ACA Now

Implementation Status

The healthcare.gov website maintains a general page on this provision. Additionally, an August 12, 2011, Treasury fact sheet provides an overview of the premium tax credit.

2010

The December 30, 2010, Medicare and Medicaid Extenders Act of 2010 increased the limitation on the aggregate amount of the advance premium tax credit that can be recaptured upon reconciliation with the actual amount.

2011

The Comprehensive 1099 Taxpayer and Repayment of Exchange Subsidy Overpayments Act of 2011, which was enacted on April 14, 2011 (full statutory text available here), further modified the thresholds for recapturing excess advance premium tax credit amounts.

The Department of Defense and Full-Year Continuing Appropriations Act, enacted on April 15, 2011, repealed the free choice voucher requirement under section 10108, provisions related to which had been noted under section 1401 (conforming changes were therefore made).

2012

IRS Notice 2012-31 (April 26, 2012) solicits comment and furnishes some details on potential approaches to assessing if employer-sponsored plans provide “minimum value.”

On May 23, 2012, Treasury released a final rule on this tax credit for health insurance premiums.

On December 28, 2012, the GAO released a report examining the expiration of the Health Coverage Tax Credit (HCTC), and specifically, how the implementation of the ACA premium tax credits, cost-sharing subsidies and Medicaid expansion will affect HCTC participants’ costs for health plans in multiple ways.

2013

On January 30, 2013, Treasury issued final regulations on the premium tax credit affordability test for related individuals. This provides “guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit.”

HHS’s March 11, 2013, final rule – the Notice of Benefit and Payment Parameters for 2014 – finalizes several provisions relating to the administration of advance payments of the premium tax credit.

On April 30, 2013, the IRS released a proposed rule regarding the minimum value (MV) of eligible employer-sponsored plans and other issues related to the health insurance premium tax credit. The rule addresses several considerations relating to calculating MV and assessing affordability of employer-sponsored coverage, as factors related to employees’ eligibility to access subsidies in the Exchange, including such issues as wellness program incentives and HRA contributions.

The application window for submitting Qualified Health Plan (QHP) applications for Federally Facilitated Marketplaces closed on May 3. CCIIO continues to post detailed operational guidance on the Registration for Technical Assistance Portal (registration required) about Federally Facilitated Marketplaces and other topics (see the “About REGTAP” page). Additional developments include:

On May 1, CCIIO posted guidance regarding the role agents, brokers and web-based brokers may perform in Health Insurance Marketplaces and how they can be compensated.

On May 10, CCIIO released FAQs on Small Business Health Options Program (SHOP)-only Marketplaces indicating its intent to proposed rule-making allowing all States, in 2015, to have the option of running State-Based SHOPs while having Federally Facilitated Individual Marketplaces. The FAQs indicate that this option would be available in 2014 only to States that submitted blueprints and were conditionally approved as State-Based Marketplaces. CCIIO Director Gary Cohen wrote a May 10 letter to Utah Governor Gary Herbert regarding this 2014 pathway for Utah’s Avenue H.

On May 13, CCIIO posted a presentation regarding the Minimum Value (MV) Calculator, referencing HHS’s finalized policy on section 1302(d)(2)(c) of the Affordable Care Act (regarding the calculation of actuarial value) and reviewing the MV Calculator’s development, design and process.

On May 13, CCIIO posted FAQs on essential community providers (ECPs), noting, among other things, that “CMS is simply alerting providers that serve predominantly low-income and medically underserved individuals of an important potential new opportunity to participate in a QHP issuer’s network,” adding that “[i]ssuer requirements of providers serving in their networks will vary.” CCIIO Director Gary Cohen also wrote a letter to ECPs referencing the FAQs, noting the availability of an HHS inbox (essentialcommunityproviders@cms.hhs.gov) for queries and encouraging ECPs to consider participating in QHP networks.

On May 13, CCIIO released FAQs on allowable uses of section 1311 funds in States with a State Consumer Partnership Marketplace. A non-exhaustive list of potentially eligible activities is detailed in a table, including those involving consumer and stakeholder engagement and support, SHOP and contracting and outsourcing and agreements.  An additional FAQ addresses allowable uses of 1311 funds for States in a State Partnership or Federally Facilitated Marketplace.

On May 14, CCIIO posted a presentation outlining the Navigator program and other Marketplace consumer assistance personnel.

On May 14, Senate Finance Committee Republicans wrote a letter to HHS regarding press reports that the agency had encouraged private-sector contributions to Marketplace outreach and enrollment-related efforts. House Energy and Commerce Committee Republican leadership sent a letter to HHS on this issue on May 13.

On May 15, House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Subcommittee on Oversight Chairman Charles Boustany Jr., (R-LA) sent a letter to HHS inquiring about several aspects of the Navigator program, including privacy safeguards.

On May 16, Chiquita Brooks-LaSure, Deputy Director for Policy and Regulation at CCIIO, updated the Medicaid and CHIP Payment and Access Commission on Marketplace implementation, noting that CCIIO has completed the “vast majority” of regulatory work associated with the Marketplaces and is now focused on operational implementation, such as reviewing QHP applications submitted the window for Federally Facilitated Marketplaces. She added that HHS anticipates a June 2013 launch of a call center for Marketplace-related consumer inquiries.

On May 24, CMS posted a revised Paperwork Reduction Act package addressing cooperative agreements to support the establishment of State-operated Health Insurance Exchanges, including “substantial changes in the Establishment Review process.”

On June 26, the IRS issued a Notice, “Eligibility for Minimum Essential Coverage for Purposes of the Premium Tax Credit,” providing guidance on “whether or when, for purposes of the premium tax credit under § 36B of the Internal Revenue Code, an individual is eligible for minimum essential coverage under certain government-sponsored health programs or other coverage designated as minimum essential coverage,” such as Medicaid, Medicare, CHIP, TRICARE, student health or state high risk pool programs.

On July 5, CMS issued a final rule with wide-ranging eligibility provisions, including several regarding Exchanges’ eligibility and enrollment. Specifically, before January 1, 2015, State-based Exchanges may “accept the applicant’s attestation regarding enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an eligible employer sponsored plan for the benefit year for which coverage is requested without further verification.” For income verification, for the first year of operations, rule note that CMS is “providing Exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification” applicable to individuals who are not part of a statistically-significant sampling strategy that is delineated in the rule. Other provisions address, among others, authorized representatives, enrollment-related transactions, special enrollment periods and terminations. Also see a July 8 Paperwork Reduction Act package related to information collection under the Exchange-related provisions of this rule.

On July 2, IRS published in the Federal Register a notice of proposed rulemakingregarding the information that Exchanges are required to report to the agency regarding health insurance premium tax credits, including specific rules on reporting of information by Exchanges to help enable such functions as the reconciliation of the premium tax credit with advance credit payments. Comments are due on Sept. 3, 2013.

On August 30, HHS released a Paperwork Reduction Act (PRA) Package including details on information collections associated with the August 30 Marketplace Program Integrity final rule, the provisions of which addressed an aspect of the risk corridors program, agents and brokers in Federally Facilitated Marketplaces and various other issues. The PRA package also contains provisions on additional information collections related to Navigators, certified application counselors and habilitative services, among other topics.

On September 10, Sen. Orrin Hatch (R-UT), Ranking Member of the Senate Finance Committee, and Rep. Dave Camp (R-MI), Chairman of the House Ways & Means Committee, wrote to Treasury Secretary Jacob Lew opposing any regulatory action to extend premium tax credits and cost-sharing reductions to workers in multi-employer plans. On September 13, in a letter to Rep. Camp, Secretary Lew wrote, “the conclusion that an individual cannot benefit from both the exclusion from taxable income for employer-provided health coverage under such a plan and the premium tax credit provided by the ACA applies whether the individual is covered by a single-employer plan or a multiemployer plan.” On September 18, in a letter to Office of Management and Budget Director Sylvia Burwell, 21 Republicans said they are “troubled that the administration has only made a commitment to not move forward with a rule through the IRS, but has left the door open for the Department of Labor (DOL) to issue a regulation favoring labor unions.”

On September 12, the IRS posted a Q&A providing an overview of the premium tax credit, including an explanation of income and family size changes affecting adjustment and reconciliation of the advance and actual subsidy amount. On September 12, the House passed the No Subsidies without Verification Act (HR 2775), which, among other provisions, would preclude premium subsidies until a certified verification process is in place; the White House issued an SAP opposing the bill. On September 27, CCIIO released guidance noting that in light of a recent IRS ruling, “the eligibility rules with respect to premium tax credits under Code section 36B treat same-sex spouses in the same manner as opposite-sex spouses.” CMS said that while Federally Facilitated Marketplaces will be ready to implement the ruling by October 1, State-Based Marketplaces “may be unable to adjust systems to reflect the Ruling and this guidance by October 1, 2013” and “must implement this guidance as soon as reasonably practicable,” adding that states “must implement interim workarounds where reasonably practicable.”

On September 24, CMS sent the CY 2015 Notice of Benefit and Payment Parameters proposed rule to OMB for review, noting the “proposed and subsequent final rule must precede plan approval and open enrollment (must be complete by January 1, 2014).” The proposed rule is anticipated sometime in October.

On October 1, CMS posted consumer-oriented videos on Health Insurance Marketplaces and premium tax credits, among other topics. On October 28, HHS released a report finding that 46% of uninsured, single young adults ages 18-34 in 34 Federal Marketplace states could obtain bronze plans for less than $50 in post-subsidy, monthly premiums in 2014. Also see an HHS release.

On October 7, CCIIO issued an FAQ specifying that QHP issuers must send FFMs confirmed enrollments by December 16 to receive subsidy payments in January 2014. State-Based Marketplaces have the same deadline.

On October 9, Sarah Hall Ingram, director of the IRS’s ACA Office, testified before the House Oversight and Government Reform Committee on implementation of premium subsidies and enforcement of the individual mandate. She said “systems and processes the IRS has developed to support enrollment in the Marketplaces were launched on schedule and are working as planned.” See the hearing page for video.

On October 17, President Obama signed the Continuing Appropriations Act of 2014, ending a government shutdown; it embedded a provision (section 1001) relating to HHS’s ensuring and certifying to Congress that ACA income verification for premium tax credits and cost-sharing reductions is in place; it also requires an HHS report by Jan. 1, 2014, and an HHS OIG report by July 1, 2014.

On October 21, the IRS released a 1-pager on the premium tax credit and how consumers, depending on how they choose to avail themselves to it, if eligible, can “get it now or get it later.”

On October 24, CMS released a final rule (see a CCIIO fact sheet) codifying certain program integrity-related components of the ACA pertaining to Exchanges, premium stabilization programs and market standards that were delineated in a June 2013 proposed rule. The final rule also amends and adopts as final provisions delineated in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule with comment issued in March 2013 related to risk corridors and reconciliation of cost-sharing.

On Nov. 4, CCIIO posted slides explaining the process – and specific information – required for enabling monthly cost-sharing reduction and advance premium tax credit payments to health insurers. On Nov. 6, House Ways and Means Committee Chairman Dave Camp (R-MI) asked the IRS to supply data on subsidy eligibility determinations conducted for Marketplace applicants, including the average age of those applying.

On Nov. 12, CMS posted a chart generally characterizing, based on income, whether consumers may be eligible for premium tax credits, cost-sharing reductions or Medicaid.

Also on Nov. 12, CMS posted the authorization form through which QHP issuers verify that CMS may make deposits or adjustments in transmitting premium subsidy and cost-sharing reduction payments. Also see a Financial Information Template, Bank Verification Letter Instructions and Payee and Banking Information Submission Instructions. In an e-mail, the agency notes that issuers should e-mail the template and authorization agreement to vendor_management@cms.hhs.gov, while faxing decryption codes and bank verification letters to 301-492-4746 by Dec. 1, 2013.

On Dec. 3, 2013 a newly posted Treasury Inspector General for Tax Administration report, dated September 2013, indicated that the IRS’s premium tax credit systems should follow “systems development controls” for security and fraud mitigation, among other functions.

On Dec. 9, 2013, HHS’s Assistant Secretary for Planning and Evaluation (ASPE) issued a report examining, in part, African Americans’ potential qualification for advance premium tax credits.

On Dec. 31, 2013 in a report required by the October 2013 budget deal and reflecting compliance with ACA requirements, Secretary Sebelius certified that Marketplaces verify applicants’ eligibility for advance payments of premium tax credits and cost-sharing reductions. The report examines State-Based and Federal Marketplaces’ approaches to verifying specific data elements that range from residency to household income and family size, among others.

2014

On Jan. 15, 2014 U.S. District Judge Paul Friedman, in denying the plaintiffs’ motion for summary judgment and granting summary judgment to defendant HHS, ruled that the statute “must be read as allowing the IRS to deliver tax credits to individuals purchasing health insurance on federally-facilitated Exchanges”;

In mid-January 2014, CMS began paying, via an interim payment process (see Jan. 13 slides providing an overview), advance payments of the premium tax credit and cost-sharing reductions to Qualified Health Plans, net of Federally Facilitated user fees, if applicable.

On Jan. 21, 2014 HHS released its Annual Update to Poverty Guidelines that will apply to premium subsidy eligibility in 2015.

On Jan. 23, 2014, the IRS posted a fact sheet on premium tax credits, including details on claiming the credit on 2014 tax returns that will be filed in 2015.

On Jan. 30, 2014 HHS published a proposed extension to an already approved information collection (see #1, “Payment Collection Operations Contingency Plan”)  enabling it to obtain issuers’ manually entered, Excel-based payment and enrollment data used to make premium subsidy and cost-sharing reduction payments on an interim basis. The agency indicated HHS will use the information collected to make payments and collect charges in January 2014 and for a number of months thereafter, as may be required based on HHS’ operational progress.” Comments are due on or around March 30.

On Feb. 24, HHS sent the final CY 2015 Notice of Benefit and Payment Parameters rule to OMB for review, the final step before issuance of the regulation. It addresses ’15 parameters for ACA premium stabilization programs, as well as advance premium tax credits and cost-sharing reductions.

On Feb. 5, at a House Ways and Means Oversight Subcommittee hearing, IRS Commissioner John Koskinen (testimony) touched on the agency’s responsibilities under the ACA, including administering premium subsidies.

On Feb. 25, as part of a consumer-oriented “Tax Tip” series, the IRS released background information on the individual mandate penalty (here) and how changes in circumstances affect premium subsidies (here), among other topics.

On March 14, CCIIO issued a bulletin clarifying Feb. 27 guidance (Word document) on the availability of retroactive premium subsidies and cost-sharing reductions if consumers had technical issues gaining eligibility determinations and effectuating their enrollment through Marketplaces. The FAQs address the applicability and timeframe for the Feb. 27 guidance, among other issues.

On March 11, CCIIO released updated examples for Qualified Health Plans using the simplified methodology for calculating cost-sharing reductions as a component of the reconciliation process outlined in the October 2013 program integrity rule. Also see an accompanying Excel document.

On March 7, CMS released a primer, “Report Life Changes to the Marketplace After You Enroll in Coverage,” that addresses factors ranging from marriage and divorce to income-related fluctuations, noting that while some changes can affect eligibility for Special Enrollment Periods, others may affect premium tax credit amounts, among other impacts.

In a March 25 letter to House Budget Committee Chairman Paul Ryan, CBO writes, on premium subsidies, that “high rates of growth projected for the next several years reflect a startup period for the new program,” from $15B in 2014 to $41B in 2015 and rising to $143B in 2024. On March 26, noting that domestic abuse victims face barriers to filing joint returns and accessing premium subsidies, the Treasury highlighted (fact sheet) the head-of-household filing option and provided additional guidance for 2014. Specifically, it said “a married individual who is living apart from his or her spouse, and who is unable to file a joint return as a result of domestic abuse, will be permitted to claim a premium tax credit for 2014 while filing a tax return with a filing status of married filing separately” (see an accompanying IRS notice). Treasury also said it anticipates releasing proposed regulations later this spring, reflecting stakeholder input. On March 18, the IRS published a premium subsidy brochure in Spanish, noting the availability of advance payments of the premium tax credit or the ability to claim it later. For the English version, see here.

On March 24, CMS posted slides presenting the April 2014 timeline for making advance premium subsidy and cost-sharing reduction payments (see slide 7).

On April 21, CMS released an FAQ on premium subsidy eligibility upon voluntary disenrollment from COBRA. See here. On April 14, the CBO and JCT said they now project ACA coverage provisions will cost $5 billion less in 2014 and $104 billion less from 2015-2024 than they had estimated in February 2014. The decline primarily stems from the revised estimate that Marketplace premium subsidies will cost $1.032 trillion instead of $1.197 trillion between 2015-2024. On April 9, the House Energy and Commerce Committee released a Congressional Research Service analysis of CCIIO guidance permitting retroactive advance premium tax credits (APTCs) for off-Exchange plans, if consumers experienced “exceptional” enrollment barriers. The report cites case law that would “arguably support a construction of the ACA and IRC that permits APTCs to be retroactively provided for coverage that was not obtained through an Exchange,” although “it would not be unprecedented if this construction were limited to only those taxpayers who were impacted by the technical issues described in the CCIIO Bulletin,” the CRS adds. The CRS also considers the degree of administrative flexibility the Administration may have had, even if courts viewed the statute literally, which would “seem to be incompatible with the provision of APTCs to issuers for coverage that was not provided ‘through’ an Exchange.” On March 31, CCIIO provided guidance on Marketplaces’ options for assuring access to advance premium tax credits (APTCs) and cost-sharing reductions (CSRs) for domestic abuse victims, who, under a March 28 Treasury notice, may claim premium tax credits via a married-filing-separately tax return instead of a joint return.

On April 11, CCIIO released a document outlining the timeline for enrollment data submission and advance premium tax credit and cost-sharing reduction payments to Qualified Health Plans for May through September 2014.

In a May 27, 2014 letter to HHS’s OIG, Sens. McConnell, Hatch and Coburn say the OIG, in report that is statutorily required by July 2014, should address “a growing body of information” suggesting that Marketplace premium subsidies may not be subject to eligibility-related verification.

On May 23, in an updated timeline, CMS outlines Marketplace QHPs’ enrollment and payment data submission and receipt of Treasury payments of advance premium subsidies and cost-sharing reductions between May and September 2014. On May 21, saying HHS lacks income verification procedures in Federal Marketplaces, House Ways and Means Committee Republicans asked the Treasury to stop paying advance premium subsidies to insurers and requested an estimate of amounts that will be subject to recapture via tax returns.

On June 26, 2014, CCIIO released a proposed rule and guidance specifying the avenue for Federally Facilitated Marketplace (FFM) enrollees to remain auto-enrolled in the same plan for the 2015 open enrollment period, with Marketplace notices enabling them to, among other things, “update their information to get a tailored and updated tax credit that keeps up with any income changes.”  State-Based Marketplaces (SBMs) would have the ability to use the approach that FFMs intend to use (elaborated in further in the procedural guidance); existing regulatory procedures for annual redeterminations; or “alternative procedures approved by [HHS]” under specified criteria on which comment is sought. Comments are due by July 28, 2014. In tandem, CCIIO issued draft standard notices for health insurance issuers to use when discontinuing or renewing a product in the small group or individual market (see here) and instructions for using the draft notices (see here). On June 4, amid reports that 2 million Federal Marketplace enrollees have data “inconsistencies” associated with their enrollment, HHS said it is asking consumers to submit additional documentation to substantiate income, citizenship and other aspects underlying Marketplace and subsidy eligibility if reported data did not match existing sources. The agency indicated that it is offering some flexibility beyond the standard 90-day window to provide the information.

On June 19, 2014, HHS released a report finding, among other things, that QHP enrollees through 36 Federally Facilitated Marketplaces (FFMs) who received premium tax credits paid an average of $82 monthly (76% less than the average full premium of $346) across metal levels and $69 monthly for silver plans. On June 16, CMS posted IRS town hall slides discussing  premium subsidies, including eligibility; the potential impact of changes in circumstances; relevant IRS forms providing documentation; and the mechanics of advance subsidy reconciliation. Also see a 1-pager on additional premium subsidy-related resources. On June 10, the House Ways and Means Subcommittees on Oversight and Health held a joint hearing to examine the implementation of the ACA’s income and insurance verification systems. On June 6, CMS released a notice modifying an existing computer matching program with the Social Security Administration (SSA) that facilitates Marketplace eligibility data needs. It said it was revising the estimated number of fiscal year 2014 transactions (for matched CMS-SSA records) from 5.6 million to 11.8 million in the highest month and from 5.6 million to nearly 18.2 million for the year. On May 29,the IRS issued a publication orienting consumers to the changes in circumstances they should report to Marketplaces if they are having advance payments of premium subsidies made to their QHP.

On July 22, two U.S. Court of Appeals panels issued conflicting rulings regarding the legality of offering ACA premium subsidies in Federally Facilitated Marketplaces (FFMs). In King v. Burwell, the Fourth Circuit Court of Appeals in Virginia unanimously ruled that the IRS is valid in allowing premium tax credits in both State-Based and FFMs. Judges noted that “the applicable statutory language is ambiguous and subject to multiple interpretations” but found the IRS’ interpretation is “a permissible exercise of the agency’s discretion.” Just hours earlier, in Halbig v. Burwell, the D.C. Circuit Court of Appeals ruled 2-1 that subsidies are not legal – vacating the IRS’s rule – since the statutory language of the ACA does not explicitly allow enrollees on FFMs to receive them. The White House will ask the full D.C. Court of Appeals to hear the case. On July 16, the House Energy and Commerce Committee held a hearing to discuss uncertainties behind the ACA’s eligibility system, including application discrepancies. On July 11, CMS posted slides that provide an overview of a recent proposed rule and guidance on Marketplace annual eligibility redeterminations.

On June 4, the Senate Judiciary Subcommittee on Oversight, Agency Action, Federal Rights and Federal Courts held a hearing on King v. Burwell.

On June 10, the House Ways and Means Committee held a hearing with HHS Secretary Burwell, with significant discussion of King v. Burwell scenarios.

On June 25, in a 6-3 decision in King v. Burwell, the Supreme Court upheld the legality of providing premium subsidies through Healthcare.gov

On July 17, CMS released an update (also: IRS “tax tip”) on the importance of filing taxes to reconcile premium subsidies. It noted that those who do not – and are receiving subsidies – will lose subsidy eligibility for 2016 coverage.

On July 20, Senate Finance Chairman Orrin Hatch (R-UT) wrote (PDF) to the IRS to express concern about the integrity of premium subsidy payments and requested an examination of a large sample of individuals who received a subsidy yet failed to submit a tax return.

On July 23, the IRS released a “tax tip” recommending that consumers receiving premium subsidies report changes in circumstances that may affect subsidy accuracy.

On July 29, GAO released a report urging IRS to strengthen oversight of premium subsidy and individual mandate penalty compliance.

2016

On Jan. 8, 2016, the IRS updated Congress on the status of premium tax credits and individual mandate penalties during the 2015 tax filing season (as of October 2015). The agency noted that about 7.9 million reported a total of $1.6 billion in individual mandate penalties averaging $210. About 12.4 million claimed one or more exemptions.

On Jan. 21, 2016, HHS released a report on the average amount of monthly advance premium tax credits in Healthcare.gov states between Nov. 1, 2015 and Dec. 26, 2015.

In May 2016, CMS posted additional details on outreach to employers regarding employees enrolled in QHPs with premium subsidies, including an employer verification study slated to occur through June 2016.

On June 28, CMS posted slides that provide QHPs with an overview of federal efforts to recheck that consumers receiving advance premium tax credits filed a tax return and reconciled the amount of the credit to their income.

On June 30, CMS highlighted key dates for September 2016 as part of its efforts to transition to making policy-based payments (PBPs) to QHP issuers. The PBP payment process automates the monthly enrollment reporting that underlies issuers’ receipt or advanced payments of Marketplace financial assistance.

On July 8, the IRS published a proposed rule on the premium tax credit and individual mandate. The IRS explains that it “address[es] various issues regarding: (1) eligibility for the premium tax credit (including how opt-out arrangements affect an employee’s required contribution); (2) the due date for payment of premiums in the case of retroactive enrollments; (3) the premium assistance amount when certain coverage is terminated mid-month; (4) the benchmark plan premium (including how pediatric dental benefits affect the benchmark plan premium); (5) the reconciliation of advance payments for an individual whom no one claims as a dependent; and (6) certain information reporting rules [applicable to Exchanges].” Comments are due by Sept. 6, 2016.

In an Oct. 24 letter to CMS, House Energy & Commerce Committee GOP leaders criticize the Administration’s claims of premium affordability under the ACA, indicating that taxpayers are essentially “subsidizing the growing cost of health care insurance” through tax credits.

On Oct. 26, Senate Finance Committee Chairman Orrin Hatch (R-UT) and House Ways & Means Committee Chairman Kevin Brady (R-TX) released a white paper calling into question the administration’s income eligibility verification process, used to determine eligibility for subsidies, in the ACA Marketplace.

2017

On Mar. 24, CMS issued a bulletin on 2017 updated federal poverty level (FPL) guidelines, which are used in premium tax credit and cost-sharing reduction eligibility, among other applications.

On April 13, CMS issued its final rule on stability in the individual and small group insurance markets. The agency largely finalizes its proposals on abridging the 2018 open enrollment period, deferring to states on network adequacy, and widening issuers’ flexibility on actuarial value (AV) via the de minimus variation allowance. The agency also posted several subregulatory guidances, including guidance that cites the Administration’s ACA Executive Order in deferring to states on specified aspects of QHP certification and an FAQ on its approach to assessing compliance for issuers participating in the FFMs.

In May 8 slides, CMS highlighted key aspects of its Marketplace stabilization final rule, including guaranteed availability, special enrollment period verification, open enrollment policies.

On June 8, HHS issued a Request for Information (RFI) seeking comments on approaches the agency could take to reduce regulatory burdens in the individual and small group markets and saying the agency is “actively working” to further that goal under Title I of the Affordable Care Act (ACA).

2017

On July 12, the House Democrats’ Affordable and Accessible Health Care Task Force released a plan to stabilize the individual market.

On July 24, the IRS finalized a rule providing relief from the premium tax credit’s joint filing requirement for married individuals who experience domestic abuse or spousal abandonment.

On Sept. 14, CBO released a report examining federal subsidies for health insurance for those under age 65.