They say they are happy to talk about modifying the health care law ― but only if Republicans agree to leave the bulk of the coverage expansion in place, and only if Trump stops trying to sabotage the law. Republicans have said any health care reform or overhaul must give states more flexibility.
"The bottom line is that while the final rule addresses some of the challenges in the market, I think the reaction will be that it doesn't go far enough", said Cara Kelly, a vice president at the consulting firm Avalere Health.
Shoppers will have a shorter time period to choose a 2018 plan and a harder time enrolling outside that window if they lose a job or have some other special circumstance that affects their coverage.
In the coming weeks, insurers participating in the individual-market exchanges must set premiums for next year - and they'd have to be daredevils to re-up with Trump's sword of Damocles over them.
Nadler said the Republicans are "destroying" healthcare by "blowing up insurance for millions of Americans who need it". It also could prompt insurers to abandon the marketplace, leaving millions of enrollees without an insurance option. The 2018 enrollment period will begin November 1 and run through December 15. In previous years, they had twice that much time, and could still buy coverage until January 31. Insurers count on healthier enrollees to help counteract the higher costs of treating older, sicker patients.
The smaller enrollment window could be tough on some shoppers because they often have to search for an insurance plan that includes their doctor to avoid big medical bills. Without these payments, insurers will nearly certainly exit the exchanges. And if you got one of them, then you have to fill out a very complicated separate form to see if the tax credits you got from the government were too much or too little or just the right amount.
"We intend to conduct outreach to consumers to ensure that they are aware of the newly shortened open enrollment period", according to the document. Insurers say loose enforcement of these periods has been an expensive problem because it also allows people to game the system. The new federal rule, however, creates an unnecessary barrier to maintaining insurance coverage.
"There is still too much instability and uncertainty in this market", Marilyn Tavenner, president of America's Health Insurance Plans and the industry's top lobbyist, said in a statement. (It exempts certain silver plans for low-income consumers from the change.) So, for example, a bronze plan might cover only 56 percent of costs and silver 66 percent.
The changes come as insurers are figuring out their plans for 2018. Humana (NYSE: HUM) went even further by reducing its county-based coverage by almost 90% and announcing recently that it plans to not participate at all in 2018.
Trump told The Wall Street Journal that he was not sure if his administration would keep paying the cost-sharing reduction payments per the Affordable Care Act law, notes CNN. That we need bigger subsidies so people can buy better coverage that doesn't make them pay as much out-of-pocket.
Estimated at $7 billion this year, the subsidies are under a legal cloud.
The cost-sharing payments are the less well-known part of the financial help that the Affordable Care Act provides, but the support is baked into the plans bought by more than half of the 12.2 million people insured through the exchanges.
The Trump administration has indicated that the payments will continue as long as the case is being litigated, but insurers want more of an assurance that these subsidies will be available next year.
Most communities will have competing insurers on their public marketplaces next year, but a growing number will be down to one, and some areas may face having none. This year alone, premiums for ACA plans rose by an average of 25 percent.
Dave Dillion of the Society of Actuaries said growth in underlying medical expenses could drive coverage prices up another 10 percent or more.
On Thursday, two former Senate Majority leaders, Republican Bill Frist of Tennessee and Democrat Tom Daschle of South Dakota, made a call on behalf of the Washington D.C. -based Bipartisan Policy Center, to extend the subsidy payments.