New bills would offer exemptions to ACA’s individual mandate

Two pieces of legislation sponsored by Republicans would waive penalties for people who don’t have health insurance if their options are limited on the Affordable Care Act’s health insurance marketplace.

The Senate bill introduced by Sen. John McCain, R-Arizona, could allow a broad exemption to the individual mandate. Individuals wouldn’t be penalized for not having insurance if they live in a county where one or fewer insurers offer coverage on the ACA exchanges, which could be the situation in 974 counties around the U.S. for 2017.

“This legislation would ensure that Arizonans are not forced to pay a penalty due to the failure of a healthcare system that was fatally flawed from conception,” McCain said on Sept. 7. “This failed law will only continue to place undue burdens on Arizona families unless we replace it with solutions that put patients back in charge of their health care.”

McCain had introduced the bill in response to the special case of Pinal County, Arizona, which was in danger of being the first county with no insurers participating in the ACA exchange. Shortly after the bill was rolled out, Blue Cross Blue Shield of Arizona announced it would offer coverage in the county.

“The fact remains that 14 of Arizona's 15 counties will have a single health insurer to ‘shop’ for coverage when open enrollment begins on November 1,” McCain said after the announcement. “That includes Maricopa County—Arizona's most populous county—which has seen its insurance offerings plummet from eight insurers down to one.”

In the House, a bill sponsored by Rep. Adrian Smith, R-Nebraska, would waive the ACA’s individual mandate for the remainder of a calendar year for enrollees of an ACA co-op which closes in the middle of the year. Several co-ops have been forced to shut down mid-year in 2016, including those in Illinois and Oregon.

Smith said at a Sept. 8 hearing of the House Ways and Means Committee that co-op customers who lost their coverage have “concerns about penalties for lapses in coverage, about having to cover deductibles twice in the same year, and about seniors very close to Medicare who were healthy and simply didn’t see the point in dealing with a brand new insurer for a short time before transitioning to Medicare.”

The bill advanced out of the committee that same day despite Democrats’ concerns it would lead to greater medical costs when a newly uninsured person needs care.

“My concern is that there are a lot of free-riders in America who want to get away with something that they think they can avoid doing while other Americans are doing the right thing, they’re playing by the rules,” said Rep. Xavier Becerra, D-California.