Critics assail decision to extend period to enroll in health plans

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WASHINGTON -- The Obama administration's decision to allow marketplace health insurance enrollments beyond March 31 could exacerbate a credibility gap with insurers and lawmakers who have chafed at the troubled implementation of the Affordable Care Act.

After stating that the deadline would not be extended, officials at the Department of Health and Human Services Wednesday outlined a broad "special enrollment period," which gives people an unspecified amount of extra time to finalize insurance purchases that were initiated before March 31 on HealthCare.gov, the federal insurance marketplace that serves 36 states, including Pennsylvania.

"We're not going to shut the door on those people who want coverage and have come in and tried to get it," said Julie Bataille, communications director at the federal Centers for Medicare & Medicaid Services.

Ms. Bataille would not say, however, whether the department would try to verify claims by those seeking extensions that they had tried previously to get coverage.

While officials insist the March 31 enrollment deadline remains in effect, consumers nationwide will now have wiggle room to obtain coverage after that date without the threat of penalties under the law's "individual mandate." The provision requires most Americans to have health insurance for 2014 or pay fines when they file their tax returns in 2015.

The "special enrollment period" mirrors the extended period that the administration approved in December, when millions of people waited to enroll in coverage that began on Jan. 1. It's the latest in a series of White House changes to the terms and implementation timetable of the health-care law.

Affordable Care Act supporters have welcomed the administration's adjustments to the law as common-sense fixes that typically accompany the rollout of complex legislation.

But conservative legal critics and Republicans have derided the executive branch tweaks as an unconstitutional and congressionally unauthorized rewriting of the law.

"Democrats passed this law with their own members," House Speaker John Boehner, R-Ohio, said Wednesday. "A Democrat president signed it into law. The dates are the dates. And the law is the law. The president doesn't have the ability to change the law whenever he wants, which he continues to do."

With only five days remaining in the official six-month enrollment period, Health and Human Services expects a crush of people to visit the website this weekend.

The site is designed to accommodate 100,000 simultaneous visitors, but on Monday and Tuesday alone it handled 1.2 million visits.

The enrollment extension will assure that those who tried to beat the March 31 deadline can do so -- even if the website malfunctions under the increased user load. It's anybody's guess, however, how long it will take to finalize those late enrollments, Ms. Bataille said.

But insurers want specifics, especially after adjusting their collection and enrollment procedures several times to accommodate the law's clumsy rollout, which began last October.

"The new special open enrollment period needs to be limited to a defined period of time with a clear end date," said Clare Krusing, spokeswoman for America's Health Insurance Plans, the insurance industry's trade association. "This helps to ensure there is an incentive for people to enroll. It is also necessary so health plans know who is covered as they develop and submit premiums for next year, which is required in some states as early as April."

Consumers granted enrollment extensions beyond March 31 who pay their first monthly premiums by their insurers' deadlines can expect their coverage to begin on May 1 -- the same effective date as people who complete enrollment by March 31.

Paper applications for coverage must be received by April 7 to qualify for extended enrollment. Those consumers will have until April 30 to select a plan that would be effective on May 1.

People with "special circumstances" will also be able to get marketplace coverage after March 31 if they fall into a variety of categories, including those who were affected by "exceptional circumstances," such as a natural disaster, a medical emergency or marketplace outages and malfunctions that occur near the plan-selection deadlines.

Misconduct, misinformation or inaction by insurance representatives and people who provide enrollment assistance also could trigger eligibility for "special enrollment." So could an error by an insurance company that results in a person not being properly enrolled, incorrect eligibility determinations related to one's immigration status and incorrect information on a marketplace website that misrepresents key features of a plan, such as premiums or benefit offerings.

The new regulations also allow for married victims of domestic violence to apply and select a plan through May 31.


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