• 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.

    @aaronecarroll

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    • Slightly ironic that the people in debt because of “unreimbursed medical expenses” are allowed to remain without health insurance?

      Agreed that penalizing them is probably not the best way to GET them insured, but still jumped out at me as a bit of a Catch-22.

    • If people who can’t afford insurance don’t get it, then the social costs of treating the uninsured will remain with us. And so will the uninsured. So, what was the point of Obamacare?

      As for the exemption for anyone who has “incurred unreimbursed medical expenses in the last 24 months that resulted in substantial debt” those people need health insurance!! And they didn’t have any insurance that actually worked!

      The whole thing is like an expectation that Obamacare won’t work.

    • I think the ACA was a political attempt by the government to assume more control over our lives while garnering votes and not necessarily to provide those things that you and I are both depressed about, the uninsured that need help, the budget, etc.

    • You might include, that if the plaintiffs prevail in the Competitive Enterprise Institute/ACA lawsuit on the IRS rule, all persons living in a state with a federal exchange will be exempt from both penalties. Of course, zero states are currently on track to have a federal exchange by October, so the question of penalties will be moot until there are actually federal exchanges.

    • The list of exemptions does not, all by itself, help people get insurance. But the rest of of the ACA sure does.

      Most everyone who can’t afford insurance due to financial hardship (homeless, foreclosure, utility shut-off, bankruptcy etc…) is going to be eligible for Medicaid or at least substantial subsidies in the exchange.

      Cheer up Aaron. The ACA has you covered.

      I’m surprised how extensive that list is. I have to think there are vast number of people who fall into one (or more) of those categories. The dreaded mandate is looking even more toothless now.

      • “eligible for Medicaid”

        A little problem with that in some states.

        • Sure. The Medicaid expansion won’t be available in all states.

          But that’s not the fault (or at least not the intent) of the ACA’s authors.

          • “the rest of of the ACA sure does.”

            Not quite and I will discuss just one group. The young are being charged much more than their risk so that their premiums will be higher than they would normally be. This is to lower the premiums for older people. The subsidies may not be very much for many in this group. I expect to see a lot of young people remaining uninsured. The penalty is low right now and I believe the penalty can only be collected if one is due a refund from the IRS.

            I think that is a crucial mistake if one’s objective is to have everyone insured. I would think that they would want to train people early in life to carry insurance for once insured people get used to it.

    • Generally, if insurance is deemed affordable, subsidies are not available.
      What I found out recently is that certain unaffordable insurance does not incur a penalty tax, and some unaffordable insurance does incur a penalty tax.
      Kind of crazy, huh?
      Don Levit

    • Dr Carroll missed the BIGGEST exception of them all.

      ACA gives people a pass on the mandate if you have a “religious objection” to it.

      I know lots of people who arent particularly religious who plan to claim that exemption and therefore not purchase coverage.

      • “I know lots of people who arent particularly religious who plan to claim that exemption and therefore not purchase coverage.”

        I don’t think it is that easy:

        6. What are the statutory exemptions from the requirement to obtain minimum essential coverage?
        Religious conscience: You are a member of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits. The Social Security Administration administers the process for recognizing these sects according to the criteria in the law.
        Health care sharing ministry: You are a member of a recognized health care sharing ministry.
        Indian tribes: You are a member of a federally recognized Indian tribe.
        No filing requirement: Your household income is below the minimum threshold for filing a tax return. The requirement to file a federal tax return depends on your filing status, age, and types and amounts of income. To find out if you are required to file a federal tax return, use the IRS Interactive Tax Assistant (ITA).
        Short coverage gap: You went without coverage for less than three consecutive months during the year. For more information see question 22.
        Hardship: A Health Insurance Marketplace, also known as an Affordable Insurance Exchange, has certified that you have suffered a hardship that makes you unable to obtain coverage.
        Unaffordable coverage options: You can’t afford coverage because the minimum amount you must pay for the premiums is more than eight percent of your household income.
        Incarceration: You are in a jail, prison, or similar penal institution or correctional facility after the disposition of charges against you.
        Not lawfully present: You are neither a U.S. citizen, a U.S. national, nor an alien lawfully present in the U.S.