People will be better off having entered marketplace exchanges even if options worsen under the Trump administration, experts say

The last day for Americans to sign up for healthcare coverage through marketplace exchanges is upon us and health policy experts are making a last-ditch effort to encourage enrollment despite the law’s uncertain future.

The experts joined celebrities in an unlikely alliance after Donald Trump’s administration attempted to pull about $5m of taxpayer funded advertisements warning of the deadline. The administration characterized the move as a cost-saving measure, and comes as congressional Republicans are attempting to make good on a years-long pledge to dismantle the law.

That prompted many celebrities with large social media followings to tweet their own commercials, using the hashtag #PullThisAd.

Health policy experts have said that even if healthcare options become considerably worse under Trump, people will still be better off having signed up for the Affordable Care Act this year.

“Everybody is concerned about making sure that people who already have coverage can keep their coverage,” said Sherry Glied, a New York University professor whose research has focused on health reform. “It could be that the replacement plan is just a horrible plan – just for the sake of argument – imagine that is true. Even if that is true, there will be special efforts made to protect the people that are in.”

Glied also added that if Republicans dismantled state-based exchanges, for example, it could undermine people’s future chances of getting insurance.

“In some sense, before this all happened, you could say: ‘All right, if I don’t get in I pay the penalty and that’s terrible,’” Glied said. “What could happen now is if you don’t get in, and something happens to you, you could never get in.”

Experts see the last week of enrollment for so-called Obamacare as crucial for outreach, because many people wait to sign up. Additionally, some states said call centers have seen a spike in questions from consumers as federal debate over the Affordable Care Act has heated up, an analyst said.

“A lot of those marketplaces have been doing a huge enrollment,” said Emily Curran, a research fellow at Georgetown University’s Center on Health Insurance Reforms. She said many also reported that rhetoric at the federal level had caused “real spikes in their call center volume”, according to Curran’s analysis of state exchange governing-board meetings.

“A lot of states are reporting that the political climate hasn’t had this chilling effect,” said Curran. “They’ve been able to maintain their enrollment; even some states think they’re going to track ahead and might have more than anticipated.”

The deadline to sign up for insurance is the same day as a Senate committee vote on Trump’s pick for health and human services secretary, Representative Tom Price – an ardent Affordable Care Act opponent who has worked to repeal the law.

Though the most well-known elements of Obamacare are state-based exchanges, the ACA reformed a much broader set of regulations in the health insurance market. The law allowed states to expand Medicaid, a public health program for the poor, and Medicare, a public health program for the elderly; it also created consumer protections that required all health plans to have some “essential benefits”.

Reforms in the ACA drove down the uninsured rate in the US to historic lows – just 8.6% as of October 2016.

Republicans have repeatedly called the ACA a failure, because premiums in health exchanges increased 25% on average. However, health spending in the United States overall has slowed, which officials from Barack Obama’s administration have attributed to the law. Many uninsured people still cite cost as a prohibitive barrier to obtaining insurance coverage.

Consumers’ plan choices have also diminished since 2016. For the coming year, 17% of Americans eligible for ACA plans will have only one choice of insurer, according to a New York Times analysis. (By comparison, 30% of Americans insured through their employer have only one insurance plan choice.)

Tuesday’s deadline is for state-based exchanges, which are marketplaces for people who do not receive health insurance through their employers, Medicaid or Medicare. People can sign up for insurance at Healthcare.gov. About 85% of people who enroll in health insurance through exchanges are eligible for a federal subsidy to offset the cost of plans.

Glied encouraged people who sign up through the state exchanges to recheck their subsidies each year. Experts said that at least some people who remain uninsured may not know they are eligible for subsidies or Medicaid. Under most circumstances, people eligible for Medicaid do not need to pay anything. Most people who buy health insurance from Healthcare.gov, about 77%, find insurance for less than $100 per month.

About 7% of the American population, or roughly 21m people, buy insurance on their own including through state exchanges, according to the nonpartisan health research group Kaiser Family Foundation.

According to Kaiser, the majority of Americans receive health insurance through their employers (49%). Another 36% are on Medicare, Medicaid or a smaller health insurance program. Experts believe many people who are currently uninsured could qualify for federal help.