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Is it still worth signing up for Obamacare?

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With all the uncertainty swirling around the Affordable Care Act, consumers can still be certain about a few things.

Chief among them is that the last day to enroll for health care insurance in 2017 is Tuesday, Jan. 31. Second, despite the confusion about Obamacare’s future, people who sign up before the deadline will lock in coverage for the year, as well their tax subsidies. What happens to the law into 2018 remains unclear, however. 

Even with all the “repeal and replace” talk, ACA signups for 2017 coverage have been running at a faster pace than last year. Consumers tend to hold off on buying new plans through the health insurance exchanges because of two issues that aren’t related to the lack of clarity about Obamacare’s future, according to Noah Lang, chief executive of Stride Health, an online health insurance broker. 

“The No. 1 reason why people wait is affordability,” Lang said. “This is more nuanced than people might realize. Affordability sometimes just means, “Do I have enough money in my bank account today?” So we see a lot of that expense-management behavior.”

“The second reason we see is the complexity,” said. “You have to figure out your entire income stream, your deductions and how you pay your taxes to figure out how to pay for coverage,” as well as how much treatment or risk they expect within the coming year. 

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Procrastinators shouldn’t downplay risk when considering whether it’s worth signing up for coverage through the ACA’s marketplaces, said Steven Ullmann, director of the Center for Health Sector Management and Policy at the University of Miami School of Business Administration. 

“The main reason why people want to think about having insurance is for catastrophic situations that occur,” he said. “Insurance companies negotiate with providers for way-below list prices. If one doesn’t have health insurance but uses health coverage, being charged at full list prices can be devastating.” 

As for what will happen to the insurance markets after 2017, the diagnosis for the 20 million Americans who rely on the law for coverage is far from clear. President Donald Trump has pledged to repeal former President Obama’s signature health care law while also promising “insurance for everybody.” But Mr. Trump failed to reveal details, and the Republican-led Congress has yet to formulate a replacement plan. 

An immediate repeal without a replacement plan will “destabilize the individual market,” according to a January study from the Urban Institute and the Robert Wood Johnson Foundation. Insurers interviewed for the report said they would consider leaving the marketplaces in 2018 if the individual mandate -- the part of the law that requires all Americans to have health insurance -- is repealed without a replacement. 

ACA fight 01:45

However, signs indicate that Mr. Trump is ready to roll back the mandate, which has been largely unpopular with the public. According to a survey from the Henry J. Kaiser Family Foundation, only 35 percent of Americans say they support the measure, which levies a fine on people who lack health insurance. Obamacare’s most popular provision, which allows young adults to stay on parents’ insurance plans until age 26, has 85 percent of support, by comparison. 

One of the new president’s first executive actions was to order federal agencies to ease the “regulatory burdens” of Obamacare, which some interpreted as providing the leeway to eliminate the mandate. Yet scrapping the mandate could throw the insurance marketplace into turmoil because it would encourage younger, healthier Americans to snub health insurance, leaving older, sicker residents on the rolls. 

“That’s a situation where the insurance companies will be filled with people who are high-cost users,” Ullmann said. “That’s one of the concerns.”

Consumers who have been on the fence about signing up should consider enrolling before the deadline expires, experts said. Prepare ahead of time by estimating your health care expenses, income, taxes and projected health care needs for 2017, which will make the enrollment process easier, Lang added. 

“I’m sure questions are arising in people’s minds about what all of this means, and part of it is, “If I don’t buy it, will I be subject to the penalty?’” Ullmann said. “But the realization is that the risk of not signing up at this point in time is greater than the risk of signing up.”

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