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January 29, 2018

Trump may seek to exempt more from the individual mandate

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    The Trump administration is looking at ways to expand exemptions to the Affordable Care Act's (ACA) individual mandate, according to people familiar with the effort.

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    Background on GOP efforts to scale back the individual mandate

    The ACA's individual mandate requires most U.S. residents to be enrolled in health insurance or pay a fine. Last month, Congress passed and President Trump signed into law a tax reform bill that will effectively eliminate the individual mandate penalty by reducing the fine for remaining uninsured to $0.

    Trump has repeatedly called for eliminating the individual mandate, and reports surfaced in November 2017 that the administration had drafted an executive order related to the mandate. At the time, sources familiar with the matter who spoke on the condition of anonymity said the order would expand the individual mandate's so-called "hardship exemptions." The Department of the Treasury typically grants such exemptions in instances where individuals faced difficulty complying with the mandate because of:

    • A natural disaster;
    • Bankruptcy;
    • Not being able to afford utilities; and/or
    • The death of a family member.

    However, a White House official at the time refuted claims that the administration had drafted such an order.

    Sources again say admin is looking at broadening individual mandate hardship exemptions

    According to the Washington Post's "PowerPost," sources once again are saying the administration is looking to expand hardship exemptions to the individual mandate. Though the sources said administration officials have not yet finalized any guidance related to the effort, they added that the broadened exemptions likely would take effect this year. It is unclear when the administration might finalize such guidance, according to "PowerPost."

    HHS on Wednesday declined to comment on the matter, "PowerPost" reports.

    Observers split

    According to "PowerPost," lawmakers were split about the administration's potential move.

    Rep. Peter Roskam (R-Ill.) said, "I have always said we should be focused on providing the families trapped in Obamacare with as much relief as possible—as soon as possible," adding, "The administration's decision to broaden the hardship exemption will deliver much-needed relief."

    In contrast, Sen. Ron Wyden (D-Ore.), the ranking member on the Senate Finance Committee, said, "This appears to be yet another step by the Trump administration to undermine health care markets, which means higher premiums for families and those who need health care the most."

    Experts questioned whether the White House has the authority to broaden the exemptions.

    Josh Peck, a CMS official under former President Barack Obama and co-founder of Get America Covered, said, CMS under Obama had "looked very closely at the hardship exemption to make sure it was serving the people who needed the exemption," adding that he is "pretty skeptical" of any additional exemptions the Trump administration could allow.

    But Michael Adelberg, a principal at Faegre Baker Daniels Consulting specializing in health care, said because the ACA does not stipulate what constitutes a hardship exemption, the Trump "administration has wide discretion," though, "big changes to the definition might require new regulation[s]", which "take time and require public comment."

    Others expressed doubt that expanding the exemptions would have much effect, Politico's "Pulse" reports.

    According to "Pulse," the exemptions already are broad, and 12.7 million people qualified for an exemption in 2015. In comparison, 6.5 million people paid an individual mandate penalty that year.

    Chris Condeluci, a benefits expert and former Republican staffer on the Senate Finance Committee, said, "If you can't find an exemption, you're not looking hard enough." Condeluci continued, "If this administration wants to make it even easier, to me that will have an immaterial effect" (Winfield Cunningham/Eilperin, "PowerPost," Washington Post, 1/24; Diamond, "Pulse," Politico, 1/26).

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