Americans. Republicans have also lambasted the reinsurance payments, which provide money to insurers who cover the sickest and most expensive patients, calling them a "bail out."

Insurers maintain that those payments will stop some companies from fleeing the exchanges, which currently insure about 11.4 million people, in 2018.

The exchanges have already been challenged by not enough healthy people signing up, the high-profile withdrawal of some large insurers and premium increases. In the name of stability, insurers recommend that Congress fund programs that help the exchanges function and make coverage affordable through at least Jan. 1, 2019.

Among the group's other requests:

  • Sufficient funding for Medicaid to cover people and insulate states from any sudden budget impact
  • Replace Obamacare's fine for not carrying health care insurance, with "strong incentives," such as "late enrollment penalties and waiting periods"
  • Elimination of certain taxes and a reduction of rules and regulations, such as the requirement to cover an adequate network of health care providers
  • Later filing deadlines for insurers to offer insurance in 2018. Currently, they must make filings by May of next year.

"Uncertainty in early 2017 may discourage plans from submitting bids for 2018 – which could mean most people have no pathway to purchase the coverage they need," the white paper says.

But the most prominent theme woven throughout the document is a caution about just how long it can take for health insurers to prepare for whatever comes next. The trade group reminds policymakers that companies require at least 18 months to create and file plans with state regulators -- and they warn that mid-year changes to regulations could be disruptive.

The health insurers' white paper is only one example of the health care industry's efforts to sway future policy in an administration where many specific policy positions remain unclear.

Hospital groups released a report this week detailing the financial harm repealing the law could have on the industry, and they have written letters directly to leaders in Congress and to the president-elect.

"Given that health care represents a significant portion of the economy and essential public services, we urge you not to make any abrupt changes that could lead to significant instability for patients, providers, insurers and others," Richard Pollack, president of the American Hospital Association wrote to Trump.

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