Health insurers face a Wednesday deadline for submitting Obamacare plans for 2018, but are still struggling with how to proceed in light of ongoing efforts in Congress to repeal the law and questions about whether the Trump administration will continue to pay out insurer subsidies.
With that uncertainty unlikely to clear up by Wednesday, insurers will have to take an educated guess as to whether they want to participate in Obamacare next year, experts say.
And while the deadline could be extended, that would only create new questions about whether they would be ready by the Obamacare open enrollment start date in the fall, one expert said.
One way some insurers have gotten around the problem is by filing two sets of rates: one reflecting rates if Obamacare stays as is in 2018 and another reflecting higher rates if the cost-sharing reduction payments or law's individual mandate are eliminated.
"Some insurers are saying, 'I am done with this, and I can't price policies with this much noise,'" said Karen Pollitz, senior fellow for the nonpartisan Kaiser Family Foundation.
The White House has not decided if it will pay cost-sharing reduction subsidies to insurers to reimburse them for reducing co-pays and deductibles for low-income Obamacare customers. Last year, the Obama administration spent about $7 billion in cost-sharing payments.
Insurers that rely the most on cost-sharing payments could see a 7 percent profit margin turn into a 25 percent loss if those subsidies go away, according to an analysis from the healthcare think tank Commonwealth Fund.
"Since marketplace insurers would need to substantially raise premiums, there is a risk of further market instability as healthy individuals earning too much to be eligible for the [Affordable Care Act's] tax credits decide to drop out of the market entirely," the think tank said in a report earlier this year.
But the cost-sharing reductions aren't the only uncertainty for insurers.
Pollitz noted that the American Health Care Act, which passed the House last month, would make a key change to the age rating. The age rating determines how much insurer plans can charge seniors. For instance, under Obamacare, a plan on the individual market can charge a senior three times the premium it charges a younger person.
But the legislation, which narrowly passed the House last month, increases that to five times.
"Assuming the Congress passes something this summer, whatever deadline happened will have to be revisited," she said.
Technically, the June 21 deadline can be changed or even extended again to give Congress more time to pass healthcare reform. The deadline has already been extended from the beginning of May to June.
Senate leadership said it wants to pass its own version of the American Health Care Act by the July 4 recess, but that goal is doubtful. If that goal slips, leadership hopes to hold a vote before the monthlong August recess.
But Pollitz said time is running out to get plans in order by the start of 2018 open enrollment on Nov. 1.
"The deadline is there for a reason. It is not just some annoying rule," she said. "If you count backwards from open enrollment being operational, healthcare.gov needs to be programmed, plans need to get approved."
But deadlines have been fudged before to accommodate insurers. Last year, a county in Arizona wound up with no insurers, so the Obama administration let Blue Cross submit a plan after the deadline to serve that county.
A White House aide told the Washington Examiner that the Trump administration is still considering all of its options on the cost-sharing payments.
Meanwhile, Republicans in Congress are ramping up talk to make the payments. However, some disagree over whether the White House or Congress should do it.
Some Republicans have called for a short-term rescue bill to stabilize individual insurance markets for 2018, but no legislation has advanced in the Senate or House.
Pollitz noted that some insurers remain committed to the individual market, but she couldn't predict what they would do if nothing changed by the fall.
"We are in the red zone now," she said. "We have issuers in a lot of areas that would like to continue operating within the individual market and will keep trying everything they can do. We have just never seen anything like this before."