Latest ACA fix benefits consumers, state exchanges

Americans who couldn't enroll in health insurance plans due to problems with state exchange websites and bought coverage elsewhere can still get federal tax credits and retroactive cost-sharing, the Centers for Medicare & Medicaid Services announced yesterday.

"We recognize that some states have experienced difficulties in processing automated eligibility determinations and enrollments, and [are] providing options to marketplaces to ensure eligible consumers have access to financial assistance and issuers are paid," the Obama administration said in a statement, the Associated Press reported.    

Consumers must have submitted an application for coverage through the marketplace during open enrollment, and the health insurance they bought outside government sources must meet certain legal requirements, the CMS bulletin said. If technical difficulties prevented state exchanges from providing timely eligibility determinations on marketplace enrollment applications, the federal government acknowledges an "exceptional circumstance" may exist.

This latest Affordable Care Act fix is noteworthy since the Obama administration previously said the only place to get taxpayer-subsidized insurance under the ACA was through the exchanges; those who bought plans outside the marketplace were ineligible for subsidies, the Associated Press reported. Along with delaying the employer mandate, this policy change exemplifies federal attempts to iron out ACA implementation wrinkles, the article noted. Health insurance website problems in some states have overshadowed prior problems with          

Though the new policy fix is available in all states, states that created their own health insurance exchanges rather than defaulting to federal control of their marketplaces have the most to gain from it, the AP reported. Healthcare reform is flourishing in states where officials support it and earmark resources to increase its success, according to study results reported by FierceHealthPayer.

Gov. John Kitzhaber (D-Ore.) praised the fix. "Today's news means that more Oregonians will be able to access better coverage at a more affordable cost," Kitzhaber said yesterday in a statement. "I applaud the federal government for its efforts to make this financial assistance available for more Oregonians."

For more:
- here's the CMS bulletin (.pdf)
- read the AP article
- see Kitzhaber's statement