Here’s when we’ll know the future of Obamacare

(AP) – President Donald Trump and his fellow Republicans have failed, at least for now, in their bid to repeal Obamacare entirely, but they still have plenty of ways to cripple the law without pulling it off the books.

By blocking funding for subsidies or refusing to enforce the individual mandate, the administration and congressional Republicans could undermine the law’s insurance exchanges — government-established marketplaces where individuals can buy health insurance from private companies, often with the help of federal subsidies. The exchanges and an expanded Medicaid program are the main programs in Obamacare, officially known as the Affordable Care Act, aimed at expanding coverage to the uninsured.

While Republicans can attack the exchanges, the marketplaces’ health is ultimately in the hands of the health insurance companies that have to decide whether to participate in them by selling insurance plans and consumers who have to decide whether to buy that insurance.

When Trump promised Friday that the law would “explode” on its own, he appeared to be referencing an argument shared among many Republicans that the exchanges would falter because people wouldn’t sign up for coverage and insurers would pull out, deciding that participating would be a bad investment.

The current health of the exchanges is hotly debated. Some insurers have curtailed their participation, leaving nearly a third of counties with only one insurer. But the Congressional Budget Office noted in its recent analysis that the market would “probably be stable in most areas” under current law. Republicans are vowing they aren’t finished with health care yet, which could prolong the uncertainty for insurers trying to make plans about what to do next year.

For now, Republicans haven’t announced any specific changes, and — given their plan was to repeal the law entirely — they’re likely still mulling what to do now. Insurers are largely keeping quiet about their next steps, in large part because they want to see if the White House and Congress will make policy changes to help address some of the problems in the exchanges.

But policymakers and insurers each have a deadline coming up that will force decisions, whether they’re ready for them or not. Here are two key dates to watch.

May 22: The ACA’s day in court

One key to insurers selling plans in the marketplace are reimbursements they receive called cost-sharing reductions. These aren’t the same as the tax credits that people receive to help pay their premiums; it is financial assistance to help low-income people pay their out-of-pocket costs, such as deductibles. The Congressional Budget Office projected those payments would add up to $7 billion this year and $10 billion in 2018.

But for insurers, there’s a question over how long that money will be delivered, due to an ongoing political and legal dispute about whether the cost-sharing money should be distributed at all.

June 21: Decision day for insurers

While all this uncertainty swirls, health insurers must decide — soon — whether to make rate filings to sell insurance in 2018. The deadline varies by state, but for those that have marketplaces run by the federal government, it is June 21. Filing doesn’t mean that insurers will participate; they’ll have months more to negotiate and could still drop out. But it’s the first step toward offering plans in 2018 and should provide a signal about what the marketplaces are likely to look like.