Getting insured under Obamacare three years ago was a godsend for Mercedes Ibarra. It meant she could finally afford to get treated for lupus, an autoimmune disease that nearly ended her ability to dance flamenco.



"Within that year, the Affordable Care Act totally saved my life," said Ibarra, who is now healthy enough to work part-time as a dance instructor in Los Angeles.



In the last year, she and her husband faced a financial setback, when his business saw a slowdown. She's been able to maintain her health insurance coverage, thanks to a premium tax credit and a cost-sharing reduction subsidy, which lowers her out-of-pocket costs. Consumers qualify for the subsidies based on their income.



"My specialist — who I do have to see once a month — my rheumatologist … before the subsidy (was a) $75 co-pay. And I'm now paying $16 when I see her," Ibarra explained.



"It's a huge difference, and it's a lifesaving difference because… if I didn't have access to health care right now, I wouldn't be able to do the things I do," she said.



But the fate of those cost-sharing reduction subsidies remains up in the air. With just one week until the deadline for insurers to submit rate requests for 2018 exchange plans, the Trump administration has not said whether it will continue to make the payments, which are at the center of a lawsuit.



Republican health-care policy consultant Lindsay Bealor Greenleaf said there needs to be clarity.



"They view it as some sort of leverage going forward, on the Obamacare negotiations — the Obamacare repeal negotiations," said Bealor Greenleaf, a director at ADVI Health. "That certainty lacking is certainly not helping shore up the exchanges."



The uncertainty has pushed some insurers to pull out of the exchanges for 2018. This spring Aetna said it was pulling out of Virginia and Iowa. Wellmark will also stop selling exchange plans in Iowa next year, while Blue Cross of Kansas City says it will pull out of Kansas and Missouri.



But with the clock ticking, there's some movement to stop the exodus. In Iowa, which could be left with no insurers offering Obamacare plans next year, state officials are asking the Trump administration for a waiver and funding to prop up their exchange.



This week, the largest insurer on the exchange by membership, Centene, announced it will be expanding coverage from its current six states to three new states next year – Nevada, Kansas and Missouri. The insurer sees an opportunity to step into county markets that competitors have abandoned.



"So, though we have these last-minute exits that we have to worry about, there's also potential for last-minute expansion of these insurers in the marketplace," said Bealor Greenleaf.



A senior official at the Centers for Medicare and Medicaid Services said it continues to work with states to try to provide greater flexibility on the exchange marketplaces, noting that the rate-approval process extends through the summer.



Ibarra said she hopes it will include funding for the subsidy that keeps her on her feet.



"I don't want to go on disability," because treatment is unaffordable, she said. "I want to be able to keep working."