It’s hard to come up with new ways to describe the Obama administration’s improvisational approach to the Affordable Care Act’s troubled health insurance exchanges. But last night, the White House made its most consequential announcement yet. The administration will grant a “hardship exemption” from the law’s individual mandate, requiring the purchase of health insurance, to anyone who has had their prior coverage canceled and who “believes” that Obamacare’s offerings “are unaffordable.” These exemptions will substantially alter the architecture of the law’s insurance marketplaces. Insurers are at their wits’ end, trying to make sense of what to do next.
Here’s how we got to where we are. As many as six million Americans who purchase health coverage on their own have seen their plans canceled, because they don’t comply with Obamacare’s newly-imposed regulations. On the other hand, the bungled rollout of the law’s healthcare.gov website has meant that only tens of thousands of Americans have been able to enroll in new coverage under the law. This means that by January 1, 2014, less people will have health coverage under Obamacare than before.
The White House has been working hard to fix the problems with the exchanges, with modest success. Henry Chao, the deputy Chief Information Officer at the Centers for Medicare and Medicaid Services, testified to Congress in November that 30 to 40 percent of Obamacare’s exchange software had yet to be constructed. Most critically, the systems needed to pay insurers—and thereby enroll people in coverage—had not yet been built.