1. The ACA, with all its benefits and requirements, is still the law of the land. That includes the health insurance marketplaces in every state, the financial help for low and moderate income enrollees, the essential health benefits (EHBs) – and the tax penalty for not having insurance.
  2. Open enrollment for 2018 starts today. In most states, open enrollment for the ACA’s health insurance marketplaces will run from November 1 through December 15, half as long as last year’s sign-up period. A few states have extended their enrollment periods: Washington, DC’s, for example, will last through January 31, 2018.   
  3. Millions of people could get a better deal this year than they did last year. For people who qualify for subsidies, the president’s decision to stop making cost-sharing reduction payments (CSRs)[1] might be a blessing in disguise. Insurance companies are still legally required to provide CSRs, even if the federal government is no longer reimbursing them for it, so lower-income enrollees will still get plans with reduced deductibles and copayments. And if their premiums increase when insurers increase rates to recoup the lost CSRs, their tax credit subsidies will increase along with them. Many states loaded all the CSR-related premium increases onto silver plans, since silver plans are the only ones that offer CSRs. Because tax credit amounts are based on the premium for a silver plan, tax credit-eligible enrollees (with incomes under 400% FPL) will get bigger subsidies. Those who make too much to get CSRs (and so don’t have to stick with silver plans) could use their enhanced subsidy to buy a more generous gold plan, while others might even be able to get a skinnier bronze plan for $0 a month. (The federal government will probably pay more in increased tax credits than it will save by ending the CSR payments.)   
  4. But others will be hurt by premium increases. People who make too much to qualify for subsidies could be hit with significant CSR-related surcharges on top of existing premium increases, depending on how their state managed the cost sharing issue. You can find out your state’s strategy, and the rate increases attributed to the CSRs ending, from this Kaiser Family Foundation issue brief. In states that loaded the premium increases onto silver plans, middle and upper income enrollees could avoid those increases by enrolling in a bronze or gold plan, if they’re aware of the option.  
  5. It will be harder to find consumer assistance this year. In August the Trump Administration announced that it would be cutting 2018 outreach and enrollment assistance. There will be fewer advertisements promoting open enrollment, and fewer workers giving in-person help than there were in the first four ACA open enrollment periods.    


[1] There are two main affordability assistance mechanisms in the ACA: Tax credits are given to enrollees between 100-400% of the federal poverty level (FPL) to help with premiums, and can be used for any marketplace plan (e.g. gold, silver, bronze, etc.). CSRs are paid to insurers to reimburse them for lowering out-of-pocket costs for people with incomes between 100-250% FPL, and are offered by silver plans only. Both the tax credits and the cost-sharing reductions are still alive.