The end of Obamacare's open enrollment comes amid big questions about its future

Obama trumpGetty Images/PoolPresidents Trump and Obama

Tuesday marks the final day of open enrollment on the Affordable Care Act’s exchanges.

Facing down the possibility of repeal, Americans can still sign up for health insurance coverage for 2017 through the end of the day. But the uncertainty facing the law known as Obamacare may already be affecting the number of people signing up.

President Donald Trump’s administration has ceased nearly all communications and outreach trying to get Americans to enroll — which may cause big problems in the health insurance market.

Uncertainty abounds

The last few weeks of enrollment are particularly important — not only is there an uptick in overall sign ups, but a higher percentage of young people typically sign up.

Younger enrollees are needed to help adjust the risk pool in the individual market. With too few young people, the risk pool becomes older, sicker, and more expensive to cover for insurers.

In years past, this has led to large losses for insurers on exchange-based plans, as well as questions over the long-term sustainability of the exchanges.

Yet the Trump administration yanked roughly $5 million in advertising focused on getting people to sign up. Additionally, communication from the Department of Health and Human Services, which runs the exchanges, has decreased significantly since Trump’s inauguration.

It also appears that Trump and the GOP’s desire to move forward with a repeal and replacement of the law may have put a drag on the last few weeks of enrollment. Before going radio silent, HHS reported that it was dealing with a heavier number of calls than usual from people asking if they should still sign up for care.

“Strong demand is especially striking in light of the unique headwinds created by discouraging rhetoric from ACA opponents,” former HHS Secretary Sylvia Burwell said in a statement right before Trump’s inauguration. “More than 40,000 people have contacted our call center expressing concerns about whether they should sign up for coverage, with a sharp uptick in these questions last weekend.”

The Washington Post has reported that the grassroots organisation Enroll America — which aims to sign up as many people for plans through the ACA as possible — has had 30% fewer appointments to assist in sign-ups than during the 2015-16 enrollment period.

The increased uncertainty and possibility of a drop in young enrollees has insurers worried. The possibility of facing an even more expensive risk pool, instead of steady or improving enrollment as HHS had predicted before the open enrollment period, could cause insurers already worried about the exchanges’ uncertain future to leave them preemptively.

Aetna CEO Mark Bertolini, who runs one of the nation’s five largest public insurers, said during a quarterly earnings call on Tuesday that due to the uncertainty, the company has no plans to expand the number of states where it offers ACA plans.

“We have no intention of being in the market for 2018. Currently where we stand, we’d have to markets worked up prices worked up for April 2017 to apply, and there is no possible way that we’ll be able to do that given the unclear nature that regulation is headed,” Bertolini said. “We will, however, participate where we think it is appropriate in 2018 as we currently evaluate our performance in helping support the transition to whatever comes forward in 2019 or 2020.”

Advocates for the ACA and health-policy experts say the steps by Trump and the GOP’s insistence on a repeal will help create the “death spiral” that Republicans claimed was happening — except this time, the GOP would be in line for the blame.

Even former Vice President Joe Biden dared Republicans to repeal the law, warning: “Go ahead repeal it. Repeal it now, see what happens.”

A Republican replacement

While open enrollment wraps up, Republicans have been moving forward with the repeal of the law and attempting to craft a replacement for the ACA.

Several GOP lawmakers, including Sen. Rand Paul, have issued plans for replacements. But a cohesive replacement supported by the wider Republican leadership, however, has not been advanced.

And GOP members of the House and Senate passed a budget resolution that directed committee leaders to draft a repeal bill using the budget reconciliation. Once drafted, the repeal bill would only allow parts of the law regarding the budget to be repealed

Republicans have exhibited some trepidation about repealing Obamacare without a full replacement bill ready. Trump, House Speaker Paul Ryan, and Senate Majority Leader Mitch McConnell have all expressed the desire to replace the ACA as close to a repeal as possible.

Despite assurances from Trump that the new GOP plan will eventually cover every American at a lower cost and with better coverage, it appears that the new administration may already be causing some worrying problems in the individual insurance market already.

All of the upheaval comes at a time when the ACA has never been more popular. Recent polls from NBC News/The Wall Street Journal and Morning Consult/Politico showed the highest level of approval for the law among Americans since its passage.

In fact, both polls show more Americans in support of Obamacare than against it.

NOW WATCH: Watch President Obama tear up while addressing Michelle in his farewell speech

Business Insider Emails & Alerts

Site highlights each day to your inbox.

Follow Business Insider Australia on Facebook, Twitter, LinkedIn, and Instagram.