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Life Health > Health Insurance > Health Insurance

PPACA glitch relief not necessarily legal

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Two lawyers at the Congressional Research Service have mixed feelings about the legal basis for Obama administration efforts to overcome public exchange enrollment system problems.

The Patient Protection and Affordable Care Act might not necessarily give the administration authority to offer retroactive access to health insurance subsidy tax credits to exchange glitch victims, according to Edward Liu and Erika Lunder, the CRS lawyers.

But it also isn’t clear who would have standing to challenge the administration’s interpretation in court, because it’s not clear whether anyone would be injured by the administration offering retroactive access to the tax credits, Liu and Lunder write.

A court also might decide to respect the efforts of the Internal Revenue Service and its parent, the U.S. Treasury Department, to implement PPACA, the lawyers write.

The Supreme Court has written that Congress cannot be expected to anticipate every conceivable problem that might arise from implementing a law, the lawyers write.

The level of deference a court might provide might depend on what kind of document the IRS and the Treasury Department use to help the glitch victims, the lawyers add.

“If Treasury/IRS were to issue a regulation subject to notice and comment rulemaking, a court might afford it the highest level of deference,” the lawyers write.

A court might be less deferential if the IRS simply issues informal guidance, the lawyers write.

Republicans at the House Energy and Commerce Committee asked CRS lawyers to review an effort by the Center for Consumer Information and Insurance Oversight to help consumers affected by PPACA exchange qualified health plan enrollment problems.

CCIIO has been supervising all of the public exchanges, and it manages the day-to-day operations of the HHS-run ones.

CCIIO has ruled in a bulletin that, at the HHS-run exchanges, consumers who end up enrolling in plan coverage late because of technical problems might be able to get retroactive coverage, and retroactive access to the PPACA “advance premium tax credits” that are supposed to help consumers pay for coverage.

Consumers can get the retroactive tax credits if they temporarily used QHP coverage bought outside the exchange system while waiting to get into it, according to CCIIO.

A literal reading of PPACA suggests a consumer can get the tax credit only if the consumer buys QHP coverage “through an exchange,” but, in the past, lower courts have rejected literal application of a statute when it would lead to an illogical result, the lawyers write.

House Energy Republicans made the CRS analysis public. They say it raises questions about the legality of the CCIIO bulletin. 

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