ACA Sign The sign-up season forcoverage next year comes five days before a mid-term election seenas a referendum on Trump and his agenda. (Photo:Shutterstock)

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When insurance customers log onto the Affordable Care Act'ssign-up websites, they'll find that health-care coverage prices arehigh but largely stable, after months of tinkering by the Trumpadministration.

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While many of Obamacare's core elements remain intact, otherpieces have been weakened or removed. President Donald Trumppledged to “let ObamaCare implode,” and cut some of the law'ssubsidies. Congress neutered a mandate to buy coverage, and theadministration has promoted cheaper plans with fewer benefits.

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Related: 7 things to know as ACA open enrollment kicksoff

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The sign-up season for coverage next year comes five days beforea mid-term election seen as a referendum on Trumpand his agenda. Polls have showed that voters consider health carea top issue, and the administration has been eager to take creditfor the stabilizing insurance premiums in the Affordable Care Act.On average, the premium for typical plans in the 39 states that usethe federal healthcare.gov website will drop 1.5 percent in Trump'sthird year in office, the administration said.

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Trump “took decisive action to stabilize insurance markets andexpand choices for American consumers,” Health and Human ServicesSecretary Alex Azar said in a September speech. For next year, abenchmark “silver” plan — which provides a mid-level of coverage —will cost $406 a month for a 27-year-old, before any subsidies,according to data from the U.S. Centers for Medicare and Medicaidservices. Prices vary by region, age, and coverage level.

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Premiums might have been lower still without some of theadministration's actions, according to one study. The price for ACAhealth plans is 16 percent higher than if the administration andCongress hadn't cut subsidies to insurers, repealed a mandate thatall Americans have coverage or pay a fine, and promoted cheaperforms of coverage, according to an analysis from the Kaiser FamilyFoundation, a health research group.

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Some of the downward pressure onrates this year comes after particularly sharp increases in pastyears, according to Cynthia Cox, director of health reform andprivate insurance at Kaiser.

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In Tennessee, Cox said, premiums for ACA plans exceeded medicalcosts by some of the highest margins in the country in 2017, thenwent up in 2018 anyway. For 2019, they'll fall by 26 percent,according to CMS data. Rate changes in other states includingMissouri, Pennsylvania, and New Hampshire followed a similarpattern.

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Past premium increases have made the markets more attractive forsome insurers.

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“It's incredible what a 60 percent rate increase actually doesto your earnings,” Molina Healthcare Inc. Chief Executive OfficerJoseph Zubretsky said at the company's investor day May 31,according to a transcript. The company is expanding its ACAofferings in Utah and Wisconsin next year, states it had previouslyexited.

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Compared to this year, 23 additional health insurers will offercoverage during open enrollment, according to CMS. Companiesincluding Cigna Corp. and Anthem Inc. are selling in areas they hadleft, the agency said. Only five states on the federal exchangewill have just one insurer, compared with 10 in 2018, according tothe agency.

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“Average rates are still too high,” Seema Verma, the agency'sadministrator, said on Oct. 11. “If we are going to truly offeraffordable, high quality health care, ultimately the law needs tochange.”

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A spokesman from Verma's agency declined to offer a projectionon how many people will sign up for coverage through the exchangesfor next year.

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Still expensive

The plans are expensive for people who don't get help. About 15million Americans bought coverage in the individual market lastyear, and 8 million of them got federal subsidies to help themafford it, according to Kaiser Family Foundation data. MoreAmericans are also in plans with high deductibles — forcing them topay more out of pocket when they use care.

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Paul Tellez, a 48-year-old attorney at a small firm in El Paso,Texas, said he pays almost $1,000 a month to insure himself, hiswife, and their young daughter on the ACA market. That's aftersubsidies lowered the cost by about $200. Premiums for his currentplan went up so much last year, he said, he considered droppingcoverage.

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“I'm just trying prepare myself for the sticker shock,” Tellezsaid.

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When he looked on healthcare.gov last week, the site saidTellez's estimated income of $85,000 next year disqualified himfrom getting a tax credit. His monthly health insurance billalready approaches his $1,300 mortgage payment.

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Tellez takes medication for diabetes and high blood pressure. InMay, he went to the emergency room for what he called a “ragingbloody nose” that doctors cauterized. The incident cost him about$5,000 because he hadn't met his plan's deductible.

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He's skeptical of the short-term health plans that the Trumpadministration is promoting as less expensive alternatives. Tellezhad a short-term policy between jobs about six years ago. “Readingthe fine print, it didn't cover much of anything,” he said.“They're just a bunch of flim-flam.” New Plans

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Another Trump administration rule will let groups offer what areknown as association health plans. The Nebraska Farm Bureau isoffering such a plan with insurer Medica. It would let smallfarmers, ranchers, and other agricultural businesses to bandtogether to buy health plans similar to what large employersoffer.

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Other policies from the Trump administration could boost thoseshort-term and association plans. One proposal would give statesmore leeway over the type of coverage that can be sold, and wouldlet states steer ACA subsidies toward short-term policies andassociation health plans, including some that don't coverpre-existing conditions.

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The proposal won't likely take effect until 2020.

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