(Part 12 of ?): We Win One!
(Part 12 of ?): 2016 Exemption Awarded on Appeal

As described in various earlier posts, I applied for a 2016 ACA exemption on the basis of provisions applicable to individuals whose pre-ACA plans were cancelled as a result of the program. This is the same exemption I applied for and was granted for 2015. Despite clear federal guidance showing the 2016 exemption should have been similarly granted, my 2016 application was denied. This initiated a long series of appeals, a chronology and description of which were related in Part 9. Those appeals culminated in an August 19, 2017 hearing. Yesterday (September 23, 2017), I received the findings of that hearing. Those findings rightly overturned the previous exemption denial.

While I am pleased that someone in this long process took the time to review the applicable ACA guidance and possessed the insight to apply it correctly, I have to wonder how many applicants would have dropped by the wayside before getting to the hearing stage. A full ten months passed from application to hearing results. All information exchanged during the process was one-sided. No rationale was ever provided with the various exemption determinations that were made along the way. The applicant is never sure what they are fighting to overturn as they are never provided with the decision-makers thinking. It is a blind process. Most importantly, there is no recourse available to losing applicants once they start this process, as the ability to buy insurance is lost with the closing of the enrollment window well before even the earliest stages are complete. Resolution is effectively limited to a non-coverage penalty or an exemption. Like everything associated with the ACA, the exemption process is ripe for serious refinement.

Anyway, a win is a win and I’ll take it. Unfortunately, this does nothing to resolve the premium and deductible shortcomings of the ACA, or to address the uninsured nature of our current existence. It is now only one month until the enrollment window for 2017 opens. The exemption criteria I utilized for 2015 and 2016 expire with the 2016 health insurance season, so time to formulate a new approach. More on this and any other continuing ridiculousness in Part 13.

Posted September 24, 2016Questions or comments can be sent to aca@meszler.com