Lucky duckies who are exempt from the individual mandate

I’ve been working on a talk about the individual mandate and the employer penalty. In preparation, I was taking a look at the HHS “Guidance on Hardship Exemption Criteria and Special Enrollment Periods“. This document discusses the various reasons why one might become exempt from the individual mandate. They include anyone who:

  • becomes homeless;
  • has been evicted in the past six months, or is facing eviction or foreclosure;
  • has received a shut-off notice from a utility company;
  • recently experienced domestic violence;
  • recently experienced the death of a close family member;
  • recently experienced a fire, flood, or other natural or human-caused disaster that resulted in substantial damage to the individual’s property;
  • filed for bankruptcy in the last 6 months;
  • incurred unreimbursed medical expenses in the last 24 months that resulted in substantial debt;
  • experienced unexpected increases in essential expenses due to caring for an ill, disabled, or aging family member;
  • is a child who has been determined ineligible for Medicaid and CHIP, and for whom a party other than the party who expects to claim him or her as a tax dependent is required by court order to provide medical support. We note that this exemption should only be provided for the months during which the medical support order is in effect; or
  • as a result of an eligibility appeals decision, is determined eligible for enrollment in a QHP through the Marketplace, advance payments of the premium tax credit, or cost-sharing reductions for a period of time during which he or she was not enrolled in a QHP through the Marketplace, noting that this exemption should only be provided for the period of time affected by the appeals decision

Anyone who falls into one of these categories is “lucky” enough not to have to pay a penalty for not having insurance.

What depresses me is that this document recognizes these are reasons why someone might not be able to afford insurance, even under the ACA. But it doesn’t talk about how we might help these people get insurance. It recognizes these as situations that might prevent someone from not being able to afford insurance from an exchange. I wish the focus was a bit more on getting these people coverage, and making sure they can all afford it, than worrying about making sure they’re not further penalized.


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