In the latest war over the Affordable Care Act, the Republican Party is essentially trying to encourage Americans everywhere to seek an exemption from the individual mandate, the health-care law provision that requires nearly everyone to get insurance by March 31 or face a penalty.
The Obama administration says exemptions are much more limited than the GOP and opponents of the law would have you believe.
Separately, the Republican-controlled House passed a bill Friday that would delay the individual mandate until 2018. Under this legislation, 13 million fewer people would have insurance in 2018 than if the mandate remained in place, the Congressional Budget Office said this week.
Behind the renewed attacks are the GOP's hatred of the mandate. The provision is unpopular, but administration officials and insurers view it as a critical component of the law. Its main purpose is to prevent people from waiting until they're sick to sign up for insurance -- a scenario that would drive up insurance costs for everyone else. Whether this will work is another question.
The twin attacks aren't surprising. The GOP has been trying to undermine the individual mandate from the moment the Affordable Care Act was signed into law. The vote in the House is of little consequence because the bill has almost no chance of passing the Senate.
But the GOP's exemption argument has the potential to be a little more disruptive. The exemptions are real. Back in December, the administration spelled out 14 types. This week, the GOP has focused on two in particular.
The first one has to do with canceled plans. The administration said in December that people whose individual health plans were canceled last year wouldn't have to pay the penalty in 2014 if they remain uninsured. Those people also have the option of purchasing cheaper catastrophic plans. Just last week, the White House extended that exemption for two more years. The GOP said the White House tried to sneak through that latest exemption.
The other focus has been on a vague hardship exemption. People can avoid penalties if they "experienced another hardship in obtaining health insurance." This language is pretty broad. And those who claim hardship don't have to provide documentation. So, doesn't this mean anyone can just claim hardship and avoid the penalty for not having insurance? The GOP is arguing as much.
But the administration says that such exemptions are limited and that just applying for one doesn't guarantee that you're going to get it. Each request is processed manually, and people could be asked to provide more information or be denied outright.
"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," said Joanne Peters, a spokeswoman for the Health and Human Services Department. "This form, which was published last December, allows a limited number of individuals who are facing hardship to apply for an exception. This exception also makes it easier to find insurance by allowing those individuals to access catastrophic-level plans."
Washington and Lee University law professor Tim Jost, a supporter of the health-care law, agrees that the exemptions are supposed to be limited. Still, he said the confusion over exemptions could create a problem. "The administration is opening itself up to having to deny a lot of frivolous claims," he said.
Before the latest flap, the Centers for Medicare and Medicaid Services had predicted that 12 million exemption applications would be filed by 2016. The administration hired Serco last summer to process the paperwork, but HHS has not said how many have been filed or how many people at the company were reviewing applications.