Many insurers with a presence on the exchanges also participate in Medicaid.
Subsidies that help low-income people pay for exchange insurance will also continue. More than 80 percent of people who enrolled in the individual market in 2017 got subsidies. That assistance scales with rising premiums, so many people will be shielded from the impact of any enrollment declines, and insurers can be assured of at least some participation.
Protections for people with pre-existing conditions remain in effect as well, which is more of a mixed blessing. That's great news for anyone who is or may get sick. But it compounds the risk-pool issues created by the individual mandate repeal.
The ACA has remained surprisingly resilient in the face of this year's disruptions. It may withstand mandate repeal with similar elan.
There are even faint glimmers of possible upside. Health and Human Services Secretary nominee Alex Azar may not be the torch-bearing anti-ACA partisan his predecessor Tom Price was. There's a chance insurer cost-sharing subsidies and a premium-lowering reinsurance bill may be funded -- though hope dimmed with the news that those measures have been pushed out of a must-pass funding bill and into next year.
States could create their own individual mandates, though it would be politically and practically difficult.
No matter what, the year ahead will be tough for insurers, tough for consumers who have fewer choices, and toughest of all for people who don't qualify for subsidies and bear the full brunt of premium increases.
But Obamacare will survive, which is more than some would have predicted a few months ago.
Unfortunately, it will likely remain in survival mode instead of becoming the stabilizing and increasingly profitable market it might have been.
This column does not necessarily reflect the opinion of Bloomberg LP and its owners.