American flag and medical symbolProposed rate hikes have thus far come in from fewer than a dozenstates, and even those may be further lowered once they'reconsidered by state insurance regulators

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Even though premiums for health care coverage under theAffordable Care Act will go up for 2020, it doesn't appear asthough they'll be those dizzying increases consumers experienced inthe past.

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Instead, according to Politico, for the second year in a rowincreases should be fairly modest—if the initial batch of insurerrates is any indication. That's in spite of Trump administrationactions that were expected to be even more disruptive to coveragethan it has been—although the move to overturn the ACA itself could stillprove to be “profound.”

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Related: CMS wants to know: How should the ACA systemchange?

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Proposed rate hikes have thus far come in from fewer than adozen states, and even those may be further lowered once they'reconsidered by state insurance regulators, according to the report,which also points out that this year's rates actually fell for thefirst time since the ACA kicked in, with benchmark plans' premiumsdropping by 1.5 percent in 39 states that rely onHealthCare.gov.

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Enrollment was fairly stable as well, onlydropping 2.6 percent nationally.

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Still, insurers have been raking it in on ACA customers, most ofwhom come with substantial subsidies. And plans that don't satisfyACA requirements aren't seeing soaring popularity in the absence ofavailability of ACA coverage.

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But it's early days yet to figure out how things will stand for2020. While lots of insurers dropped out of the marketplaces,leaving many counties throughout the country with no ACA options,eventually the gap was breached and experts expect the trend ofincreased competition to continue.

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“I would be surprised if we start hearing about bare counties,”Cynthia Cox, an insurance expert at the Kaiser Family Foundation,told Politico. “It's probably more likely that we see insurersentering the market.”

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One factor driving rates is the rising cost of care, expected to rise between 4and 8 percent in 2020. In addition, the ACA's health insurance taxends its one-year hiatus to return and is expected to increasepremiums by approximately 2 percent.

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Plan designs are being squeezed to wring every savings from themwithout sparking an outcry over cuts to providers; insurers arealso working on trying to identify how expensive customers are sothat they can maximize risk-adjusted payments.

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But the Trump administration's actions still present a threat,whether through actions like a potential ban of “silver-loading,”which boosted premium subsidies for consumers, or from its supportof the ruling in the lawsuit filed by Republican-led states tooverturn the ACA altogether. A lower-court judge ruled that theremoval of the individual mandate invalidated the entire law, andthe administration's backing of that ruling could mean that,depending on intermediate court rulings, the ACA could end upbefore the Supreme Court.

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Dave Dillon, a fellow with the Society of Actuaries who advisesseveral states on rate review, said of the possibility, “Iwould be hopeful that there would be some kind of transitionperiod” if the ACA ends up on the chopping block, adding, “Themarkets would be in an uproar.”

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.