Implementing the Affordable Care Act:
Delays, Extensions, and Other Actions Taken
by the Administration
C. Stephen Redhead
Specialist in Health Policy
Janet Kinzer
Information Research Specialist
April 14, 2014
Congressional Research Service
7-5700
www.crs.gov
R43474
Implementing the Affordable Care Act: Delays, Extensions, and Other Administrative Actions
Introduction
The two federal agencies primarily responsible for administering the private health insurance
provisions in the Patient Protection and Affordable Care Act (ACA)—the Centers for Medicare &
Medicaid Services (CMS) within the Department of Health and Human Services (HHS), and the
Internal Revenue Service (IRS) within the Treasury Department—have taken certain actions to
delay, extend, or otherwise modify the law’s implementation.1
Table 1 summarizes selected administrative actions taken by CMS and the IRS to address ACA
implementation. The table entries, which are grouped under general topic headings, are not
organized in any particular priority order. Each entry includes a brief summary of the action and
some accompanying explanatory material and comments to help provide additional context.
Where available, links are provided to relevant regulatory and guidance documents online.
Readers are encouraged to review these documents for more details about each action taken.
The actions summarized in the table, which address some of the ACA’s core insurance expansion
provisions,2 are not the result of a single policy decision. They represent multiple separate
decisions taken by the Administration to address a variety of factors affecting the implementation
of specific provisions of the law. In compiling the table, CRS made decisions about which
administrative actions to include, and which ones to leave out. Generally, CRS included the more
significant actions that have been the subject of debate among health policy analysts and, in some
instances, the target of criticism by opponents of the ACA. The table is not intended to be a
comprehensive list of ACA-related administrative actions.
Perhaps the most controversial action is the Administration’s decision to delay enforcement of the
ACA’s “employer mandate.” On July 9, 2013, the IRS announced that it would not take
enforcement action against employers who fail to comply with the law’s employer mandate until
the beginning of 2015. This ACA provision, which took effect on January 1, 2014, requires
employers with 50 or more full-time equivalent employees to offer their full-time workers
affordable health coverage or pay a penalty if one or more employees purchase coverage through
an exchange and receive a premium tax credit. The IRS subsequently announced that employers
with at least 50 but fewer than 100 full-time equivalent employees will have an additional year to
comply with the employer mandate. According to the Administration, these actions were taken
after it concluded that the ACA’s employer mandate could not be enforced until the related
requirement that employers report the coverage they offer to their employees had been fully
1 The ACA was signed into law on March 23, 2010 (P.L. 111-148). On March 30, 2010, the President signed the Health
Care and Education Reconciliation Act (HCERA; P.L. 111-152), which amended numerous provisions in the ACA.
HCERA also included multiple new freestanding provisions related to the ACA. Several other bills enacted during the
111th and 112th Congresses made additional changes to selected ACA provisions. All references to the ACA in this
report refer, collectively, to the law as amended and to the related HCERA provisions.
2 A detailed examination of the ACA is beyond the scope of this report. Readers who are unfamiliar with the ACA’s
provisions to restructure the private health insurance market and expand access to affordable health insurance through
the competitive marketplaces—or exchanges—and the expansion of state Medicaid programs will find numerous CRS
products that provide more in-depth information on the law at http://www.crs.gov/pages/subissue.aspx?cliid=3746&
parentid=13&preview=False.
Congressional Research Service
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Implementing the Affordable Care Act: Delays, Extensions, and Other Administrative Actions
implemented. The IRS says that it is working with stakeholders to simplify the reporting process
consistent with effective implementation of the law.3
Other controversial administrative actions include those taken in response to the decision by
insurers to cancel individual and small-group health plans that do not meet the ACA’s new
standards for health insurance coverage, which also took effect on January 1, 2014. On November
14, 2013, the Administration notified state insurance commissioners of the option to delay
enforcement of certain health insurance reforms under the ACA. It encouraged state officials to
permit insurers to renew noncompliant policies in the individual and small-group market for
policy years starting between January 1, 2104, and October 1, 2014.4 The Administration has
since extended this policy for two years. Thus, at the option of state regulators, insurers may
continue to renew noncompliant policies at any time through October 1, 2016.5
Finally, HHS has been criticized for providing special enrollment periods for individuals who
were unable to enroll in a qualified health plan (QHP) offered through a federally facilitated
exchange prior to the March 31, 2014, deadline due to technical problems or other exceptional
circumstances.6
Opponents of the ACA, who believe that the law is fundamentally flawed, argue that some of the
Administration’s actions effectively rewrite the law in an effort to make it work and confuse the
public. The ACA’s critics also assert that the actions taken by the Administration to delay
enforcement of the employer mandate are illegal and raise concerns that the President is not
upholding his constitutional duty to faithfully execute federal law.7
The Administration counters that its actions are not a refusal to implement and enforce the ACA
as written. Instead, they represent temporary corrections necessary to ensure the effective
implementation of a very large and complex law. Agency officials point to a number of factors
that have made it difficult to meet various ACA deadlines. Those factors include a lack of
appropriations to help fund implementation activities, technological problems including the
poorly managed launch of the websites for the federally facilitated exchange and the state-based
exchanges, and the need to phase in the various interconnected parts of the law so as to avoid
unnecessary disruption of employment and insurance markets.8
3 Internal Revenue Service, “Transition Relief for 2014 Under §§ 6055 (Information Reporting), 6056 (Information
Reporting) and 4980H (Employer Shared Responsibility Provisions),” Notice 2013-45, July 9, 2013,
http://www.irs.gov/pub/irs-drop/n-13-45.PDF.
4 The White House, “Fact Sheet: New Administration Proposal to Help Consumers Facing Cancellations,” November
14, 2013, http://www.whitehouse.gov/the-press-office/2013/11/14/fact-sheet-new-administration-proposal-help-
consumers-facing-cancellatio.
5 Department of Health & Human Services, Centers for Medicare & Medicaid Services, “Insurance Standards Bulletin
Series - Extension of Transitional Policy through October 1, 2016,” March 5, 2014, http://www.cms.gov/CCIIO/
Resources/Regulations-and-Guidance/Downloads/transition-to-compliant-policies-03-06-2015.pdf.
6 Department of Health & Human Services, Centers for Medicare & Medicaid Services, “Guidance for Issuers on
Special Enrollment Periods for Complex Cases in the Federally-facilitated Marketplace after the Initial Open
Enrollment Period,” March 26, 2014, http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/
complex-cases-SEP-3-26-2014.pdf.
7 Simon Lazarus, “Delaying Parts of Obamacare: ‘Blatantly Illegal’ or Routine Adjustment?,” The Atlantic, July 17,
2013, http://www.theatlantic.com/national/archive/2013/07/delaying-parts-of-obamacare-blatantly-illegal-or-routine-
adjustment/277873/.
8 Timothy Stoltzfus Jost and Simon Lazarus, “Obama’s ACA Delays - Breaking the Law or Making it Work?,” New
England Journal of Medicine, April 2, 2014, http://www.nejm.org/doi/pdf/10.1056/NEJMp1403294.
Congressional Research Service
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Implementing the Affordable Care Act: Delays, Extensions, and Other Administrative Actions
Regarding the employer mandate delay, the Administration says that its actions are no different
from those taken by previous administrations faced with the challenges of implementing a
complicated law. The Administration notes that its decision to grant employers “transition relief,”
taken pursuant to administrative authority under the Internal Revenue Code to “prescribe all
needful rules and regulations” to administer tax laws,9 is part of an established practice to provide
relief to taxpayers who might otherwise struggle to comply with new tax law.10
Notwithstanding the Administration’s arguments, critics question whether some of the recent
delays of ACA provisions exceed the executive’s traditional discretion in enforcing law to the
point that they represent a blatant disregard of the law. For example, they argue that the decision
to encourage states to allow insurers to renew noncompliant policies for people who want to keep
their current plans directly contravenes provisions of the ACA that had become politically
inconvenient.11
This report is updated periodically to reflect significant ACA implementation actions taken by the
Administration. A companion CRS report summarizes all the legislative actions taken by
Congress since the ACA’s enactment to repeal, defund, delay, or otherwise amend the law.12
9 Section 7805(a) of the Internal Revenue Code; 26 U.S.C. §7805(a).
10 Letter from Mark J. Mazur, Assistant Secretary for Tax Policy, to Honorable Fred Upton, Chairman, Committee on
Energy and Commerce, July 9, 2013, http://democrats.energycommerce.house.gov/sites/default/files/documents/Upton-
Treasury-ACA-2013-7-9.pdf. For a legal analysis of the Administration’s decision to delay enforcement of the
employer mandate, see CRS Legal Sidebar, Obama Administration Delays Implementation of ACA’s Employer
Responsibility Requirements: A Brief Legal Overview, posted July 8, 2013, http://www.crs.gov/LegalSidebar/
details.aspx?ProdId=582.
11 Nicholas Bagley, “The Legality of Delaying Key Elements of the ACA,” New England Journal of Medicine, April 2,
2014, http://www.nejm.org/doi/pdf/10.1056/NEJMp1402641. For a legal analysis of the Administration’s decision to
permit insurers to renew noncompliant policies for individuals and small businesses, see CRS Legal Sidebar, Obama
Administration’s “Fix” for Insurance Cancellations: A Legal Overview, posted November 18, 2013,
http://www.crs.gov/LegalSidebar/details.aspx?ProdId=724.
12 CRS Report R43289, Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act, by C. Stephen
Redhead and Janet Kinzer.
Congressional Research Service
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Table 1. Selected Administrative Delays and Other Changes to ACA Implementation
Summary of Administrative Action
Explanatory Notes and Comments
2014 Open Enrollment: Hardship Exemption, December 2013 Enrollees
On October 28, 2013, CMS announced that it would exempt from the individual
ACA Section 1501(b) requires most U.S. citizens and legal residents to maintain
mandate penalty those individuals who wait until after February 15, 2014, to enrol in a
minimum essential health coverage beginning in 2014. Individuals without coverage for
qualified health plan (QHP) offered through an exchange during the 2014 open
three consecutive months will have to pay a penalty unless they qualify for one of the
enrol ment period. See http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/
statutory exemptions.
Downloads/enrol ment-period-faq-10-28-2013.pdf.
CMS specified in regulation (45 C.F.R. 155.410) that the initial open enrollment period
HHS fol owed that action with additional announcements aimed at individuals seeking
for individuals to enroll in coverage through an exchange would extend from October
to enrol for coverage beginning January 1, 2014. First, on November 22, 2013, HHS
1, 2013, through March 31, 2014. For individuals who sign up for coverage between
extended the December 15 deadline to sign up for health coverage beginning January 1 the 1st and 15th of a given month, the coverage effective date is the first day of the
by eight days, to December 23. Second, citing delays due to heavy use of
immediately fol owing month. However, for those who sign up between the 16th and
Healthcare.gov, HHS on December 23 announced a 24-hour grace period for
end of a given month, the coverage effective date is the first day of the second
individuals trying to sign up for coverage beginning January 1, effectively extending the
fol owing month. Thus, an individual who signed up on February 16, 2014, would not
deadline to December 24. Third, HHS announced on December 24 that individuals
be insured until April 1, 2014. That individual would be uninsured for the first three
might qualify for a special enrol ment period, pursuant to ACA Section 1311(c)(6)(C),
months of 2014 and would have to pay a fine, unless otherwise exempt. CMS
as implemented by 45 C.F.R. 155.420, if they could show that they missed the deadline
exercised its authority under IRC Section 5000A(e)(5), as added by ACA Section
for coverage beginning January 1 because of problems with Healthcare.gov. For more
1501(b), to establish a hardship exemption in order to provide relief for such
information, see http://www.nytimes.com/interactive/2013/12/20/us/politics/changes-
individuals who waited until after February 15, 2014, to enroll.
and-delays-to-health-law.html?_r=1&.
2014 Open Enrollment: Special Enrollment Periods in the Federally Facilitated Exchanges
On March 26, 2014, five days before the close of the 2014 open enrol ment period,
The circumstances that warrant a special enrollment period include a natural disaster,
CMS announced that people who attest that they have been unable to enrol in a QHP
a serious medical condition, unresolved casework, errors related to immigration
through the federally facilitated exchange for various specified circumstances will be
status, and technical problems with Healthcare.gov. For a complete list, see
eligible for a special enrollment period, pursuant to ACA Section 1311(c)(6)(C), as
http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/complex-
implemented by 45 C.F.R. 155.420. Such individuals will be able to enroll after open
cases-SEP-3-26-2014.pdf.
enrol ment closes on March 31.
2014 Open Enrollment: Exceptional Circumstances in State-Based Exchanges and Retroactive Payment of Subsidies
On February 27, 2014, CMS issued guidance al owing state-based exchanges to provide Individuals must receive an eligibility determination in order to enroll in a QHP offered
advance payments of the premium tax credit and cost-sharing reductions on a
through an exchange and receive the premium tax credit and cost-sharing reductions
retroactive basis for eligible individuals who were unable to enroll in a QHP through
authorized by the ACA.
the exchange because IT problems prevented timely eligibility determinations. CMS
considers this situation an exceptional circumstance under 45 C.F.R. 155.420. Once a
successful eligibility determination is obtained and the individual enrolls in the QHP
through the exchange, the exchange may deem the coverage to have started on the
date the individual originally submitted an application and encountered the IT
problems. This would allow the individual to get the premium tax credit and cost-
sharing reductions retroactively if they qualify based on income.
CRS-4
Summary of Administrative Action
Explanatory Notes and Comments
Additionally, if an individual covered under this exceptional circumstance has enrolled
The February 27, 2014, guidance is at http://www.cms.gov/CCIIO/Resources/
in the QHP outside of the exchange, then once that individual receives an eligibility
Regulations-and-Guidance/Downloads/retroactive-advance-payments-ptc-csrs-02-27-
determination for exchange coverage, the exchange may deem the individual to have
14.pdf. CMS issued clarifications to the February 27 guidance on March 14; see
been enrol ed in the QHP through the exchange retroactive to the date the individual
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/retroactive-
enrol ed outside of the exchange. Again, this would allow the individual to get the
advance-payments-ptc-csrs-03-14-14.pdf.
premium tax credit and cost-sharing reductions retroactively if he or she qualifies
based on income. Upon making an eligibility determination, the exchange also must
provide a special enrollment period under 45 C.F.R. 155.420 to allow these individuals
the opportunity to change QHPs prospectively.
Renewal of Cancelled Health Plans
On November 14, 2013, the Administration established a transition policy—which it
Under the ACA, health plans that consumers had at the time the law was enacted in
encouraged state health commissioners to adopt—in response to the decision of
2010 were “grandfathered” in and have existed largely unchanged since the law’s
insurers to send cancellation notices to individuals and small businesses with health
enactment. Grandfathered plans do not have to adopt many of the ACA’s new
plans in the individual and small group markets that do not meet the ACA’s new
requirements for health insurance, including coverage of essential health benefits and
standards for health insurance coverage. Under the policy, insurers could choose to
other consumer protections that took effect at the beginning of 2014. However, new
renew such noncompliant health plans for a policy year starting between January 1,
(i.e., non-grandfathered) plans purchased since the law’s enactment have to meet all
2014, and October 1, 2014, if permitted by state insurance regulators. CMS also
the ACA requirements. For a January 8, 2014, update on state decisions regarding the
indicated that it would consider the impact of this transition policy in assessing
transition policy on health plan cancellations, see http://www.commonwealthfund.org/
whether to extend it. The intent of the policy was to allow Americans whose
Blog/2013/Nov/State-Decisions-on-Policy-Cancel ations-Fix.aspx.
insurance companies cancelled their insurance coverage for 2014 to remain in their
plans. See http://www.whitehouse.gov/the-press-office/2013/11/14/fact-sheet-new-
administration-proposal-help-consumers-facing-cancel atio.
On December 19, 2013, CMS issued further clarification of the options available to
consumers with cancelled policies. These consumers are eligible for a hardship
exemption from the individual mandate penalty if other available options are
unaffordable, or they can purchase a catastrophic plan if one is offered in their area.
See http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/
cancellation-consumer-options-12-19-2013.pdf.
On March 5, 2014, CMS extended the transition policy for two years, to policy years
beginning on or before October 1, 2016. Thus, at the option of state regulators,
insurers who issued (or plan to issue) a policy in the individual or small group market
under the November 14, 2013, transition policy may renew such policies at any time
through October 1, 2016. CMS also indicated that it would consider the impact of the
two-year extension in assessing whether an additional one-year extension is
appropriate. CMS also extended the hardship exemption established for consumers
with cancelled policies until October 1, 2016. See http://www.cms.gov/CCIIO/
Resources/Regulations-and-Guidance/Downloads/transition-to-compliant-policies-03-
06-2015.pdf.
CRS-5
Summary of Administrative Action
Explanatory Notes and Comments
Exchange Applicant Eligibility and Verification
HHS’s July 15, 2013, final rule on health insurance exchange eligibility and enrollment
Under IRC Section 36B(b), as added by ACA Section 1401(a), individuals and families
included two one-year delays regarding verification of applicant information. First, the
who enroll in qualified health plans (QHPs) offered through an exchange are eligible
rule permits state-based exchanges during 2014 to audit less than 100% of exchange
for refundable premium tax credits if their income is between 100% and 400% of the
applicants who report income at least 10% below the amount indicated by IRS and SSA federal poverty level.
records, provided the sample size used is statistically significant. The government
initial y had proposed an audit of all such individuals.
Second, state-based exchanges will not be required until 2015 to verify applicants’
Under IRC Section 36B(c)(2)(C), as added by ACA Section 1401(a), individuals whose
information about employer coverage in order to determine eligibility for premium tax employer offers a health plan that is affordable (i.e., the employee’s share of the
credits. During 2014 the exchanges may accept an applicant’s attestation regarding
premium does not exceed 9.5% of the employee’s household income) and provides
employer coverage without further verification. See 78 Federal Register 42159,
minimum value (i.e., the plan’s share of the total allowed costs of benefits provided
http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-16271.pdf.
under the plan is at least 60%) are not eligible for a premium tax credit through the
exchange.
2015 Open Enrollment
On November 22, 2013, HHS announced that it was planning to delay by one month
The open enrollment period for 2015 will begin November 15, 2014—instead of
the open enrol ment period for plan years that begin in 2015. The dates for the 2015
October 15, 2014—and extend through February 15, 2015.
open enrol ment period were included in the final rule for benefit and payment
parameters for 2015, which was published on March 11, 2014. See 79 Federal Register
13743, http://www.gpo.gov/fdsys/pkg/FR-2014-03-11/pdf/2014-05052.pdf.
Employer Mandate and Insurer Reporting
On July 9, 2013, the IRS provided transition relief to employers by delaying until 2015
Generally, under IRC Section 4980H (“Shared Responsibility for Employers Regarding
the ACA requirement that employers with at least 50 ful -time equivalent employees
Health Coverage”), as added by ACA Section 1513, employers with at least 50 ful -
provide health coverage for their full-time workers or risk paying a penalty. The IRS
time equivalent employees are liable for a penalty if (1) they do not offer health
also delayed until 2015 the requirement for employers and insurers to report certain
coverage to at least 95% of their ful -time employees (and their dependents) and at
information to the IRS. The agency indicated that these actions were taken pursuant to least one ful -time employee receives a premium tax credit for coverage purchased
its administrative authority under IRC Section 7805(a) to grant transition relief when
through an exchange; or (2) they offer health coverage to all or at least 95% of ful -
implementing new legislation. See http://www.irs.gov/pub/irs-drop/n-13-45.PDF.
time employees, but at least one ful -time employee receives a premium tax credit for
coverage purchased through an exchange because the employer didn’t offer coverage
The IRS’s February 12, 2014, final rule on the ACA’s employer mandate included an
to that employee or because the coverage offered was either unaffordable or did not
additional year of transition relief for employers with at least 50 but fewer than 100
provide minimum value (see explanatory note for “Exchange Applicant Eligibility and
ful -time equivalent employees, provided the employers meet certain other
Verification”). IRC Section 6055, as added by ACA Section 1502(a), requires reporting
requirements such as not reducing their workforce to qualify for the additional relief
by insurers, self-insuring employers, and other parties that provide health coverage.
and maintaining previously offered coverage. These employers would not be subject to IRC Section 6056, as added by ACA Section 1514(a), requires certain employers to
the ACA’s employer mandate until 2016. In addition, employers subject to the
report on the health coverage they offer to their full-time employees. For more
mandate in 2015 (i.e., those with 100 or more ful -time equivalent employees) can
information on the ACA employer mandate, including transition relief, see
avoid a penalty by offering coverage to 70% of their ful -time employees, as opposed to http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-
95% of such employees (as described in the explanatory notes). See 79 Federal Register
Responsibility-Provisions-Under-the-Affordable-Care-Act.
8543, http://www.gpo.gov/fdsys/pkg/FR-2014-02-12/pdf/2014-03082.pdf.
CRS-6
Summary of Administrative Action
Explanatory Notes and Comments
W-2 Reporting of Employer-Sponsored Health Coverage
In a series of notices, the IRS has provided transition relief to employers by giving
IRC Section 6051(a), as amended by ACA Section 9002, general y requires the cost of
them additional time to make any necessary changes to payrol systems and
employer-sponsored health coverage to be reported on Form W-2 (Wage and Tax
procedures in order to comply with the ACA’s W-2 reporting requirement. First, it
Statement). This reporting requirement applies to taxable years beginning after
made reporting on the 2011 W-2—typical y provided to employees in January 2012—
December 31, 2010. For more information on the W-2 reporting requirement and
optional. Second, while employers are generally required to report the cost of health
associated transition relief, see http://www.irs.gov/uac/Employer-Provided-Health-
benefits on the W-2 for 2012 and subsequent years, the IRS has provided transition
Coverage-Informational-Reporting-Requirements:-Questions-and-Answers.
relief for certain employers and with respect to certain types of coverage. Employers
covered by the transition relief are not required to report until future guidance is
issued.
Annual Limits on Cost-Sharing and Deductibles
Plans may use more than one service provider to help administer benefits (e.g., a
PHSA Section 2707(b), as added by ACA Section 1201, requires group health plans to
separate pharmacy benefits manager for coverage of pharmaceuticals), each of which
ensure that any annual cost-sharing (e.g., deductibles, coinsurance, copayments)
may impose different cost-sharing. To allow service providers more time to
imposed under the plan for a plan year beginning on or after January 1, 2014, does not
coordinate their cost-sharing requirements so that the plan meets the ACA’s annual
exceed the limitations established under ACA Section 1302(c)(1) and (c)(2). Under
cost-sharing limits, the Administration on February 20, 2013, announced a one-year
ACA Section 1302(c)(1), annual cost-sharing for a plan year beginning in 2014 may not
grace period to allow each service provider to apply the cost-sharing limits to the
exceed the current-law Health Savings Accounts limits; for each plan year thereafter
benefits they administer. Under this policy, for example, many group health plans will
these limits are indexed to the percentage increase in average per-capita premiums.
be able to maintain separate cost-sharing limits for medical coverage (e.g., hospital and
Under ACA Section 1302(c)(2), which applies only to the small group market, the
doctors’ services) and for prescription drug coverage. However, this policy applies
deductible for a plan year beginning in 2014 may not exceed $2,000 for individuals and
only to the first plan year beginning in 2014. See http://www.dol.gov/ebsa/faqs/faq-
$4,000 for families; again, for each plan year thereafter these limits are indexed to the
aca12.html.
percentage increase in average per-capita premiums.
Pre-Existing Condition Insurance Plan (PCIP)
On March 14, 2014, HHS announced that individuals enrol ed in a PCIP who had not
ACA Section 1101 instructed the HHS Secretary to establish a temporary program—
yet found new health insurance coverage through an exchange could purchase an
PCIP—to provide health insurance coverage for eligible individuals who have been
additional month of PCIP coverage through April 30, 2014. This is the third time that
uninsured for six months and have a pre-existing condition. PCIP is federal y
HHS has extended PCIP coverage. The PCIP program was originally scheduled to
administered in 23 states and DC; the remaining states administer their own PCIPs.
terminate on January 1, 2014. However, on December 12, 2013, HHS announced that
The ACA appropriated $5 billion, to remain available without fiscal year limitation, to
the PCIP program would be extended through the end of January 2014. Then on
pay claims against (and administrative costs of) PCIPs that are in excess of premiums
January 14, 2014, HHS announced that individuals could keep their PCIP coverage for
col ected from enrol ees. The federally-run PCIP and state-run PCIPs stopped
two additional months, through March 31, 2014. Under the most recent
accepting new enrol ees on February 16, 2013, and March 2, 2013, respectively,
announcement, PCIP participants must enrol in a new plan by April 15 for coverage to because of the finite amount of available funding. Under the law, PCIP coverage was to
begin on May 1, if they want to avoid a lapse in coverage.
end on January 1, 2014, and the Secretary was instructed to develop procedures for
transitioning individuals enrolled in PCIP into qualified health plans offered through the
exchanges. However, ACA Section 1101(g)(3) gave the Secretary the authority to
extend PCIP coverage, if necessary, to avoid a lapse in coverage for such individuals.
For more information, see https://www.pcip.gov/.
CRS-7
Summary of Administrative Action
Explanatory Notes and Comments
Basic Health Plan Option
On February 7, 2013, HHS announced that implementation of the Basic Health
ACA Section 1331, as amended, permits states to establish a BHP in which states
Program (BHP) would be delayed by one year until 2015. The BHP gives states the
contract with private-sector and cooperative health plans to provide health insurance
option of using ACA subsidies to help cover certain low-income individuals whose
coverage for certain low-income individuals not eligible for the state’s Medicaid
income is too high to qualify for Medicaid. See http://www.medicaid.gov/State-
program with incomes between 133% and 200% of the federal poverty level. States
Resource-Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-Implementation/
that decide to offer a BHP receive federal funding equal to 95% of the value of the
Downloads/FAQs-by-Topic-BHP.pdf.
premium tax credits and cost-sharing subsidies that eligible individuals would have
received had they purchased coverage through an exchange. For more information,
see http://medicaid.gov/Basic-Health-Program/Behavioral-Health-Program.html.
Small Business Health Options Program (SHOP) Exchanges
HHS’s June 4, 2013, final rule for the SHOP exchanges included a transition policy that
ACA Section 1311 requires each state (or the federal government on its behalf) to
delays until 2015 a requirement that SHOP exchanges provide qualified employers the
establish a SHOP exchange through which small employers will be able to purchase
option to offer employees a choice of QHPs. For plan years beginning in 2014,
plans for their employees. Initial y, states can choose to open SHOP exchanges to
federally facilitated SHOP exchanges will only allow employers to select one QHP to
companies with up to 100 employees or limit participation to companies with 50 or
offer to their employees, while state-based SHOP exchanges may allow employers to
fewer employees. By 2016, states must open the exchanges to companies with up to
choose one or more QHPs to offer to their employees. See 78 Federal Register 33233,
100 employees. Beginning in 2017, states have the option to open SHOP exchanges to
http://www.gpo.gov/fdsys/pkg/FR-2013-06-04/pdf/2013-13149.pdf.
companies with more than 100 employees. Employers with fewer than 25 employees
may qualify for tax credits if they purchase insurance coverage for their employees
On November 27, 2013, HHS announced that federally facilitated SHOP exchanges
through a SHOP exchange. For more information, see https://www.healthcare.gov/
will not accept online enrollments for one year, until November 2014. In the
small-businesses/.
meantime, small businesses can enroll in plans listed on these exchanges through an
insurance agent or broker, or directly with the insurance carrier. Note: This
announcement represented the third delay in launching the online SHOP exchange,
which was original y expected to be fully functional at the beginning of October 2013.
See http://www.hhs.gov/healthcare/facts/blog/2013/11/direct-new-path-to-shop-
marketplace.html.
On March 14, 2014, CMS announced that it will consider requests from states that are
not yet able to enroll small businesses through their SHOP exchanges online to use
the same direct enrollment approach that the federally facilitated SHOP exchanges
have implemented for 2014. See http://www.cms.gov/CCIIO/Resources/Fact-Sheets-
and-FAQs/Downloads/retroactive-advance-payments-ptc-csrs-03-14-14.pdf.
Electronic Reporting
HHS’s July 15, 2013, final rule on health insurance exchange eligibility and enrollment
Exchanges must also provide required notices by regular mail or, if an individual elects,
delayed until 2015 a requirement that state Medicaid agencies provide notices
electronically, provided that the specifications for electronic notices in 42 C.F.R.
electronical y to beneficiaries. Between October 1, 2013, and January 1, 2015, state
435.918 are met. However, exchanges may choose to delay until 2015 the
Medicaid agencies must give individuals the choice to receive notices in electronic
requirement in 42 C.F.R. 435.918(b)(1) that individuals who elect to receive electronic
format or by regular mail. Agencies must ensure that an individual’s choice to receive
notices receive confirmation by mail. [45 C.F.R. 155.230(d)]
electronic notices is confirmed by regular mail, and must inform the individual of his or
her right to switch to receiving notice through regular mail. [42 C.F.R. 435.918] See 78
Federal Register 42159, http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-
16271.pdf.
Source: Prepared by the Congressional Research Service based on a review of the documents cited in the table.
CRS-8
Implementing the Affordable Care Act: Delays, Extensions, and Other Administrative Actions
Author Contact Information
C. Stephen Redhead
Janet Kinzer
Specialist in Health Policy
Information Research Specialist
credhead@crs.loc.gov, 7-2261
jkinzer@crs.loc.gov, 7-7561
Congressional Research Service
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