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September 12, 2018 01:00 AM

CMS removes one more barrier to the ACA individual mandate exemption

Susannah Luthi
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    CMS Administrator Seema Verma

    People who opted out of the Obamacare exchanges this year can claim a "hardship" exemption to the individual mandate penalty without presenting supporting documents or a written explanation, the CMS announced Wednesday.

    The move will impact people who chose either to go uninsured or who bought coverage that doesn't comply with Obamacare regulations. It follows the agency's April guidance that expanded the exemption to people who live in bare counties or regions with just one insurer on the exchanges. The CMS invited exemption claims going back to the 2016 benefit year, but claimants still had to give a written explanation for why they required the exemption.

    The Obama administration set fairly broad parameters for the hardship exemption in 2013, including a sudden change in personal or domestic finances or financial duress that would make the cost of an exchange plan unfeasible.

    On Wednesday, the CMS touted its newest guidance as helping families on the lower-middle income scale who decided not to buy coverage on the exchanges, and said it followed President Donald Trump's executive order from 2017 that required agencies to "minimize the unwarranted regulatory and economic burdens" of the Affordable Care Act.

    "Of the $3 billion ... collected from taxpayers in individual mandate penalties in 2015, over 5 million households, or nearly 80%, earned $50,000 a year or less," according to the CMS' press release.

    CMS Administrator Seema Verma said the Trump administration wanted to mitigate the penalty in its final year. The 2017 Republican tax bill zeroed out the fine starting in 2019.

    "Although the tax cuts signed by the president earlier this year eliminate the mandate penalty starting in 2019, Americans are still under threat of the penalty for this tax year of 2018," she said.

    The CMS' April guidance also extended the exemption to people who object to abortion but only have access to an insurance plan that includes abortion coverage. This would apply to people in three populous states—California, Oregon and New York—which require nearly all their insurance plans to cover abortion services, according to the National Women's Law Center. Those three states account for a big chunk of the Affordable Care Act enrollment numbers.

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