U.S. directs insurers to cover gay spouses

President Barack Obama and House Speaker John Boehner visit at a Friends of Ireland luncheon Friday on Capitol Hill. Boehner voiced new doubts about the health-care law Friday.
President Barack Obama and House Speaker John Boehner visit at a Friends of Ireland luncheon Friday on Capitol Hill. Boehner voiced new doubts about the health-care law Friday.

WASHINGTON - Insurers participating in health-insurance exchanges must cover legally married same-sex couples as families, the U.S. government said Friday.

Separately, the government said a program for sick Americans who were denied insurance coverage before this year will be extended another month, through April.Insurers, meanwhile, were told to include more health providers for low-income people in their networks next year and accept premium payments from federal and state programs.

President Barack Obama’s administration is seeking to maximize insurance coverage ahead of a March 31 deadline to sign up for private plans under the 2010 Patient Protection and Affordable Care Act. The government has regularly adjusted the health law’s rules, including a decision last week to allow people with health plans that predate the law to extend them through 2016.

“Insurance companies will not be permitted to discriminate against married same-sex couples when offering coverage,” said Matthew Heinz, the director of gay, bisexual and transgender outreach at the Department of Health and Human Services, in a blog post. “This will further enhance access to health care for all Americans, including those with same-sex spouses.”

A married gay couple in Ohio sued the state and federal governments Feb. 18 after the two tried to buy a family policy through the federal health-insurance exchange and were denied because Ohio doesn’t recognize same sex marriages, according to their complaint.

Insurers offering family policies must sell to someone whose spouse is of the same sex, regardless of whether the marriage is recognized by the applicant’s state government, the Department of Health and Human Services said Friday. The policy takes effect next year.

Many large-employer plans are already operating under similar rules issued last fall by the Labor Department. Those are so-called self-insured plans in which an employer sets aside money to cover most of the expected medical costs of workers. Self-insured employers generally hire an insurance company to administer their benefit plan.

The new rules apply to plans that are sold directly by insurance companies to individuals and employers, usually small to midsize companies.

There are exceptions to the new rule. “Grandfathered” plans that existed when the health law passed four years ago and have changed very little since then do not have to offer coverage to same-sex spouses. Those plans, however, represent a dwindling share of the market.

The new policy also does not apply to Medicaid coverage for low-income people. The administration encourages states to offer Medicaid benefits to same-sex spouses, but state authorities have the final say.

Meanwhile, the decision to extend the program for sick Americans, called the Pre-Existing Conditions Insurance Plan, was posted Friday on the program’s website. The plan was created as a transitional program for people who had been turned down for coverage because of health problems.

“Time is running out,” the administration said on the site. “You need to act to avoid a lapse in coverage.”

About 21,000 people remained in the program as of Jan. 31, according to data released by the U.S. Centers for Medicare and Medicaid Services.

In another change that will take effect in 2015, insurers will be required to include at least 30 percent of federally funded health clinics, public hospitals and other health services used by low-income people in their local networks. The direction came in the final version of a letter to insurance companies participating in the federal Affordable Care Act enrollment system, healthcare.gov. The change had been proposed last month.

The Health and Human Services Department also announced Friday that insurers cannot turn down HIV/AIDS patients whose premiums are being paid through the federal Ryan White HIV/AIDS Program.

The rule was announced after three Louisiana insurers and one North Dakota insurer said they would stop taking funds from the taxpayer-supported program. The insurers said they were relying on another federal policy that discourages third parties from paying individuals’ premiums.

Blue Cross Blue Shield of Louisiana, the state’s largest insurer, stopped taking checks in January, prompting a lawsuit in federal court in Baton Rouge claiming the insurers were rejecting funds so they wouldn’t have to cover HIV patients.

Since major provisions of the Affordable Care Act began in January, health coverage has been extended to millions of Americans, including those previously denied insurance because of pre-existing medical conditions. Insurers are concerned that a large percentage of patients now signing up are older and sicker, forcing the companies to take on more risk.

The new rule says insurers must accept third-party premium payments from the Ryan White program and other federal and state programs.

Enrollment for the current year ends March 31, and administration officials are hoping for a late rush of applications beyond the 4.2 million they claim have already signed up. That is particularly true for younger people, whose health is often good and whose participation helps lower the cost of coverage for sicker people.

Despite a disastrous start and relentless Republican opposition, Obama said Friday that enrollment in the healthcare program is high enough to make it stable for the millions who have signed up.

“At this point, enough people are signing up that the Affordable Care Act is going to work; the insurance companies will continue to offer these plans,” the president said in an interview with WebMD.

“We look forward to seeing more and more people take advantage as some of the politics of the thing get drained away, as people start feeling more confident about the website,” he said.

The president’s remarks were made public as House Republicans held the 51st vote in 38 months to repeal or undermine the law.

The House voted 238-181 Friday to repeal the “individual mandate” for five years in order to finance a new system to pay doctors who participate in Medicare, the U.S. health program for the elderly and disabled. The mandate is a contentious provision that requires most Americans to purchase insurance or pay a penalty.

The four representatives from Arkansas, all Republicans, voted in favor of the House bill, which is not expected to pass the Democratic-controlled Senate.

By itself, the makeover in the Medicare payment system enjoys widespread support among lawmakers in both parties as well as from medical organizations. It is designed to end a cycle of uncertainty that has periodically threatened providers with abrupt cuts in their reimbursements.

Without action by Congress, for example, the fees paid to health professionals who treat Medicare patients are scheduled to drop by 24 percent March 31.

Yet the decision by Republicans to combine the change in the payment system with a delay in the individual mandate meant that even the American Medical Association backed away from the bill. In a statement after the vote, the organization that lobbies on behalf of doctors said it intends to continue working toward legislation that both Congress and Obama can accept.

Republican opponents of the health law said the individual mandate is so riddled with exemptions that it’s almost impossible to run afoul of it. They have pressed the Obama administration to formally lift it.

Millions of people may be exempt from the mandate under rules issued by the Obama administration. Homeless people or homeowners who’ve been foreclosed upon can apply for an exemption. So can those whose utilities have been shut off, who have suffered domestic violence or who have experienced a death in their families.

In December, the administration said people whose existing health plans had been canceled wouldn’t have to comply with the mandate. Last week, the government said that exemption will be extended through 2016. In a catch-all category, anybody who believes he’s had a “hardship in obtaining insurance” can apply for an exemption - documentation is optional.

House Speaker John Boehner, R-Ohio, said the administration may have intentionally gutted its own mandate.

“Quietly, without any fanfare, there’s a real question about whether the White House has just abandoned the individual mandate, the heart of Obamacare itself,” Boehner said Thursday. “This is a huge public policy decision that could affect millions of Americans.”

In a memorandum opposing the House bill, the White House said Friday that repealing the mandate “would result in higher numbers of uninsured Americans, higher premiums for those who remain insured, and fewer premium tax credits for middle-income families, and would increase cost-shifting of uncompensated care to health-care providers, workers, and businesses.” Information for this article was contributed by Alex Wayne and Caroline Chen of Bloomberg News and by Ricardo Alonso-Zaldivar and David Espo of The Associated Press.

Front Section, Pages 1 on 03/15/2014

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