Today, the Obama administration announced that people whose insurance
plans were canceled this year will "temporarily" be exempted from the
law's individual mandate. Here's how they're doing it -- and what it means for the law.
1. The individual mandate includes a "hardship exemption." People who
qualify can either ignore the individual mandate altogether or purchase
a cheap, bare-bones catastrophic insurance plan that's typically only
available to people under 30.
2. According to HHS,
the exemption covers people who "experienced financial or domestic
circumstances, including an unexpected natural or human-caused event,
such that he or she had a significant, unexpected increase in
essential expenses that prevented him or her from obtaining coverage
under a qualified health plan."
3. Today, the administration agreed with a group of senators, led by
Mark Warner of Virginia, who argued that having your insurance plan
canceled counted as "an unexpected natural or human-caused event." For
these people, in other words, Obamacare itself is the hardship. You can
read HHS Secretary Kathleen Sebelius' full letter here. HHS's formal guidance is here.
4. How may people does this affect? No one quite knows. Republicans
estimate that about 5 million people have seen their plans canceled. The
Obama administration believes the number, at this point, is actually in
the hundreds of thousands. There's no truly reliable figure here.
5. The Obama administration argues that there's little reason to fear
that these people won't purchase health insurance if they could
otherwise afford to. After all, they were already buying health
insurance on the individual market before there was any penalty at all.
They clearly want health insurance. This just smooths their transition
and, in the cases where there really is financial strain, gives them
time to figure out a solution.
6. But this puts the administration on some very difficult-to-defend
ground. Normally, the individual mandate applies to anyone who can
purchase qualifying insurance for less than 8 percent of their income.
Either that threshold is right or it's wrong. But it's hard to argue
that it's right for the currently uninsured but wrong for people whose
plans were canceled.
7. Put more simply, Republicans will immediately begin calling for
the uninsured to get this same exemption. What will the Obama
administration say in response? Why are people who plans were canceled
more deserving of help than people who couldn't afford a plan in the
first place?
8. The same goes for the cheap catastrophic plans sold to customers
under age 30 in the exchanges. A 45-year-old whose plan just got
canceled can now purchase catastrophic coverage. A 45-year-old who
didn't have insurance at all can't. Why don't people who couldn't afford
a plan in the first place deserve the same kind of help as people whose
plans were canceled?
9. The insurers aren't happy. "This latest rule change could cause
significant instability in the marketplace and lead to further confusion
and disruption for consumers," says Karen Ignani, head of the trade
group America's Health Insurance Plans. They worry the White House is
underestimating the number of people whose plans have been canceled and
who will opt to either remain uninsured or buy catastrophic insurance
rather than more comprehensive coverage.
10. This puts the first crack in the individual mandate. The question
is whether it's the last. If Democratic members of Congress see this as
solving their political problem with people whose plans have been
canceled, it could help them stand against Republican efforts to delay
the individual mandate. But if congressional Democrats use this ruling
as an excuse to delay or otherwise de-fang the individual mandate for
anyone who doesn't want to pay for insurance under Obamacare, then it'll
be a very big problem for the law.
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