Obama policy change could allow people to retroactively claim discounts on coverage bought outside state health exchange.
Minnesotans who threw up their hands in frustration over technical problems with the MNsure website and bought health insurance outside of the state exchange may be able to apply for subsidies retroactively.
The Obama administration made the policy change in part to help states such as Minnesota, where technical problems prevented consumers from using exchanges to buy insurance.
In a bulletin issued last week, the Centers for Medicare and Medicaid Services said consumers who were prevented from shopping for coverage because of technical issues “may be considered an exceptional circumstance,” but offered vague guidance in how to carry out the new policy.
Much of the work, it appears, will fall on the health insurance companies, which will receive payments from the federal government and then have to process credits or refunds to consumers who already have paid their full premium. Such a process won’t be easy to execute, with one insurance executive calling it a “can of worms.”
“How do you prove that? You tried to get on one night and couldn’t?” said the insurance executive, who asked not to be identified. “Do you have to have something from the exchange? How do you enforce it?”
The push to expand financial assistance came from Oregon Gov. John Kitzhaber, whose state exchange still hasn’t gone online. Other state exchanges, including those in Maryland, Hawaii and Massachusetts, have been beset with technical issues in what has become a political hot potato for Democrats going into an election year.
“The clear game politically is to get as many people signed up from the law as they possibly can,” said Steve Parente, a health finance professor at the University of Minnesota. “The only reason why the administration would do this, that I can think of politically, is when they look at what has come through the exchanges, the numbers are so underwhelming that they want to go outside the market, give those folks a gift and in return, boost their numbers.”
On Monday night, the governor’s office released this statement from Gov. Mark Dayton: “I guarantee that my administration will do everything possible to provide Minnesotans with all the federal tax credits for which they are eligible.”
MNsure officials are expected to meet with insurance carriers at 8 a.m. Tuesday to discuss the logistics of how to proceed.
“There are a number of important decisions for MNsure to make in regards to this bulletin,” MNsure said in a statement. “There will be opportunities for Minnesotans to secure retroactive coverage when warranted, which is certainly a positive step for consumers who need affordable health insurance. We are still assessing this situation, and we are working very closely with our health insurance company partners to determine how we will proceed.”
More than 107,000 Minnesotans have signed up for coverage through MNsure, with about 32,000 purchasing private insurance. Enrollment is far below original estimates, in large part because of a huge system failure in late November and December, when the site was unable to verify identities and eligibility for tax credits.
At the end of December, MNsure officials took the unusual step of advising people not to shop on the MNsure website if they didn’t believe they qualified for tax credits.
Under the Affordable Care Act, individuals earning up to $45,960 are eligible for tax credits. They were supposed to be available only for those who bought a health plan through the new online marketplaces. As part of the federal health law, insurance policies offered on the exchanges must meet a certain set of requirements to be considered a “qualified health plan.” Such plans have to cover such things as children’s dental care, maternity care and addiction treatment and have caps on deductibles and out-of-pocket expenses.
Jackie Crosby • 612-673-7335