Health Insurance Exchanges

The heart of Obamacare has been the array of online shopping centers it created, dubbed Health Benefit Exchanges by the 2010 Affordable Care Act, where people who don’t get insurance through their employers or the government can go to buy coverage. The big question about the exchanges used to be whether they could attract enough younger and healthier consumers to offset the cost to insurers of older or sicker enrollees. Now that a Republican Congress and a Republican president-elect, Donald Trump, are setting to work to repeal Obamacare, the big question is what a Republican version of the exchanges might look like — and whether they'd be able to weather a potentially bumpy transition.

As the new Congressional session began, Republicans put in motion pursuing a plan to repeal Obamacare but delay its actual dismantling by up to four years while they worked on a replacement. Democrats warned that such an approach could lead to a collapse of the exchanges if insurers decided they didn't want to invest money in their uncertain future. The Obama administration pointed to the 8.8 million people who signed up for coverage in 2017 through the federal exchange, 200,000 more than last year, as proof that the exchanges were rebounding from earlier troubles. During the campaign, Trump and other Republicans had pointed to news that several big insurers were pulling out of many exchanges and that millions of consumers would face sharp price increases as proof that Obamacare was failing. Aetna, UnitedHealth Group and Humana said they were tired of recording big losses on exchange plans, and didn’t see the market stabilizing soon. The cost of insurance also climbed for people in the individual-policy market: Insurers will be boosting their premium rates by about 22 percent. But roughly three-quarters of current enrollees will still be able to find ACA plans for less than $100 a month, once subsidies are taken into account. The enrollment period runs through Jan. 31.