The health insurance exchanges were supposed to be the crowning glory of Obamacare -- an easy way to help the 45 million people who don't have health insurance get some. Turns out, it hasn't been so easy. The White House has rolled out so many last-minute fixes that critics and supporters alike are asking how anyone can understand what the rules are now.
First, it was a year’s reprieve for businesses that were supposed to be providing health insurance for workers. Then came a batch of delays, exemptions and other exceptions, coming to a head late Thursday night as the White House scrambled to announce -- and then clarify -- a break for people who are the most furious about losing their insurance coverage.
Republicans piled on Friday, saying the White House has now made meaningless the individual mandate – the requirement that everyone have health insurance or pay a tax .
Here’s a run-down of what's changed so far:
1. The exemption. Thursday night, the Obama administration offered a special “hardship exemption” to people whose individual plans were canceled and who have yet to arrange other coverage. They can get either extremely cheap, bare-bones plans known as catastrophic coverage, or skip health insurance without paying the tax.
These catastrophic plans had only been available to people under 30 or those who could not find health insurance plans with premiums costing less than 8 percent of their income. An updated list of exemptionsincludes those who recently filed for bankruptcy or had medical expenses they couldn't pay, among other hardships.
2. The slip. Late in November, the administration gave people an extra week to get signed up, slipping the deadline from Dec. 15 to Dec. 23 for people who wanted to enroll and get health insurance starting the first day possible, Jan. 14. This came with a clear admission that the federal online insurance exchange was badly flawed.
The site went down again for repairs for several hours on Friday, just days before one major deadline for people to use it. "We screwed it up," President Obama said in his last news conference of the year.
3. The slide. Last week, officials gave people another week to pay their first premiums and still get coverage. This was forced on insurers: the industry later said it would let people pay as late as Jan. 10 and still get credit for coverage starting Jan. 1, so long as they had already signed up. It's a big concession — insurers usually like a lot more lead time and they want everything buttoned up, including payment, before they hand out insurance cards.
4. The fix. After an onslaught of attacks about his promise that “if you like you insurance plan, you can keep it”, Obama formally apologized and said that people could, in fact, keep their policies – even if they were policies his administration said were rotten and provided lousy coverage. The catch: insurance companies may have already discontinued the plans and state insurance commissioners would have to agree, and not all did.
5. The redefinition. There was October’s redefinition of what the March 31 deadline meant, made after it looked as if people needed to actually sign up by Feb. 15 to make the March 31 deadline to have coverage or pay a tax.
6. The delay. Back in July, the administration delayed for one year the requirement that large employers provide health insurance for their employees. The 2010 health reform law requires anyone with 50 or more workers to provide health insurance – something small businesses have been complaining about, loudly, for years. On Tuesday, the government said they could have more time to get it done.
But Obama says despite the tweaks, the law is working.
"The basic structure of the law is working, despite all the problems," Obama said.
He said at least 500,000 people, and maybe more, have managed to sign up using the federal and state web sites. "Since that time, I now have a couple of million people, maybe more, who are going to have health care on Jan. 1 and that is a big deal. That's why I ran for this office," Obama added. California says it got more than 53,000 people signed up in just the first three days of this week.
None of the delays appear to have helped Obama’s approval rating – the latest NBC/WSJ poll gave Obama a job approval rating of just 43 percent. Half of those surveyed said they are dissatisfied or disappointed with Obama’s presidency and 58 percent say their discontent comes from his handling of health reform.
And the delays appear to have rewarded people who want to defy the law’s requirements, rather than those who did what the administration asked and signed up early.
“This is a slap in the face to the thousands of Americans who have already purchased expensive insurance through the Obamacare exchanges,” said Sen. Marco Rubio, a Florida Republican who has been an outspoken critic of the 2010 Affordable Care Act.
Administration officials called the latest changes “common sense." "This is essentially an additional safety net in case folks might have slipped through the cracks," Obama said. But the insurance industry and critics said they just made things even more bewildering.
“One thing is certain: The Administration’s latest initiative is not going to simplify anything,” Robert Moffit and Alyene Senger, health policy experts at the right-leaning Heritage Foundation, wrote in a blog post. “Rest assured it is going to create even greater confusion for health insurers trying to sell these products. Also, don’t expect the unhappy consumers who’ve just lost their previous coverage to understand clearly which plan they can pick and be legally qualified to pick it.”
Health policy expert Doug Holtz-Eakin, who leads the center-right American Action Forum, says this week’s changes are “a big deal”. “Substantively, it opens the door to deferring the mandate entirely and by acknowledging that catastrophic plans would be suitable coverage it makes a lie of all the rhetoric about how existing insurance (“underinsurance”) is ‘subpar’ and ‘poor,’” he wrote in a blog post.
“It is an invitation to those who have chosen policies through HealthCare.gov to cancel them and waive the mandate.”