Would Obamacare Delays Make Any Difference?

Here’s a guide to understanding what’s going on with Obamacare, who wants to delay what — and whether any of it would have an impact.

US Sen. Jeanne Shaheen (C), D-NH, speaks during a press conference to highlight the impact of the government shutdown on small bussinesses on October 3, 2013 in the Mansfield Room of the US Capitol in Washington, DC.
National Journal
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Sam Baker, Clara Ritger and Sophie Novack
Oct. 28, 2013, 5:02 p.m.

The vari­ous pro­pos­als to delay Obama­care are al­most as con­fus­ing as the law it­self.

Mem­bers of Con­gress are in a frenzy over the prob­lems plaguing Health­Care.gov. Re­pub­lic­ans are re­heat­ing their calls for delays as they try to cap­it­al­ize on the Health and Hu­man Ser­vices De­part­ment’s ter­rible pub­lic re­la­tions, and Demo­crats, seek­ing polit­ic­al dis­tance from the botched rol­lout, are float­ing their own set of delays.

Toss in a poorly un­der­stood an­nounce­ment from the White House last week and it’s easy to see why ana­lys­is of the way for­ward is of­ten con­fused. Here’s a guide to un­der­stand­ing what’s go­ing on, who wants to delay what — and wheth­er any of it would make a dif­fer­ence.

Op­tion 1: Delay the in­di­vidu­al man­date. The Af­ford­able Care Act re­quires most Amer­ic­an tax­pay­ers to either buy in­sur­ance or pay a tax pen­alty. Some law­makers — mostly Re­pub­lic­ans, but also Sen. Joe Manchin, D-W.Va. — have pro­posed delay­ing the man­date for a year. That means the re­quire­ment to buy in­sur­ance wouldn’t ap­ply for that peri­od, and the gov­ern­ment also wouldn’t col­lect pen­al­ties from people who re­main un­in­sured.

While law­makers have called for a one-year delay, a man­date delay could be as short as a month or two, or less.

A long delay of the in­di­vidu­al man­date, on its own, doesn’t make much sense as a way to make up for the slow start to en­roll­ment. The point of the man­date is to bring young, healthy people in­to the sys­tem to off­set the costs of guar­an­tee­ing cov­er­age to sick people.

Re­mov­ing the man­date in the first year would not it­self give con­sumers more time to buy in­sur­ance, and would ac­tu­ally make it easi­er for people, es­pe­cially young people, not to sign up for cov­er­age. That’s not what Demo­crats need to make Obama­care work.

“The only reas­on to delay the man­date is out of a sense of fair­ness,” said Aus­tin Frakt, a health care eco­nom­ist at Bo­ston Uni­versity. “It doesn’t help the mar­ket in any way.”

Frakt said the Obama ad­min­is­tra­tion could delay the man­date on its own, without con­gres­sion­al ap­prov­al, be­cause the law in­cludes an ex­emp­tion for any­one who has ex­per­i­enced a “hard­ship” ap­ply­ing for cov­er­age. The in­ab­il­ity to sign up on­line would prob­ably count.

Op­tion 2: Ex­tend the open-en­roll­ment peri­od. The Af­ford­able Care Act provides a six-month win­dow for people to sign up for cov­er­age in the first year. It began on Oct. 1 and ends on March 31. A defined en­roll­ment win­dow was in­cluded to pre­vent people from simply sign­ing up for in­sur­ance on their way to the doc­tor’s of­fice — or, worse, the emer­gency room.

(There are ex­cep­tions for people whose cir­cum­stances change at an­oth­er point in the year — for ex­ample, if they have a child they need to in­sure, if they get mar­ried, or if they be­come preg­nant.)

Sen. Jeanne Shaheen, D-N.H., and a hand­ful of oth­er Demo­crats are call­ing on the ad­min­is­tra­tion to ex­tend the en­roll­ment win­dow, al­low­ing con­sumers to buy in­sur­ance later than March 31. Some have sug­ges­ted a two-month ex­ten­sion, or one that simply lasts as long as Health­Care.gov con­tin­ues to have prob­lems.

“Ex­tend­ing this peri­od will give con­sumers crit­ic­al time in which to be­come fa­mil­i­ar with the web­site and choose a plan that is best for them,” Shaheen wrote in a re­cent let­ter to HHS Sec­ret­ary Kath­leen Se­beli­us. “In­di­vidu­als should not be pen­al­ized for lack of cov­er­age if they are un­able to pur­chase health in­sur­ance due to tech­nic­al prob­lems.”

Ex­tend­ing the en­roll­ment peri­od without delay­ing the man­date would mean con­sumers who missed the man­date dead­line could still en­roll, and would simply pay a pen­alty for each month they re­mained un­in­sured after Jan. 1.

Key Dates for the Individual Mandate National Journal

Op­tion 3: Do both. As of now, the end of the en­roll­ment win­dow is March 31. The cutoff to avoid pay­ing the in­di­vidu­al man­date’s pen­alty will also be March 31, the White House has said. Most health policy ex­perts say that if the en­roll­ment win­dow is even­tu­ally ex­ten­ded, it only makes sense to push back both dead­lines to­geth­er.

Mis­matched dead­lines have already caused plenty of con­fu­sion. The cutoff for the in­di­vidu­al man­date was ini­tially set for Feb. 15 — mean­ing there was about a six-week peri­od in which people were al­lowed to buy in­sur­ance but could have been fined any­way.

That didn’t make a lot of sense, so the White House an­nounced that it would push the man­date cutoff to March 31.

Even that small change touched off re­ports of “delay­ing the in­di­vidu­al man­date,” though the ac­tu­al change was simply tech­nic­al. But we’ll prob­ably have to go through that all again if the White House de­cides to ex­tend the open-en­roll­ment peri­od.

Op­tion 4: Do noth­ing. If the ad­min­is­tra­tion can get Health­Care.gov on track by the end of Novem­ber, it might not need to worry about the op­tics of any delays.

“Un­less there is far more dis­aster than the ad­min­is­tra­tion is ad­mit­ting right now, it would be a really bad idea to delay, and cause more prob­lems for in­surers nervous already about what kind of risk pool they’re draw­ing from,” said Tim Jost, a Wash­ing­ton and Lee Uni­versity law pro­fess­or and a sup­port­er of the Af­ford­able Care Act. “On the oth­er hand, if no one can get through [the] site, I’m sure in­surers would prefer [to delay].”

Jost and Frakt said that if Health­Care.gov is func­tion­al by its new dead­line, people will still have plenty of time to sign up for in­sur­ance. Some might miss the Dec. 15 dead­line for a policy that takes ef­fect on Jan. 1, but will still have three full months to sign up. That should be enough time, they said.

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