WASHINGTON — The Obama administration said Friday that it would
allow some people to receive federal subsidies for health
insurance purchased in the private market outside of health insurance
exchanges. The sudden shift was the latest in a series of policy changes,
extensions and clarifications by federal officials trying to help beneficiaries
and minimize political damage to Democrats in this election year.
Federal
officials said they had agreed to provide such assistance retroactively because
technical problems had prevented consumers from using online exchanges to
obtain insurance and financial aid in some states.
Gov.
John Kitzhaber of Oregon, a Democrat, had specifically asked the federal
government to allow financial assistance, in the form of tax credits, for
people buying insurance outside the state’s troubled exchange. Other states
running their own exchanges, including Hawaii, Maryland, Massachusetts and
Minnesota, have also experienced technical difficulties, creating political
problems for their governors.
The
Obama administration’s decision came as a surprise because the Affordable Care
Act is clear: Federal subsidies are available only to people who enroll in a
“qualified health plan” through an exchange.
But
some of the online state exchanges have not been working well enough to
determine if people are eligible for coverage, one of the basic functions of an
exchange. The exchanges are competitive marketplaces where consumers are
supposed to be able to shop for insurance, enroll and get financial assistance
to help pay premiums.
“We
recognize that some states have experienced difficulties in processing
automated eligibility determinations and enrollments,” said Aaron K. Albright,
a spokesman for the federal Centers for Medicare and Medicaid Services. “We
released guidance providing options to marketplaces to ensure eligible
consumers have access to financial assistance.”
The
new policy applies to people who — because of “technical issues” — were stymied
in trying to buy insurance through an online exchange and signed up for a
health plan outside the marketplace. They will now be allowed to sign up for
coverage in the exchange and get federal subsidies “on a retroactive basis,”
going back to the date on which they first enrolled in a health plan outside
the exchange.
Representative
Joe Pitts, Republican of Pennsylvania and the chairman of the Energy and
Commerce subcommittee on health, expressed disbelief at the latest policy
change.
“The
administration is blatantly ignoring the law, paying subsidies to plans outside
of exchanges,” Mr. Pitts said. “The unilateral delays and changes have been
rampant.”
Until
now, people who bought insurance outside an exchange were not eligible for
subsidies.
Under
the new policy, insurers may have to give refunds or credits to reimburse
consumers for some of the money they spent on insurance premiums and
co-payments before getting subsidies.
The
subsidies can greatly reduce the cost of coverage. The Congressional Budget
Office estimates that four-fifths of people buying insurance through exchanges
will qualify for subsidies, with the government spending an average of $4,700
for each “subsidized enrollee” this year.
Sara
Rosenbaum, a professor of health law and policy at George Washington
University, said that by offering subsidies for insurance purchased outside an
exchange, the Obama administration was avoiding a huge potential legal
liability.
“People
could have gone to court to obtain benefits denied without due process of law,
because of a breakdown in government eligibility systems, and a judge would
probably have ordered retroactive relief,” Ms. Rosenbaum said. “The federal
government is voluntarily providing equitable relief that a court would have
given.”
Mr.
Kitzhaber thanked the administration, saying its action would “ensure that
Oregonians who enrolled in health plans outside of our insurance exchange would
still be able to claim tax credits that are a key benefit of the Affordable
Care Act.”
Dr.
Joshua M. Sharfstein, Maryland’s health secretary and chairman of its insurance
exchange, said he was studying the new federal policy to see if it could be
used in Maryland. Many “logistical details” would need to be worked out, he
said.
The
health law fix this week comes after the administration delayed the requirement
for larger employers to offer coverage to employees; extended the deadline for
people to sign up for coverage starting on Jan. 1; delayed the opening of
online marketplaces for small businesses; and asked insurers to extend
individual health care policies that had been canceled for not complying with
the new federal law.
News Source: www.nytimes.com
0 comments:
Post a Comment