Why the Latest Obamacare Delay Is the Biggest One Yet

This time it's about fairness

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Rod Lamkey / Getty Images

Health and Human Services Secretary Kathleen Sebelius testifies in the Rayburn House Office Building on Capitol Hill, December 11, 2013, in Washington, DC.

When fairness goes out the window, you know politics has caused the White House to take its Obamacare scramble to a whole new level.The administration said Thursday night that people with canceled policies will not be subject to the individual mandate in 2014. This is huge, but you wouldn’t know it from Health and Human Services Secretary Kathleen Sebelius’ letter announcing the change, which she sent in response to senators worried that those who saw their health insurance policies canceled this fall did not “consider” Obamacare replacement policies to be affordable.

In the letter to six Democratic senators, Sebelius tried to downplay the impact of announcing consumers with canceled policies would qualify for a “hardship exemption” from the Affordable Care Act’s requirement they have insurance in 2014. She characterized those affected as “a small number” and said “the population of individuals with canceled plans who do not have quality, affordable coverage for 2014 is clearly shrinking.”

But it would be a mistake to believe this most recent regulatory change is not very important.

Giving those with canceled policies a “hardship exemption” means they will be allowed to purchase catastrophic insurance through Obamacare exchanges. Previously such plans were only available to Americans under 30 or those who could not find ACA plans that cost less than eight percent of their income. As Ezra Klein has pointed out:

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?

In other words, if you had individual market insurance before the ACA, you have more choices now than if you did not. Sebelius’s extension of the hardship exemption to Americans who lost their insurance this year creates just the kind of uneven playing field Obamacare was supposed to eliminate with a total reset of the individual insurance market in 2014.

In addition, Sebelius is essentially implying that a situation the Obama administration has rightly anticipated for years — that insurers would cancel plans in the fall of 2013 if the plans did not comply with ACA rules — creates a special kind of unforeseen “hardship.” The original individual mandate hardship regulations were issued long before insurers began canceling plans this fall. According to the Centers for Medicare and Medicaid Services (CMS), a person was to qualify for a hardship exemption if:

1. He or she 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;

2. The expense of purchasing a qualified health plan would have caused him or her to experience serious deprivation of food, shelter, clothing, or other necessities;

3. He or she experienced other circumstances that prevented him or her from obtaining coverage under a qualified health plan.

There is no reasonable interpretation of these guidelines that lines up with what Sebelius is saying now. Even if the general public was surprised when policy cancellation letters started showing up in mailboxes this year, the termination of many individual market plans was hardly “an unexpected natural or human-caused event.” As Sebelius said in her letter Thursday, there’s huge turnover in this market every year. Likewise, there’s nothing about having a policy canceled that makes it more difficult to obtain new Obamacare coverage (let’s assume the administration does not believe that having your individual insurance policy canceled means buying a replacement policy will cause “serious deprivation of food, shelter, clothing, or other necessities”).

Offering further clarification in June 2013 about what would qualify a person for a “hardship” exemption, CMS said a person could get a hardship exemption if he or she:

  • 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.

With this latest change, a new circumstance is added to this list:

  • Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.

Up until this point, there was a plausible argument to be made that most of the other ACA exceptions, exemptions and delays announced in the last year were made in the name of fairness. Employers were supposedly having trouble getting their paperwork and computers systems in line to comply with the employer mandate, so it was delayed a year — for all employers. Consumers trying to buy new plans through HealthCare.gov were struggling to navigate a dysfunctional website, so the deadline to sign up for coverage was extended from Dec. 15 to Dec. 23 — for everyone shopping through HealthCare.gov.

In contrast, the Obama administration’s changes in response to political fallout from individual market plans being canceled this fall — allowing states to extend existing plans for an extra year and this new hardship exemption — are something else. Thursday’s change puts those with canceled policies in a unique category that offers them a different kind of coverage and the ability to disregard the individual mandate, a major tenet of the law, which does not seem fair to those who did not have insurance prior to the law and who would very much like to buy a catastrophic plan but cannot. Republicans have already pounced on this latest change to argue that if Obamacare rules are simply too onerous for the small subset of Americans whose policies were canceled this fall, then they are too onerous for everyone else as well.

629 comments
Cmnsense
Cmnsense

Obama care is a joke, they need to start over and address the real reason why healthcare costs to much, time magazine had a good article addressing the real problem. If other countries can give same care at 10% of what we charge, the solution is not paying more money to the kidnappers and extortionists, make it affordable by addressing we are overcharged for everything having to do with medical service.

RonAlthoff
RonAlthoff

none of this would have occurred if sebelius had done her job. ----- PPACA section 1302 clearly MANDATES that the secretary create a venue via which the public could be notified of the new requirements, and she was supposed to do this by october 2011.

roknsteve
roknsteve

Conservatives really need health care for all their whining, crying, mental problems.  

destor23
destor23

Silliness.  The plan architects saw this as a real possibility but that doesn't mean that individual citizens did.  There's not a contradiction here so much as a shift in point of view.

Phlunked
Phlunked

Obamacare can never be made to insure more people than before or to appeal to any reasonable person's sense of fairness and that's why it will fail. 

AlphaJuliette
AlphaJuliette

Despite the fact that something needed to be done about the ever upward spiraling costs of health care insurance and healthcare costs the ACA is not the answer.  This thing is so huge and complex that it is rendering itself unmanageable.

What we have here is an application of the Law of Unintended Consequences.

The intention was good.  The plan is bad.  The implementation is worse.

I believe that the ACA will fail under its own crushing weight.  Hopefully our "representatives" in D.C. will learn a lesson and come up with something that is sane and affordable.  For now they need to drop back 10 and punt.

RonAlthoff
RonAlthoff

@roknsteveyou know what ??? ---- if our elected leaders did their jobs, nobody would need to complain about either party. ------ in this case, you have an appointed secretary of health, who did not even obey the very law she is supposed to be administrating. ------ and then for whatever reason, you have someone else saying "if you like your policy, you can keep it". ------ and you wonder why these policyholders are confused ???

MarilynMartina
MarilynMartina

@roknsteve  

 Liberals really need healthcare for all of their whining, crying and mental problems; i.e. whining that the government isn't paying for all their perceived needs and for their continued whining about Conservatives.  

Liberals/Democrats/Socialists/Progressives are non-stop whiners about Conservatives/Republicans/The Tea Party.  Pretty soon it's going to have its own chapter in the DSM manual for psychiatric disorders.   



mantisdragon91
mantisdragon91

@MarilynMartina

GWB's Motto: Your either with us or against us, now excuse me while I help the Saudi officials that financed 9/11 out of town and out of reach of prosecution.

mantisdragon91
mantisdragon91

@MarilynMartina@roknsteve 

Reality check Marilyn. Guess who has been whining no stop ever since Obama was elected, crying about birth certificates and secret Muslims. Maybe it about time you stop projecting your party's behavior unto others.

manapp99
manapp99

@mantisdragon91 @MarilynMartina Difference is one is retired and the other has three more years of damage to inflict on us. No point carping about the past when we need to fix the present. 

AlphaJuliette
AlphaJuliette

@jswarren

No. Let's either repeal, revise or replace it.

A huge part of the problem is two fold.  Democrats forced this thing through with the super-majority.  They didn't fully read the law nor did they really consider the over all costs of it and how it was going to affect We the People.  They didn't do their due diligence or their jobs.

Republicans have only thrown out the anchor and stood on the brake pedal on this issue and the Obama administration in particular.  Their extremist positions, their obstructionistic agenda and their utter refusal to discuss anything of import has only widened the schism within D.C. and made the whole thing worse.

Democrats and Republicans both have good ideas and valid concerns.  What they need to do to fix this monstrosity is to work together. 

mantisdragon91
mantisdragon91

@adm454@mantisdragon91@MarilynMartina 

Yes he did, and he is a fool and possibly a criminal. I hate all useless wars. Having served and having had friends pay the ultimate price in Iraq, I excuse no President that creates needless ground wars

RonAlthoff
RonAlthoff

@mantisdragon91@MarilynMartinaand btw, if you aspire to a certain philosophy, why be embarrassed about it ??? ----- if this country is leaning towards socialistic ideals, and you approve ( and many other people do also ), then why should a label make any difference ??? ------ frankly, however, in regular socialism, all activities are geared towards an even distribution of outcome. ---- in other words, your share of available assets is maintained as equally as possible. ------- in communism, on the other hand ( a subset of socialism) you have that same distribution, but perks are available to those who contribute the most. ------ i lived as a communist for awhile back in the 70's, and if you are the sort of person who doesn't mind sharing the fruits of your labors with others ( some of whom may not contribute much of anything to society ), then it's not really such a bad way to live.

RonAlthoff
RonAlthoff

not my party ----- i don't have a party..... don't even like political parties ------- and what you just did is called deflection...... can't really defend your own party, so you point at the other.------ my point is..... statistically, when you are at a low point, improvement always looks impressive. ------- and even when things have returned to where they were, you need to look at all the factors, not just one.

MarilynMartina
MarilynMartina

@mantisdragon91@MarilynMartina 

I live on this planet and am very well planted.  

From all of your posts on this thread you come off as "out of touch with reality," not much different than the rest of the Democrats/Socialists/Progressives/Liberals/Liars.

Have a good day, Mantis.  Our conversation is over.  

We will see who is right come 2014 and 2016.  I hope for the sake of this country I am right.  

mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91 

What planet exactly do you live in? For starters where do you get this Socialist idiocy from? Do banks typically have record profits under Socialists, do CEOs get record pay? When you use a term which has no relevance to what actually happens in this country you come of as out of touch with reality, not much different than the rest of the GOP base.

MarilynMartina
MarilynMartina

@mantisdragon91@MarilynMartina 

The Socialists have lost the young, the Hispanics and they're losing women on a regular basis.  The GOP doesn't have to run on anything.  The Socialists just keep on losing, and that's all it will take. 

mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91 

If you believe for a second that the GOP will win a majority with anyone except old white men you are deluding yourself. The economy is getting stronger every month and come 2014 the ObamaCare issues will be ironed out and people will be getting better health care for less. What will the GOP run on then?

MarilynMartina
MarilynMartina

@mantisdragon91@MarilynMartina 

The Middle East has been unsettled since its inception.  There's nothing new there.

You -- the Democrats, Progressives -- have turned off women, students and the minorities.  They were all expecting some miracles because of how they were over promised by the Obama Administration, and none of it came to pass.  

They no longer are buying the War on Women, the War on Minorities, the War on Students fallacies that the Progressives have been selling.  It's exposed now.  

mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91 

Not even close. We are still dealing with an unsettled Middle East and an Iran trying to get nukes both of which are the direct results of GWB's idiotic foreign policy. We are still digging out from a once in a life time fiscal collapse which GOP obstinance has made longer and more painful.

And if you think the GOP will win another national election based on the rate at which you are turning off women, students and minorities you are even more delude than your posts make you out to be.

 

MarilynMartina
MarilynMartina

@mantisdragon91@MarilynMartina 

Obamacare is THE biggest lie and THE biggest debacle we're dealing with right now.  And 2014 can't come soon enough to vote all the lying Democrats out of the Senate and the Congress.  

Obama, the celebrity draw, will not be on the ballot.  The rest of us will be out voting en mass who never looked at Obama as any sort of Messiah or celebrity.  The ones who voted JUST because of some abnormal celebrity draw in Obama will stay home.  

And as far as the young voters, you all -- Obama, the Democrats, the Progressives -- you've lost most of them because of Obama's lying and the website not being managed correctly and the fact that healthcare for them is going to cost an arm and a leg after being told differently. They now realize that Socialism, Progressivism is not all it's cracked up to be.  

mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91 

The biggest debacle ever? During GWB's two terms government spending rose by 67% while he gave tax cuts to the rich. Under Obama it has not even risen 12%. Under GWB our economy collapsed, we suffered the biggest attack on US soil since Pearl Harbor, only to have the identity of the nation behind the attack hidden from us, and then we were lied into a useless war in Iraq. And yet Obama Care is the biggest debacle ever?

MarilynMartina
MarilynMartina

@mantisdragon91 

And then we have Obamacare, the biggest debacle ever.  The liar-in-chief is losing support at all turns, as he should.

mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91@manapp99  

Here is some reality for you and this from April of 2013. We have added close to a million jobs since then.

  • The economy has added more jobs since Obama took office than it did in his predecessor’s entire eight years in office
  • Federal spending under Obama has grown faster than inflation, but far more slowly than it did under President Bush.
  • Domestic oil production has soared; oil imports have dropped by one-third; new cars are getting 17 percent better mileage; and wind and solar power have increased 157 percent.

 http://www.factcheck.org/2013/04/obamas-numbers-quarterly-update/


mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91@manapp99 

Last time I checked we went from losing 800,000 jobs a month when he took office to years of steady job gains. In fact he has already created more jobs in 5 years than GWB did in 8 and that is despite the collapsed economy he inherited. Funny thing about number and reality, they tend to have a liberal slant to them.

MarilynMartina
MarilynMartina

@mantisdragon91@MarilynMartina@manapp99 

Before that, Obama, the Democrats had a full majority of everything.  Republicans were irrelevant.  What did they accomplish?  Nothing.  Not jobs, nothing.  All they spent their time on was passing a law, Obamacare, without even reading it and shoving it down our throats.  And they didn't even bother to follow-through to make sure Obamacare was going to work.  They're a bunch of incompetents.  They shoved it down the country's throat, got it and then walked away and just somehow hoped it was all going to do what it was supposed to do.  What a bunch of narcissist incompetents!!!

And you're trying to somehow make this mess the Republicans' fault.  Well, no one is buying it.  2014 is going to make 2010 look like child's play.  

The Liberal/Progressive experiment is now exposed as the failure it always has been.  

mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91@manapp99 

Very expensive political games is what the GOP has been playing since winning Congress. According to one conservative think tank, the Peterson Foundation their games have cost us 2.1 million jobs since 2011 alone.

mantisdragon91
mantisdragon91

@MarilynMartina@mantisdragon91@manapp99 

No Marilyn they weren't they surveyed 73 people which is a large percentage of all CEOs who run Health Care Systems of 1,5 Billion or more. How many health care systems of that size do you think there are in the US? 

MarilynMartina
MarilynMartina

@mantisdragon91@manapp99@MarilynMartina 

I'm not a GOP bot.  I'm a person who sees this utter mess called Obamacare.  I posted Obama's, yes, we con post several times so that new people coming to the board will read it.  

I personally think it's funny because of the misleading, "Yes, I can" political platform Obama used to win the country over when the reality of Obama is that, yes, he conned us all with the help of the Democrat Party and with the help of the swooning media who thought some type of Messiah arrived in Obama.

Thank goodness "The un-Messiah's" name will not be on the ballot in 2014 or 2016.  Then we can get back to dealing with reality in America instead of playing some VERY expensive political game that Obama's been playing.

   

MarilynMartina
MarilynMartina

@mantisdragon91@manapp99@MarilynMartinaThose major health system CEOs were handpicked by Ezekiel Emanuel's brother who authored Obamacare.  They're totally biased towards Obamacare.  You need to come up with something better than that. 


Most health professionals think Obamacare is awful.  They are saying it all over the place, even in my doctors' offices that I go to for personal reasons.  I ask them everywhere.  At first they shy away from answering.  Then when they realize I'm informed about this mess Obama has made, they tell me how they REALLY feel, and not one has a positive opinion about any of this.

mantisdragon91
mantisdragon91

@manapp99@mantisdragon91@MarilynMartina 

So you don't actually have a clue if there will be a negative impact, but choose to disregard the overwhelming consensus of major health system CEOs who feel that the end result of the law will be a positive,

manapp99
manapp99

@mantisdragon91 @manapp99 @MarilynMartina The ACA's contribution to the screwing of America is not clear yet. So far we know that we were lied to about it, many have had their policies cancelled, many are finding the coverage not affordable and coverages only covering 60% of their medical expenses. The website for the President's signature legislation shows that either the administration did not pay enough attention to it or they are just that inept in hiring capable contractors. Probably due to federal government's arcane system for hiring talent. The cost of the website is not even disclosed by the feds because the amount is obscene compared to the private sector. 


So we know we are screwed on the costs so far. We know some are screwed on coverage and costs, and we know we are being forced to buy something or risk being punished by government. 


Coming soon will be taxpayer dollars given to private insurance companies to make up for lost revenue. Coming soon could be many with employer based insurance kicked to the exchanges. Coming soon might be the lack of the young invincibles paying for insurance they are not supposed to use and the skyrocketing of premiums your are forced to pay. Coming soon is the increase in the debt and deficits due to the subsidies and forcing people into the already broken state Medicaid programs. 

mantisdragon91
mantisdragon91

@manapp99@mantisdragon91@MarilynMartina 

How is tinkering with a plan that 93% of Health Care CEOs surveyed just this week said will improve and reduce the cost of Health Care, screwing the American People? How is it comparable to what was done to this country when the GOP was in charge?

manapp99
manapp99

@mantisdragon91 @manapp99 @MarilynMartina And the reality is that the people you keep beating on, Reagan and Bush, are no longer in power. The person currently screwing the American people is Obama. Your post reflects the attempt by many on the left to deflect criticism of Obama by delving into the past. 

mantisdragon91
mantisdragon91

@manapp99@mantisdragon91@MarilynMartina 

Lets use simple logic. When you make it clear to Wall Street that you will no longer regulate or oversee what they do, what end result should you expect. Do you think it is a coincidence that the great majority of the toxic derivatives that collapsed the banking system were created in the years after he was appointed.

manapp99
manapp99

@mantisdragon91 @manapp99 @MarilynMartina Signaled to Wall Street? That all you got? Clinton deregulation of Wall Street was far more than a signal. Frank's refusal to reform Fannie was far more than a signal. As far a going after Wall street goes who arrested Bernie Madoff? Bush's justice dept. Who turned a blind eye and disregarded a complaint about Madoff? Clinton's SEC. Who brought Enron to justice? Bush/. Who didn't? Clinton. Who brought down Arthur Andersen? Bush. Who didn't? Clinton. 

mantisdragon91
mantisdragon91

@manapp99@mantisdragon91@MarilynMartina 

GWB appointed Christopher Cox as head of the SEC is June of 2005. Cox was an avid Ayn Rand disciple who stated on numerous occasions that he had no desire to regulate or prosecute Wall Street. In essence this is no different than broadcasting that you are shutting down the cameras and firing the security guards in a bank and the acting shocked when the bank is robbed. If more proof is needed feel free to look up what percentage of the toxic loans and derivatives that crashed the economy were issued after his appointment.

manapp99
manapp99

@mantisdragon91 @manapp99 @MarilynMartina You are wrong that Bush crashed the economy and I have given you plenty of examples of why the crash is more the product of Democratic legislation and policies than Bush's. The useless war part I agree with but the economic crash no. 

MarilynMartina
MarilynMartina

@mantisdragon91@MarilynMartina@jswarren@AlphaJuliette 

Obama lied to us about Obamacare.  Now it's passed.  He neglected to pay the LEAST bit of attention to the website.  The only thing Obama cared about doing was campaigning and winning.  He had no care about what to do when he got the prize.  That is borne out by the fact that he used phenomenal media and social outlets and techno savvy to win the election and just neglected using any of that knowledge and know-how for Obamacare.  

What has he done that deserves any respect?  Nothing.  He's the liar/campaigner-in-chief who only knows how to community organize.  That would be pretty funny except that there's really 320 million people in the US that need a leader, someone they can count on, someone that's going to make America work as much as possible.  We all now see it's not Obama.

mantisdragon91
mantisdragon91

@MarilynMartina@jswarren@AlphaJuliette 
Bush lied us into a war and covered up the Saudi involvement in 9/11. He also rewrote the constitution and outsourced torture oversees. Not to mention squandered a surplus and crashed the economy by removing all oversight on Wall Street. So what has he done that deserves any respect?

manapp99
manapp99

@mantisdragon91 @manapp99 @jswarren @AlphaJuliette As the Democrats said before Bush took office that he was not legitimate due to the popular vote and Al Gore delaying his transition due to endless lawsuits. Don't you remember the Democrats bitching about how he was selected not elected?  How about when Nancy took over the house in 07 declaring Bush the lamest of ducks. How about Democrats going overseas during the Iraq war bitching about Bush marking the first time a party violated the idea of politics ending at our borders?


Political opponents getting down right nasty with each other did not start with Obama. Congressional Democrats tried to take down Reagan many times but he was able to dodge them. They called him teflon Ron remember? 

mantisdragon91
mantisdragon91

@manapp99@jswarren@AlphaJuliette 

 Sure and the GOP saying even before he was elected that they would have nothing to do with him had nothing to do with it. How many GOP Tea Party politicians are still claiming his birth certificate is fake and he isn't eligible to be president?

manapp99
manapp99

@jswarren @manapp99 @AlphaJuliette W having been a governor before becoming President gave him the skills needed to force the opposition to go along with his proposals. Obama have been a community organizer did not have the same skill set. Democrats just elected the wrong guy for the job. 

jswarren
jswarren

@manapp99@jswarren@AlphaJuliette
GWB received TONS of DEM votes for his budget-busting tax cuts.  That's legitimacy.

GOPs had 4 years of ABSOLUTE POWER and did NOTHING except pass an UNPAID for Welfare program: Medicare Part D, for the constituency that had the least problems with paying for healthcare.

manapp99
manapp99

@jswarren @AlphaJuliette What a canard. The Democrats never accepted the legitimacy of the George W Bush presidency due to the popular vote in 2000. The party out of power has opposed the party in power since the beginning. Seems like many in the Democratic party just started paying attention to politics in 2008. 

jswarren
jswarren

@AlphaJuliette@jswarren 

Can never happen when the GOPs don't acknowledge the legitimacy of the DEMs to govern at all.  Reagan "settled it".  GOPs SHOULD be PREZ.  A DEM Prez is illegitimate by definition. 

How do you work with that?