The Centers for Medicare and Medicaid Services issued a final notice last week further diminishing the individual mandate and essential health benefits under the Affordable Care Act.
The individual mandate under the Affordable Care Act requires virtually all Americans to have minimum essential health coverage or pay a tax penalty. In December, Congress repealed the penalty associated with not having appropriate health coverage, but the individual mandate stays in effect through the end of 2018. The new CMS rule provides two new reasons that may be used to be excused from having health coverage.
First, an individual living in a county that has only one insurer may apply for a hardship exemption from having coverage. Since half of all US counties have only one insurer, this could result in many more people being exempt from the individual mandate.
Second, an individual can seek an exemption from coverage if the only plans available to the individual cover abortion services, and the individual has an objection to abortion.
The new rule also gives states authority to cut back on the 10 essential health benefits that are required under the Affordable Care Act for insurance policies sold in the Marketplace. This will result in less generous coverage. The responsibility for making sure the state Marketplace has enough care providers has also been turned over the states (from the Federal government). The changes take effect for plans sold in the fall open enrollment for 2019 coverage.
While the Affordable Care Act remains the law of the land, the government is still chipping away at ACA through agency rulemaking.
