The Affordable Care Act has been much-debated and derided, but it remains law, and insurance enrollment for Arizonans begins this week with federal subsidies for those who qualify.

Pima County residents have 45 days starting Wednesday to enroll in health insurance plans offered on the ACA marketplace. The ACA is sometimes known by its unofficial name, Obamacare.

Overall, local residents should expect lower premium increases and more choice than they had for coverage in 2017.

The enrollment period, which ends at midnight Dec. 15, is half the length of what it was last year, and federal dollars to market it have been slashed. Also, healthcare.gov is no longer expected to be running 24/7.

But the marketplace will still be offering health insurance plans with federal subsidies for 2018, and cost sharing reductions on silver level plans to help pay for them.

One company — Ambetter from Health Net — will sell plans on the marketplace to Pima County residents for 2018.

A positive for Pima County residents buying marketplace plans is that Banner Health is going to be in network for Ambetter plans sold in Pima and Maricopa counties, company officials confirmed last week. Banner, which operates two local hospitals, in addition to clinics and urgent care centers, was not in the network in 2017.

Nearly 197,000 Arizonans, including about 30,000 Pima County residents, purchased health insurance on the federal marketplace last enrollment season.

Most qualified for federal subsidies to help them pay for the insurance, and about half qualified for cost sharing reductions to further reduce their cost of care.

While some states like California and Colorado have their own health insurance exchanges, Arizona is one of 39 states that rely on the federally facilitated marketplace — healthcare.gov

Most Pima County residents don’t get their health insurance on the federal marketplace. A majority are covered by either employer-sponsored coverage or a government plan — typically Medicaid or Medicare.

For Pima County residents getting health insurance coverage for 2018 on the marketplace (or who want to know whether they can), here are seven key things to know:

1. Confused?
You are not alone

Retired photojournalist Linda Hitchcock is hoping to buy her insurance on the marketplace again, like she’s done for the past two years. But the 62-year-old Tucson resident is confused about whether it will be available, and whether or not she’ll get a subsidy.

“One day it’s good, the next day it’s not,” Hitchcock said. “I have to have insurance. I just have no idea whether I’ll be able to get it.”

Similarly, 38-year-old Tucson Realtor Jennie James hopes she can get health insurance through the marketplace this year. But she is afraid that changes she’s been hearing about from President Trump and his administration mean it will either be unaffordable or not available.

“Last year I made $50,000 and still got a (federal) subsidy. To me that was amazing,” James said. “It’s a lot better than anything I could get before the ACA. But now I am a little concerned, obviously.”

Arizona health marketplace experts say both Hitchcock and James should go ahead and renew their plans.

“Having health insurance is a foundation to create a healthier life. People should not be distracted by the politics in Washington. The ACA has not been repealed,” said Julia Strange, a spokeswoman for Tucson Medical Center, which is working with other local hospitals to promote enrollment.

Don’t wait; sign up as soon as enrollment begins, advises Allen Gjersvig director of navigator and enrollment services for the Arizona Alliance for Community Health Centers.

“Financial help is available and open enrollment will be here really soon,” he said. “If you already have a marketplace plan, read the mail from your insurance company and from Healthcare.gov giving instructions on how to re-enroll for free.”

Gjersvig said he has been fielding a lot of questions about whether the ACA has been repealed, and whether low income people would benefit from signing up.

His answer? 

“Yes. Everything is still there.”

2. The enrollment
period is much shorter

New polling data released by the Kaiser Family Foundation this month found that most potential marketplace enrollees are unaware of when they can enroll and have not seen any related advertisements.

Last year, consumers had 90 days and were able to enroll after the Christmas holiday season and into January.

This year they’ve got half that time and the federal government has cut marketing and outreach funding by 90 percent, a Kaiser Family Foundation report says.

“The clear message should be, renew quickly when you get the notice,” said health policy expert Dr. Dan Derksen, a professor at the UA’s Mel & Enid Zuckerman College of Public Health, and director of its Center for Rural health. “It will be here and gone in the blink of an eye.”

Due to that reduced federal funding, fewer “enrollment assisters” are available to help people enroll, Derksen said. That’s why it’s important for consumers to enroll as early and quickly as possible, he said.

Enrollment could go down by 10 to 15 percent because of the changes and confusion, Derksen says.

“Somehow people think it’s all been repealed and is no longer available,” he said. “There are an awful lot of Arizonans who don’t understand what they might be eligible for and how they do it, how to get their questions answered or where to get enrolled.”

And about 10 percent, or 700,000 Arizona residents, still do not have health insurance, down from 19 percent in 2010, the University of Arizona’s Center for Rural Health says.

There are people without insurance who may not realize they qualify for Medicaid, or for subsidized health care on the marketplace, some health care advocates say.

3. Don’t worry too much about cost-sharing reductions ending

Insurers are still legally required under the ACA to offer reduced cost-sharing via silver-level plans to low-income consumers with incomes of up to 250 percent of the poverty level, the Kaiser Family Foundation said in an analysis released Friday.

Many insurers anticipated that the payments might not continue and built the loss of payments into their premiums for 2018, the analysis said.

“The recent decision to end paying cost-sharing reductions will have no immediate or direct impact on consumers in Arizona,” Gjersvig said.

Federal subsidies are not the same as cost-sharing reductions. But both are federal payments that help qualified people offset the cost of their health insurance.

Nearly 80 percent of Arizonans who enrolled in 2017 marketplace plans qualified for federal subsidies to help pay for them. And about 50 percent of those who enrolled also qualified for cost-sharing reductions on silver level plans to further decrease their out-of-pocket payments.

While it could change in 2019, both subsidies and cost-sharing reductions remain intact for the upcoming year, said Tucson insurance broker Ray Magnuson, owner of Magnuson & Associates and regional vice president of the National Association of Health Underwriters.

4. Only one insurer is selling individual plans to residents in Pima County

This year it’s just Ambetter from Health Net selling plans in Pima and Maricopa counties.

Officials with Ambetter from Health Net, a company owned by publicly traded Centene Corp. of Missouri, say they’ll be selling one gold plan, two silver plans, and one bronze plan in Pima County.

The problem with the 2017 marketplace in Pima County was a lack of choice and a narrow network where people weren’t able to keep their doctors, Magnuson said. He’s feeling better about this year’s choices in terms of both plans and available providers.

5. Tucson hospitals have banded together to help

With reduced federal funding for enrollment marketing this year, the Southern Arizona Cares Coalition has relaunched, with Tucson Medical Center (TMC) as the lead organization. The group has a website, and is doing coordinated outreach.

“During the last few years we did not feel the need to invest in outreach,” said TMC’s Strange.

“At this time, the executive branch (of the U.S. government) is making changes in how it’s going to administer the law and it’s impacting our community...We felt it was time to make sure we don’t lose the great gains we’ve had getting the uninsured rate to drop. “

Southern Arizona Cares is focused on encouraging people to go to one of the two community events (see box), or to sign up for an individual enrollment appointment at one of various local locations by calling 1-800-377-3536 or going to the website soazcares.org.

“We believe it is important for people who can have insurance to have insurance,” Strange said.

Strange said one of her biggest worries about this year’s enrollment is that people will procrastinate.

“The period of time is tighter to take action and the fact that it’s during the holidays is concerning,” she said. “We just want people to get the message that the marketplace is still open for business and there are good options to select from.”

6. You probably won’t have sticker shock

“Last year we were the poster child for the highest rate increases in the country,” Gjersvig said. “This year we are one of the lowest and we are not going to see the disruption of past years when insurance companies left the market.”

A nonsmoking 35-year-old Pima County man earning $30,000 per year is looking at monthly premiums that range between $130.72 and $275.53, plan previews show, with annual deductibles ranging from $6,550 to $1,400.

People who don’t qualify for subsidies have always been hardest-hit by costs. That population represents a little more than 20 percent of the Arizonans who signed up for plans in 2017. But overall, costs are going up by less than 2 percent.

Plan previews show a 59-year-old nonsmoking female making $90,000 per year, who doesn’t qualify for a subsidy, is looking at monthly premiums that range between $583 and $892.

A 59-year-old non-smoking female earning $25,000 per year, by comparison, would qualify for both a tax credit and a cost sharing reduction for a silver level plan, and her monthly premium choices range from $2.33 for the bronze plan to $295.33 for a gold-level plan.

7. You still may have to pay a penalty if you don’t have health insurance in 2018

Under current law, there is a minimum penalty of $695 for not having health insurance.

The so-called “individual mandate” that people have health insurance has been much criticized, and could still go away. No one knows for sure. As of right now, however, the individual mandate is still intact.

Derksen stressed it will be more difficult to sign up outside of open enrollment in 2018 than it has been in the past.

Not having health insurance can result in more than just a penalty. It can mean large medical bills, and in some cases personal bankruptcy over an unforeseen illness or accident.

When people are uninsured and can’t pay their medical bills, the result is a more expensive health system overall, health policy experts say.

Contact health reporter Stephanie Innes at 573-4134 or email sinnes@tucson.com. On Twitter: @stephanieinnes