On Wednesday, open enrollment begins for the fifth time under Obamacare. There is much uncertainty in the insurance market and premiums are expected to continue to rise. According to Gallup, the uninsured rate rose to 13 percent, up from 10 percent last year — most experts attribute the rise to ballooning individual insurance costs, diminished choice, and competition (due to the exit of many insurance providers), as well as volatility within the insurance market. Insurers need to be able to predict their payouts and costs year after year in order to more accurately price premiums. With the state of Obamacare in limbo due to inaction in Congress, predicting the future of healthcare has been difficult.

What to expect during open enrollment

First of all, this year’s open enrollment period is significantly shorter — it's only six weeks long instead of three months as in previous years. In addition, there is far less advertising on the national level as compared to the years during the Obama administration. President Trump cut the advertising budget by 90 percent. In addition, insurance costs are rising and many will be unable to afford their premiums. Many will be affected, particularly those in the individual market who make too much money to qualify for subsidies or tax credits.

In addition, with the elimination of subsidy payments back to insurance companies by Trump’s executive order in October, many insurers are likely to pull out of the exchanges. Those that remain will have to raise rates. Many counties in the U.S. only have one choice of insurer, which will cause further price increases. According to Kaiser, more than half of marketplace enrollees expect premium increases to create a substantial financial burden. So far, the price of bronze plans increased, on average, 18 percent; gold plans, 16 percent; and platinum plans, 24 percent. Due to confusion, increased costs, and a shorter enrollment window, I expect a lower rate of enrollments for 2018.

I am certain that both parties will use scaled-back enrollment as political fodder — Democrats will blame Trump and Republicans will blame Democrats for an unwillingness to move on healthcare reform. In short, more of the same in Congress.

How did we get here?

In one phrase: lack of congressional action. After years of bemoaning Obamacare, the Republican majority cannot even put forward one piece of reasonable legislation. Infighting and intraparty power plays have left Republicans in both the House and Senate impotent. Democrats, while in the minority, are happy to do nothing and blame Republicans for the failure of Obama’s legacy-defining legislation.

Obamacare was designed in order to tax the young and healthy (through required costly insurance purchases) in order to fund the care of the older and sicker patients. Instead of lowering healthcare costs overall, the opposite has occurred. Healthcare costs continue to rise, patients who sign up for the exchanges are much older and sicker than expected, and premiums are rising. These costs are rising for several reasons, including the fact that many insurers have left the exchanges due to huge financial losses, and because Trump has now eliminated payments back to insurers who cover expensive, high-risk patients.

While customers who receive subsidies continue to be shielded from rate increases, those without subsidies, particularly those who choose a midtier silver plan, are seeing enormous rate increases. Some families in this “middle income” bracket are unable to afford any plan at all. In addition, deductibles in the lowest-tier Obamacare plans will continue to rise — they averaged $6,000 for individuals and more than $12,000 for families in 2017. Currently more than 10 million people have private coverage through the exchanges and eight in 10 of these are provided federal subsidies and are not subject to rate increases. However, someone has to pay the bill — and it continues to be taxpayers.

What can be done now?

Obamacare is failing. Congress did nothing to amend the legislation. Repeal and replace has failed multiple times. Trump’s executive actions over the last several months have likely served to hasten the failure of Obamacare. If we do nothing, I fear there will be millions of people left without insurance (or simply underinsured) in the coming years.

Whether Congress makes extensive changes to the current healthcare law or scraps the law and starts fresh is immaterial. Something must be done. If Congress does not act, we must act for them by voting out incumbents in the midterms. Neither Republicans nor Democrats have shown any real commitment to reform, and both parties promised action when they were elected in 2016. It's time for voters to stand up and be heard: Fix healthcare or go home.

Kevin Campbell (@DrKevinCampbell) is a contributor to the Washington Examiner's Beltway Confidential blog. He is an internationally recognized cardiologist and medical, health, and wellness expert. He has authored two books and appears regularly on Fox News, Fox Business, CBS, and other media outlets. Campbell is the CEO of PaceMate, a healthcare data solutions company.

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