For a year, consumers will be on the honor system for subsidies under the Patient Protection and Affordable Care Act.
That’s what the Obama administration quietly announced Friday, days after unexpectedly announcing they would delay the employer mandate penalty for another year.
In a new 606-page rule published Friday, the administration said they would significantly scale back on the law’s requirements that the new exchanges verify consumers’ income and health insurance status until 2015, when stronger verification systems are in place.
In the meantime, the government will rely on consumers’ self-reported information.
Health insurance exchanges set up under PPACA are set to begin open enrollment Oct. 1. Enrollees with incomes ranging from 100 percent to 400 percent of the federal poverty line are eligible to receive tax subsidies to help them buy insurance. They also must not have access to insurance through their employer to qualify.
“The exchange may accept the applicant’s attestation regarding enrollment in eligible employer-sponsored plan … without further verification,” according to the final rule.
The administration has said they would conduct random checks to verify whether new applicants receive employer-sponsored insurance benefits, while also verifying income status.
But the new regulations from the Department of Health and Human Services said the 17 state-based exchanges would have until 2015 to do random checks, citing “legislative and operational barriers.”
In all 50 states, though, the federal government will scale back oversight of what applicants say they earn.
That move, some critics say, could lead some consumers to overreport their income in order to qualify for federal tax subsidies, at least in states that is not expanding Medicaid coverage.
In the same rule, the government said it would give states until 2015 to roll out electronic notices because “states are at different places in the development of their eligibility and enrollment systems,” HHS said.
The rule is the latest setback in the health care overhaul law.
Last week, the administration announced it would not require employers with 50 workers or more to provide insurance benefits until 2015, a move business groups applauded but Republicans slammed as confirmation that “Obamacare costs too much and it isn’t working the way the administration promised.”
The administration has said the exchanges and other parts of the law are on target, and they are making delays and changes to better suit the public and employers.
Troy Underwood, CEO of Benefits Connect in Rancho Cordava, Calif., said, though, that he expects to see more PPACA delays and missed deadlines as the months go by.
“Platitudes, political favors and hope never replace a solid and realistic plan,” Underwood said. “As an expert in the processing and administration of employee benefits I can tell you the government’s efforts, even if well-intentioned, are grossly inefficient.”