Friday, October 18, 2013

Fwd: qotd: 24 million will be permitted to remain uninsured without penalty

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-------- Original Message --------
Subject: qotd: 24 million will be permitted to remain uninsured without
Date: Fri, 18 Oct 2013 13:15:00 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

Health Affairs Blog
October 16, 2013
Implementing Health Reform: The State Of The Exchanges, Income
Verification, And More
By Timothy Jost

Information collection.

On October 11, 2013, HHS published a notice of information it was
intending to collect to establish individual mandate exemptions.

There is nothing new in this notice, but the scope and number of
exemptions from the ACA's individual responsibility requirement are
truly impressive. In addition to the religious conscience, health care
sharing ministry, incarceration, Native American tribe membership, and
lack of affordable coverage exemptions, there is an extensive list of
hardship exemptions, including:

* Homelessness;

* Eviction in the previous 6 months or the threat of eviction or

* A utility shut-off notice;

* Recent death of a close family member;

* A fire, flood, or other natural or human-caused disaster that caused
substantial property damage;

* A bankruptcy filing in the last 6 months;

* Medical expenses in the past 24 months that could not be paid;

* Unexpected increases in necessary expenses due to caring for an ill,
disabled, or aging family member;

* The presence in the household of a child claimed as a tax dependent
who was denied coverage in Medicaid and CHIP where another person is
required by court order to give medical support to the child. In this
case, the penalty need not be paid for the child;

* A favorable eligibility appeals decision that makes an individual
eligible for enrollment in a qualified health plan (QHP) through the
Exchange, lower the costs on monthly premiums, or provides cost-sharing
reductions, which removes the penalty for the time the individual was
not enrolled in a QHP through the Exchange; or

* Residence in a state that fails to expand Medicaid if the individual
would have been eligible for Medicaid.

HHS estimates that 24 million Americans will be eligible for individual
responsibility exemptions and that as many as 12 million will apply for
exemptions through the exchange. In most instances, documentary
evidence will need to be supplied to verify the exemption. Unless the
federal exchange website is vastly improved in the not too distant
future, this could create major problems for the implementation of the
individual responsibility requirement. - Supporting Statement for the Information Collection
Requirements Contained in the Exemptions Eligibility Information
Collection Request (25 pages):–10466.html

Comment: The Affordable Care Act includes multiple categories of
exemptions from the shared responsibility payment - the penalty for
remaining uninsured. This new CMS release defines the category of
hardships which would allow you to remain uninsured without having to
pay a penalty. When you check the list, it seems that most of these
hardships would indicate a greater need for having health care coverage.
But instead of seeking ways to fill these gaps, ACA simply cuts these
people loose with no coverage at all.

The largest category of those who are exempt from the requirement to be
insured are those who simply cannot afford to pay for their share of
health insurance premiums. That includes families whose incomes are so
low that they are not required to file income tax returns, and
individuals who would have to pay more than 8% of their incomes for
premiums beyond employer contributions or tax credits for the exchange
plans. It includes individuals who would have been eligible for Medicaid
but are excluded simply because their states elected not to participate
in the Medicaid expansion.

HHS estimates that 24 million Americans will be eligible for exemptions
from the shared responsibility payments. That is, 24 million individuals
will have the right to remain uninsured without having to pay a penalty.
That is quite a stipulation for an Act that was supposed to bring health
care to everyone. 24 million!

Clearly our politicians selected the wrong model for reform. We do not
have to put up with this. If enough of us protest vehemently, we should
be able to get our politicians to replace this highly dysfunctional
system with a single payer national health program - an improved
Medicare that covers everyone - absolutely everyone.

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