Maryland Obamacare Exchange Forms Advisory Committee Reflecting 'Gender, Racial, Ethnic, and Geographic Diversity'

    The state agency in charge of Maryland's beleaguered Obamacare Marketplace, the Maryland Health Benefit Exchange (MHBE), is looking to establish a standing advisory committee to provide the board of the MHBE advice and input on a "broad range of policy issues."  The MHBE sent out a letter to "stakeholders" this week who might have an interest in serving on the committee.  While the solicitation does not include prerequisites, qualifications, or credentials required to serve, it expresses the board's desire that the committee reflect "the gender, racial, ethnic, and geographic diversity of the State, as well as one that constitutes a diverse cross–section of stakeholders in the MHBE."
    A copy of letter appears below [highlight added]:

    At the link included in the letter, the board provides a template of a "voluntary, non-binding letter of interest" that asks respondents only for name, organization (including business category), contact information, and  two short answers: how their participation would contribute to the expertise, experience, and diversity of the standing advisory committee, and a description of their knowledge and expertise regarding policy issues of importance to the MHBE.
    The problems with the implementation of the Affordable Care Act in Maryland have ranged from website crashes to lower than expected enrollment to, more recently, faulty Medicaid enrollments.  The exchange has tried extending deadlines, offering retroactive coverage, and even replacing the leadership of the team in charge of the Maryland Health Connection, but problems persist.
    In February, the MHBE even solicited proposals for "WEB-based entities", essentially substitute websites to perform the sign-up and enrollment functions that MarylandHealthConnection.gov was intended to perform.  These "WEB-based entities", however, would still be forced to take the enrollment information back to the Maryland Health Connection to actually enroll consumers in health plans.  While the MHBE confirmed this via email on February 10, the agency has failed to provide further information despite multiple follow up email requests in the intervening weeks.
    In the meantime, the MHBE posted the notice regarding the standing advisory committee.  The original deadline of February 28, 2014 for applications for the committee has been extended to March 7, 2014.  No reason was given for the extended deadline.


Note: A version of this post first appeared at The Weekly Standard.

Maryland Delays Obamacare Small Business Exchange, Jeopardizes Tax Credits

    In mid-October, the Maryland Health Benefit Exchange quietly postponed all of the forums it had scheduled to inform small businesses about the Small Business Health Options Program (SHOP), as reported by THE WEEKLY STANDARD.  Now, in a Friday press release, the Maryland board overseeing the state's Obamacare website announced it had postponed the opening of the SHOP exchange itself from January 1 until April 1, 2014, which could impact businesses who are counting on the tax credits heavily promoted by the Obama administration to help small businesses provide coverage to their employees:

Maryland has a well- functioning small group market which offers the same prices as those that will be offered through the small group exchange, known as the SHOP. The Board approved a plan to open the SHOP on April 1, 2014, which will allow more time for testing and coordination over the next several months.

     Although the press release says that Maryland's small group market offers the same prices as SHOP plans, it does not mention that beginning in 2014, the health insurance tax credits available to businesses are only available to plans purchased via the SHOP exchanges, as noted at Healthcare.gov, and as we reported back in July.  Coverage for small businesses through Maryland's SHOP was previously able to start as early as March 1, 2014, but now that the opening of the marketplace has been delayed until April 1, the earliest date coverage can begin is unclear.  A business that desires to take advantage of the tax credits would either have to delay coverage until SHOP plans are available, or buy a plan through the conventional insurance system, and then reapply through SHOP once the exchange opens.  In either case, the tax credit would only be available for the portion of the year that SHOP coverage is in effect.
    The Maryland Health Connection website itself is also still promoting the tax credits.   It does not indicate what effect the delay will have on the ability of businesses to qualify, though it also notes that "[t]he health care tax credits and deductions are available only if you get coverage through the SHOP."
Since only premiums paid on coverage obtained through SHOP qualify for the tax credit, the calculator provided on the site to come up with a business's estimated annual tax credit is not accurate for coverage obtained during 2014 because it does not take the partial year into account.
    Although the Maryland Health Connection website does not address the effects of the delay, a presentation prepared for a Maryland Health Benefit Exchange Board Meeting on Friday, November 8, asserts that "Tax credits will not be lost – available for 2 years from first receipt."  This is an apparent reference to the fact that the tax credit is limited to two consecutive years, beginning the year coverage starts.  However, according to proposed rules by the IRS published in the federal register, the two-year limit is being interpreted as two tax years, not a 24-month period that may overlap into three different years [emphasis added]:

[T]his credit is available to any eligible small employer only twice (because the credit can be claimed by a small employer only for two consecutive taxable years beginning after December 31, 2013, beginning with the taxable year for which the small employer first claims the credit). Accordingly, no small employer will calculate the credit amount or complete the process for claiming the credit under this regulation more than two times.

    This means that an employer who obtains SHOP coverage sometime in 2014 after the exchange opens could either file for a partial-year credit for 2014 and a full-year credit in 2015, or skip filing for any credit in 2014 and then file for full-year credits in 2015 and 2016.  Since the only apparent advantage of purchasing coverage via SHOP versus the conventional insurance market is the availability of the credits, the delay in the opening of SHOP seems to amount to a de facto delay to January 1, 2015, at least for businesses intent on obtaining the maximum benefit from the tax credits.
    Unless the Maryland Health Connection can reconcile the SHOP delay with the proposed IRS rules, small businesses will be getting something less than is being promised.  An email to the Maryland Health Benefit Exchange requesting clarification on the effect of the delay on tax credits has not yet been returned.


Note: A version of this article first appeared at The Weekly Standard.

Obamacare Pledge: Info on Applications 'Won’t Be Used For Immigration Enforcement Purposes'

    Beginning with a speech last Thursday, President Obama is seeking to rejuvenate his administration's push to reform immigration laws and perhaps draw some attention away from the Obamacare launch debacle that has been dominating the headlines for much of October.  The day following the speech, a new topic appeared on the Healthcare.gov website entitled "What do immigrant families need to know about the Marketplace?"  While a previous entry listed the various immigration statuses that qualified for Marketplace coverage, the new entry is an extended discussion of the questions immigrants, regardless of status, might have about the insurance exchanges.  Among the subtopics discussed are: "Lawfully present immigrants and private insurance," "Immigrant access to Medicaid and CHIP," and "Disclosure of immigration status."
    Under "Disclosure of immigration status," the site goes to great lengths to explain that Marketplaces, whether federal or state, are not permitted to ask for the immigration status of family members who are not applying for coverage or benefits.  "States can’t deny benefits because the applicant doesn’t provide the SSNs of people who aren’t applicants for benefits or recipients of Medicaid or CHIP benefits, or those not required to provide SSNs," the site explains.  After describing how government agencies, including marketplaces, use the federal "data hub" to verify application information, the site notes that "[p]eople who aren’t seeking coverage for themselves won’t be asked about their immigration status."  If an application or the subsequent verification process does reveal problems with immigration status, the site goes on to assure applicants that "[i]nformation provided by applicants or beneficiaries won’t be used for immigration enforcement purposes."
    Elsewhere on the site, users are told that the "U.S. Department of Homeland Security [DHS] may verify your immigration status and/or naturalized citizenship status." But the new statement above suggests that if DHS is unable to verify legal status or the process reveals a possible violation, no action will be taken relative to immigration laws.  However, any false statements on applications may be pursued by law enforcement according to the individual privacy statement on the Healthcare.gov site, which includes the following caution:

If you don’t provide correct information on this form or knowingly and willfully provide false or fraudulent information, you may be subject to a penalty and other law enforcement action.

    As THE WEEKLY STANDARD reported early in October, the privacy policies of the exchanges for at least some states (Maryland, for one) include statements that they "may share information provided in your application with the appropriate authorities for law enforcement and audit activities."  But based on the above language at the Healthcare.gov site, possible violations of immigration laws will not trigger the "law enforcement action" threatened in other cases.


Note: A version of this article first appeared at The Weekly Standard.

Obamacare Exchange Confirms: 'We Are Required to Respond to Certain Requests from Law Enforcement'

    On October 8, THE WEEKLY STANDARD reported that the privacy policy of the Maryland Health Connection (MHC), the state's Obamacare insurance marketplace, included a statement that the marketplace "may share information provided in your application with the appropriate authorities for law enforcement and audit activities."  An email had been sent to the MHC on October 3 requesting clarification of the policy, and included these inquires: Does that include both federal and state authorities?  What type of information from the application might be of interest to law enforcement and/or state/federal auditors?  However, no response was received, and the story was published.

    A follow up email sent to the MHC a day after the story ran was answered by the MHC with the promise of a response the following day, but none was forthcoming.  A third email sent on Friday, October 11, was finally answered late that evening by Communications Manager Betsy Charlow.  The full response reads as follows:

The Maryland Health Connection Privacy Policy has been developed in compliance with federal regulations codified at 45 C.F.R. § 155.260 and 45 C.F.R. § 155.280 to ensure consumer protections and operations of the insurance marketplace. Like all state agencies, we are required to respond to certain requests from law enforcement.

     The regulations cited by Ms. Charlow, while stating that sharing personally identifiable information is proscribed for reasons "that are not permitted or required by law," do not specifically address what types of law enforcement and/or audit activities might qualify for an exception, nor do the regulations detail who is authorized to make the determination for what qualifies for an exception.


Note: A version of this article first appeared at The Weekly Standard.

No Doctors Found in Minnesota Obamacare Exchange, Either

    Tuesday morning, the WEEKLY STANDARD reported that the doctor search feature on the Maryland Health Connection Obamacare insurance exchange was not yet operational and returned a "no doctors are found" message.  A reader from Minnesota has reported that MNsure, the Minnesota exchange, has not yet activated a provider search feature either, and provided a screen grab from the site:

    The MNsure site notes that it is still undergoing regular maintenance:

Account and application system is available Monday – Saturday, 6 am – 10 pm. 

System maintenance is performed Monday – Saturday, 10 pm – 6 am, and all day Sunday.

Note: A version of this article first appeared at The Weekly Standard.