The American health care system faces massive uncertainty heading into 2017. Three years after the rollout of the Obamacare exchanges, more Americans have insurance than ever before, but they’re also having more trouble affording it. The promise of health care reform was a key part of the platform that got Donald Trump elected, but while changes are almost certainly coming, just what they’ll be and how they’ll affect you is still unclear — and likely will be for months if not years.
President-elect Trump promised to “repeal and replace” the Affordable Care Act, but he has already begun to walk that back and signal that he may leave in place some of the more popular provisions of the law, including coverage for those with pre-existing conditions and the ability of young adults to stay on their parents’ plans until age 26.
At the same time, his choice of Rep. Tom Price (R-Ga.), an outspoken Obamacare critic, to head the Department of Health and Human Services, is being seen as a signal that Trump is committed to dismantling the Affordable Care Act.
Any such changes would have to make their way through Congress and would likely be phased in over a period of years. Whether Americans get their insurance for 2017 through work or on the exchanges, most will lock in their plan selection before Trump takes office, and it’s unlikely that new rules in Congress would impact those choices. “Any changes that are put in place usually wouldn’t start until the first day of the new plan year, which would be in 2018,” says Boston-based benefits consultant Pat Haraden.
In the meantime, here’s what you need to know about 2017:
1. You’ll pay more out of pocket….
The cost of premiums for insurance provided by a large employer is expected to go up 5 percent next year, while the cost of premiums on the exchanges is increasing by an average 25 percent. In both cases, the cost of deductibles is also rising quickly.
2. … especially for prescription drugs.
The rising cost of prescription drugs, particularly brand name pharmaceuticals, has become a major driver of the increasing cost of care. The overall cost of drugs prescribed to workers under age 65 is expected to grow 11.6 percent next year, on top of an 11.3 percent hike this year. In response, insurers are limiting their formularies and shifting away from co-pays to co-insurance, which transfers part of that cost onto consumers.
“Prescription drug prices are often one of the big first expenses that people see before they’ve met their deductible,” says Steve Wojcik, vice president of public policy at the National Business Group on Health, which represents large employers. “There is a sticker shock.”
Consumers do have some new tools, however, to help offset those costs. Websites like GoodRx provide more transparency on prescription drug pricing, make it easier to comparison shop between pharmacies and offer access to coupons. Paying for prescription drugs via tax-advantaged health savings accounts or flexible spending accounts can also help reduce the out-of-pocket hit.
3. More access to telemedicine.
A growing number of employers are encouraging the use of telehealth services, which allow workers to virtually visit with a doctor via online video. Nine in 10 employers will make telehealth services available to employees in states that allow it next year, up from 70 percent this year, according to the National Business Group on Health. In addition to a much lower cost, telemedicine is also much more convenient for workers, making it less likely that they’ll need to take time off to visit a doctor’s office for routine illnesses.
Some larger employers are installing on-site telemedicine kiosks, where employees are able to take vitals such as their heart rate or temperature while they’re consulting with a doctor. Telemedicine is also seen as an answer to the doctor shortage that’s plaguing both large metropolitan areas, where doctors are too busy to grant same-day appointments, and rural areas, where there just aren’t enough doctors. It’s becoming a growing trend among mental health providers as well.
While many employers pick up the tab entirely, the cost of a routine virtual visit with doctor runs less than $50, making it a viable option for even those who don’t have health insurance or who have to pay out of pocket because of a high deductible or other reason. “Telemedicine just doesn’t have the same expenses as the brick-and-mortar health care system,” says Sam Gibbs, executive director of AgileHealthInsurance.com.
4. Doctors’ offices go digital.
A decade or more after it became commonplace to book an airline ticket or check your bank balance online, you can finally communicate with your doctor the same way. Many medical providers were slow to make the shift due to compliance requirements for medical privacy laws, but a growing number of doctors now operate portals through which patients can make an appointment, send a note, renew prescriptions or access their medical records without sitting on hold with a receptionist.
5. Medical identity theft continues to rise.
This type of ID theft, in which thieves steal your Social Security number and health insurance information to fraudulently obtain medical services or treatment, continues to plague the health care industry. As banks and credit card providers have made it harder for crooks to crack into their systems or use the data that they obtain by doing so, medical information has become a much bigger target. Nine in 10 health care organizations have had a breach in the past two years and 45 percent had more than five data breaches in that period, according to the Ponemon Institute.
While absolute prevention of medical ID theft is nearly possible, health care providers and insurers are starting to take steps to mitigate the risk. (There are also some steps you can take to protect yourself.) In the meantime, a growing number of employers are offer ID theft monitoring as a voluntary part of their benefits package.