Lost in the overall shuffle concerning the many problems with Obamacare’s exchanges is the central problem of enforcement of those aspects of the law the president hasn’t waived or delayed yet – including the particular challenge when it comes to verifying the immigration status of those applying for taxpayer subsidized insurance.
On April 1st, the Centers for Medicare and Medicaid Services issued a new guidance document to health insurers. The CMS guidance says that people whose immigration status is uncertain will be presumed eligible for subsidized coverage in Obamacare’s marketplaces while a further review is pending. Emphasis mine:
Question:
The guidance was posted at REGTAP, a portal through which CMS provides “technical assistance and training related to Marketplace and Premium Stabilization programs guidance and operations that address the following areas: Federally-facilitated Marketplace Enrollment, Qualified Health Plan (QHP) Certification, Eligibility, Distributed Data Processing, Small Business Health Options Programs (SHOP), Advanced Premium Tax Credit (APTC) and Cost-Sharing Reduction (CSR) Programs, and the 3 R’s (Risk Adjustment, Reinsurance, and Risk Corridors)”. Here’s the screenshot:
This is categorized as a clarification of the policy, and not a new CMS position – it’s detailed further in this document, titled “FAQ on Remote Identity Proofing, Remote Identity Proofing Failures and Application Inconsistencies (Federally-facilitated Marketplace)”. You can read it here. But note the nature of what CMS is saying here: they are de facto presuming eligibility of anyone who applied in the open enrollment period, regardless of their immigration status.
While Obamacare specifically says undocumented immigrants are not eligible for subsidized coverage in the exchanges, it’s hard to see this directive to insurers as anything but an encouragement to willfully disregard the spirit of the statute. How long will it take to verify these questionable applications? How much money is being spent right now to subsidize such coverage? How would the government recoup any taxpayer dollars spent subsidizing illegal immigrants who inappropriately obtained subsidies?
This latest policy is of a piece with the prior quiet announcements from the administration that verification of eligibility in state exchanges would operate on the honor system, an honor system for employers incentivizing them to lie tied to delay of the employer mandate, and an honor system now being deployed in state exchanges for “qualifying life events” to obtain subsidized insurance.
At each turn in the creation of the exchange structure, the administration basically said “trust us” on implementation. Now they’re saying “trust us” on whether or not the eligibility of these applications with questionable immigration status will be confirmed in a timely way. Of course, they’d never stoop to playing politics with the enforcement of the law to try to boost subsidized enrollment, regardless of whether or not recipients are qualified… would they?
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