As Americans begin signing up for Obamacare health insurance plans on Wednesday, experts expect reduced participation as a bitter political debate clouds the program's future.
Republicans in Congress have repeatedly failed to repeal and replace former President Barack Obama's healthcare law, which they have said drives up costs for consumers and interferes with personal medical decisions. Democrats have warned that repeal would leave millions of Americans without health coverage.
President Donald Trump promised to kill the law in his 2016 election campaign, and he has taken executive and administrative actions to undermine it.
"The market's going to be extremely confusing. There's going to be entire complexity of choice," said David Anderson, a health policy researcher at Duke University.
The Center for American Progress, a liberal think tank, estimated this week that 2018 enrollment would have held steady from 2017, with 12.2 million people signing up for individual health coverage under the Affordable Care Act had there not been administration efforts to undercut it.
The Trump administration has cut the 2018 enrollment period in half to six weeks from Nov. 1 to Dec. 15 for states using the federal Healthcare.gov website. Enrollment previously ran until Jan. 31, and many consumers often signed up in the last two weeks, according to state officials and organizations that help people choose insurance.
Senate Republicans and Democrats are working on legislation to stabilize Obamacare markets in the short term, but the nonpartisan Congressional Budget Office has estimated that about 1 million fewer people will enroll for 2018 plans due to Trump policies.
The administration has cut off billions of dollars in subsidies that insurers use to discount out-of-pocket medical costs for low-income Americans, slashed Obamacare advertising and cut funding to groups that help people enroll in health insurance. Several insurers have exited Obamacare markets due to concerns over subsidies and other Trump actions.
The Department of Health and Human Services said on Monday that premiums for the most popular Obamacare plans would rise 37 percent in 2018. Americans eligible for Obamacare tax credits to buy insurance may pay less for coverage, but costs would increase for middle-class consumers who do not get subsidies.
"It's been such a flood of information. A lot of the population thinks the Affordable Care Act has already been put under," said Daniel Polsky, a professor at the University of Pennsylvania and executive director of the Leonard Davis Institute of Health Economics. "The strange premium increases are going to be very confusing for consumers."
The Trump administration is now planning changes for 2019. Last week, it proposed a rule giving states more flexibility over the benefits that must be covered by insurance. Under Obamacare, all insurers have to cover a set of 10 benefits, such as maternity and newborn care and prescription drugs.
(Reporting By Yasmeen Abutaleb; Editing by Michele Gershberg)