The Conversation

Broad Hardship Exemption to Obamacare Mandate Added to Healthcare.gov Since Yesterday

A broad exemption to the individual mandate which only requires people to claim they had "another hardship" first appeared on the relevant HealthCare.gov page in the past 24 hours. Another narrower exemption for people with cancelled policies, which was announced at the same time last year, has been listed on the site for months.

The exemptions page on Healthcare.gov currently shows 14 possible ways to be granted a hardship exemption and thereby avoid a penalty associated with the law's individual mandate. Exemption 14 is a catch-all category which only requires documentation "if possible." It was added to the list of qualifying hardships on the government's "Application for Exemption from the Shared Responsibility Payment for Individuals Who Experience Hardships" form last December at the same time as hardship 13, which exempts people whose insurance was cancelled.

However, the internet archive cache for the exemptions page on HealthCare.gov shows that on March 5th (last Wednesday) there were only 13 hardship exemptions listed.  This was first noted by Jeryl Bier on Twitter. This means the broad catch-all category was only added to the web page sometime during the past week, possibly even after the Wall Street Journal published a story Wednesday drawing attention to the broad exemption. [See update below: March 12th, yesterday, also showed only 13 exemptions]

Exemption 13 was widely seen as an attempt to live up to the President's promise that people who liked their plan could keep it. It meant that people who had policies cancelled could claim Obamacare itself as a hardship and thereby gain an exemption from the individual mandate (or purchase a catastrophic policy). Many news outlets reported on the new exemption in December but few if any mentioned that a second, broader exemption (#14) had also been added.

For instance, this NY Times story about the new hardship exemption for people with cancelled policies (#13) doesn't mention the broad exemption for people with "another hardship" (#14). On the contrary, the author of the Times piece writes "The White House action is sure to embolden Republicans clamoring for a broader exemption that would be available to all Americans." Apparently the Times was not aware a broader exemption already existed.

Similarly, this story in The Hill doesn't mention the broad exemption at all. The LA Times described the cancellation exemption as "a small, but potentially important, hole" in the mandate, without noting that an even larger hole (exemption 14) had also been added. Reuters did note that 14 categories of hardship existed but did not characterize number 14.

Going back further in the internet archive cache for the relevant HealthCare.gov page, we can see that exemption 13 first appeared on December 20th (a cache of the page for Dec. 18 does not include it). That means the web page was updated, at most, one day after CMS published a memo explaining the new cancelled policy hardship exemption.

As Bretibart News noted yesterday, exemption #14 was added to the list of possible exemptions to the individual mandate at the same time as exemption #13, i.e. back in December. We know this because the Wall Street Journal reported on it at the time, including a link to the pdf of the exemption form and quoting the exemption.

So Healthcare.gov was updated in December to include one of the new exemptions added by the White House but, for some reason, the other was left off the list until this week yesterday. The exemption was not a "secret" as the WSJ characterized it, but it does seem to have been downplayed.

Update: Turns out the internet archive has a crawl of HealthCare.gov dated 3/12, i.e. yesterday. The 14th exemption discussed above was not listed on the site then, but does appear today. So this was added to the site in the past 24 hours. I've updated the headline and the lede to reflect this.

This issue came up today in comments on the Healthcare.gov Facebook page (Thanks to Terri for pointing these out on Twitter). There were two official responses. The first one confirms that exemption 14 was added last December, as I reported yesterday:

The Affordable Care Act requires people who can afford insurance to buy it, so that their medical bills are not passed onto the rest of us, which drives up health care costs for everyone. This form, which was published last December, allows a limited number of individuals who are facing hardship to apply for an exemption. This exemption also makes it easier to find insurance by allowing those individuals to access catastrophic-level plans.

The second official statement focuses on who the exemption applies to:

Individuals determined to “have suffered a hardship with respect to the capability to obtain coverage under a qualified health plan” will qualify. Consumers must fill out a form and be approved to receive this exemption. Simply filling out the form does not guarantee an exemption. The hardship application form was published on Dec. 19th and included the 14 categories you see today. Call us at 1-800-318-2596 if you have further questions. Thank you.

It's not clear how this is any different from the language on the application for exemption which says "You experienced another hardship in obtaining health insurance." Granted people aren't guaranteed an exemption but we know a great many people had trouble with the Obamacare website. Given that documentation is not required, it seems anyone could claim this.


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