One of Donald Trump’s central campaign promises was to repeal the Affordable Care Act (ACA), popularly known as Obamacare. Trump memorably pledged to scrap the law “on day one” and replace it with “something terrific,” though details were scarce. Since Trump’s election, many newly insured musicians have found themselves wondering what to do in the face of this uncertainty.
There’s no consensus in Congress about what system might replace Obamacare. Health care advocates like us are watching closely to see what changes might be most likely, and which provisions are likely to stay intact.
But here’s the most important thing to understand right now: major changes to US law take time to implement. That means nothing is going to immediately change. Even if Congress repeals the Affordable Care Act in 2017, it is still currently the law. We don’t yet know what changes may ultimately come or when they will go into effect, but the best course of action right now is to get coverage and hold on to it as long as you can. That means:
If you currently have health coverage through the Marketplace or Medicaid: you should re-enroll for 2017. (For some plans, re-enrollment is automatic; check with your provider.) Additionally, if there’s any doctors’ visits, procedures, etc that you’ve been putting off, it’s probably smart to get those scheduled now and take full advantage of your current coverage.
If you are currently uninsured: you should try and obtain coverage for 2017 through the Marketplace or through Medicaid, depending on your income, family, and the state you live in.
Either way, if you want to take advantage of the ACA, you need to act quickly as the open enrollment period ends on December 15, 2016 if you want your coverage to begin on January 1, 2017. Open enrollment will continue through January 31, 2017, so you can still enroll, avoid paying a penalty and get covered for 2017, though your start date will be later.
A Quick ACA Recap
Enacted in March 2010, the ACA aimed to lower the number of people in the United States without health insurance and, to do so, made several modifications to the law. Those modifications included:
- Forbidding insurance companies from considering preexisting conditions when offering plans.
- Allowing children to stay on their parents’ plan until 26.
- Requiring plans to offer a set of essential health benefits, ensuring a baseline standard of coverage
- Requiring individuals who do not have insurance through an employer or through other means to obtain coverage.
- Creating a centralized marketplace for individual plans, providing subsidies to help individuals pay for coverage.
It’s the latter two provisions that made the ACA especially impactful to musicians. Musicians often work as self-employed freelancers, or juggling multiple part-time gigs and revenue streams, and so often lack access to employer based coverage. Our 2013 study in partnership with AHIRC found that musician respondents lacked insurance at nearly 3 times the rate of the general adult population.
Part of the way the ACA was able to bring the uninsured rate down to its current all time low was through the individual mandate, which requires everyone to get coverage. Failure will result in an annual penalty that is the greater of either $695 per adult or 2.5 percent of the household adjusted gross income, with a maximum of $2,085. (These penalties can sometimes be waived for low-income individuals if a truly affordable plan is not offered)
Fortunately, with the subsidies (available to anyone making more than 100% of the poverty rate), insurance may be more affordable than you think. According to the U.S. Department of Health & Human Services, most Healthcare.gov consumers are able to find plans with a monthly premium between $50 and $100.
Additionally, most states have adopted the ACA’s Medicaid expansion, which opens the doors to those who, previously, didn’t qualify for coverage under the free Medicaid program.
How to Get Covered
Under the ACA, qualifying individuals can purchase health insurance through their state’s health insurance exchange. If your state doesn’t have an exchange, the federal government then operates the exchange for them. Finding your local exchange is simple: you just need to visit HealthCare.gov and select your state. From there, you’ll be directed where to apply. You’ll then answer a series of questions about yourself, your family, your income and other details to determine what assistance you may qualify for. While this is often speculative for musicians whose income can fluctuate widely from year to year, you can estimate by looking at your previous year’s tax filings.
If you qualify for a subsidy, you will then be taken to a plan comparison tool where you can find the plan the works best for you. If you make less than 250% of the poverty level, “Silver” plans may be your best bet. They will provide assistance with your deductible, copayment and coinsurance.
If you make less than 138% of the poverty level, you may qualify for Medicaid. If however, you live in a state that did not accept federal funds for Medicaid expansion, you may run the risk of not making enough to qualify for subsidies on the exchange, but still lacking access to Medicaid. In situations like this, the best course of action may be to estimate your income a little higher for the next year: estimate your income at above 100% of the federal poverty limit and then plan to hustle to meet that threshhold (make sure to count every bit of revenue, side gigs, house show and merch income, etc). This will make you eligible for deeply discounted plans on the exchange.
You can also get assistance from a private health insurance broker. They’re able to give you more extensive advice about which plan to choose on the exchange, though they’re not able to help you apply for Medicaid. The commission is paid by the insurance company whose plan you ultimately choose, so it won’t cost you extra.
What’s likely to happen?
Because Democrats can use the filibuster to block congressional action, complete repeal of the ACA seems unlikely at this time. However, Republicans can use a process called reconciliation to make changes to key provisions of the ACA that directly impact the federal budget. That means regulations like the requirement that pre-existing conditions not be considered in offering plans, the ability to stay on parents’ plans until age 26, and new standards for quality coverage will likely remain on the books for now. Provisions that could be targeted for repeal include subsidies, medicaid expansion, the individual mandate, and the federal marketplace.
That said, there are lots of complicating factors that make it hard to know how repeal attemps may proceed. In part, that’s because many provisions of Obamacare remain popular. The nonpartistan Kaiser Family Foundation recently found that only about 1 in 4 people want to entirely repeal the health law. Thirty percent actually want to expand what the law does, 26 percent want it completely repealed, 19 percent say it should be implemented as is, and 17 percent say it should be scaled back.
Meanwhile, insurance companies, hospitals, and economists have warned that repealing the law without having anything in place to replace it could be profoundly disruptive to the insurance marketplace and suddenly spike the uninsured rate.
In the coming months, we’ll keep you posted on developments, including opportunities to tell your elected representatives how you feel about musicians’ access to healthcare. For now, we encourage you to get covered while you can, and encourage your friends to enroll as well.