Home > Obamacare > Would it really be illegal for Sebelius to enroll in the ACA Marketplace Exchange

Would it really be illegal for Sebelius to enroll in the ACA Marketplace Exchange

October 30, 2013

Updated 10-31-13 – It was reported after I wrote this that Sebelius is on Medicare, and thus does not qualify for the exchange. However Medicare is a voluntary program. She could theoretically dis-enroll and then be eligible for the exchange. It would not be a wise financial move for her to move to the exchange, but that was the point of the question.

Today I watched the Congressional hearing about the healthcare exchange problems with the US Health and Human Services Secretary Kathleen Sebelius in the hot seat. Honestly most of the hearing was a waste of time. Most of the Republicans spent their time attacking Obamacare instead of determining why the website roll-out of healthcare.gov had been such a debacle. By contrast most of the Democrats spent their time praising Obama and Sebelius for such a great healthcare plan. Neither side spent a lot of time actually looking at what went wrong or what should be done now. To make matters worse Sebelis had the standard answer of “I was not aware” for far too many questions.

There was one very interesting interaction towards the end however. Sebelius was repeatedly asked if she would put herself on the exchange like members of Congress are being forced to. She tried not to answer, but eventually said it would be illegal for her to do so. I found that odd. Having researched the Affordable Care Act for many projects over the last few years I felt pretty confident her statement did not ring true. So I decided to research and find out if her statement was in fact truthful.

First I decided to check out healthcare.gov (it was actually up, it went down just before her hearing) and found this topic:

Am I eligible for coverage in the Marketplace?

Most people will be eligible for health coverage through the Health Insurance Marketplace.

To be eligible for health coverage through the Marketplace, you:

  • must live in the United States
  • must be a U.S. citizen or national (or be lawfully present)
  • can’t be currently incarcerated

U.S. citizens living outside the U.S.

U.S. citizens living in a foreign country are not required to get health insurance coverage under the Affordable Care Act. If you’re uninsured and living abroad, you don’t have to pay the fee that other uninsured U.S. citizens may have to pay.

Generally, health insurance coverage in the Marketplace covers health care provided by doctors, hospitals, and medical services within the United States. If you’re living abroad, it’s important to know this before you consider buying Marketplace insurance.

Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)

Residents of a U.S. territory

U.S. territories can decide whether to create their own Health Insurance Marketplace or expand Medicaid coverage. Residents of a U.S. territory aren’t eligible to apply for health insurance using the federal or state Marketplace.

Check with your territory’s government offices to learn about these options.

Hmm, this aligns with what I remember about eligibility to utilize the marketplace exchange. But then maybe the authors of this website forgot to include all eligibility requirements. So I decided to once again break out the Patient Protection and Affordable Care Act PDF and research eligibility.

Section 1411 of ACA has the eligibility determinations in question. Here is the beginning of this section:

SEC. 1411. PROCEDURES FOR DETERMINING ELIGIBILITY FOR EXCHANGE PARTICIPATION, PREMIUM TAX CREDITS AND REDUCED COST-SHARING, AND INDIVIDUAL RESPONSIBILITY
EXEMPTIONS.
(a) ESTABLISHMENT OF PROGRAM.—The Secretary shall establish a program meeting the requirements of this section for determining—
(1) whether an individual who is to be covered in the individual market by a qualified health plan offered through an Exchange, or who is claiming a premium tax credit or reduced cost-sharing, meets the requirements of sections 1312(f)(3), 1402(e), and 1412(d) of this title and section 36B(e) of the Internal Revenue Code of 1986 that the individual be a citizen or national of the United States or an alien lawfully present in the United States;

The rest of Sec 1411 deals with credits and exemptions (which does not include the Secretary of HHS). This section states individuals must be citizens or nationals of the US or a legal alien living in the US. Three other sections of ACA were referenced, but they do nothing but further restrict what a lawful resident is.

So now it is time to look at what ACA defines as a “qualified individual”. This can be found in Sec  1312(f):

(f) QUALIFIED INDIVIDUALS AND EMPLOYERS; ACCESS LIMITED TO CITIZENS AND LAWFUL RESIDENTS.—
(1) QUALIFIED INDIVIDUALS.—In this title:
(A) IN GENERAL.—The term ‘‘qualified individual’’ means, with respect to an Exchange, an individual who—
(i) is seeking to enroll in a qualified health plan in the individual market offered through the Exchange;
and
(ii) resides in the State that established the Exchange (except with respect to territorial agreements under section 1312(f)).
(B) INCARCERATED INDIVIDUALS EXCLUDED.—An individual shall not be treated as a qualified individual if, at the time of enrollment, the individual is incarcerated, other than incarceration pending the disposition of charges.

Really all this section did was exclude incarcerated individuals. So, unless Sebelius is hiding a secret incarceration, I can’t see how this would apply to her. I searched throughout ACA to see if there was something I missed (quite possible, it is HUGE). If anyone can find something please let me know. But from what I am reading both on healthcare.gov and within the bill as passed into law, it would NOT be illegal for Sebelius to enter into the marketplace exchange.

So was Sebelius willfully lying when she said it would be illegal for her to enter the exchange? I don’t think she sees it as a lie. As I mentioned before those who enter the exchange in 2014 are not allowed employer subsidies. It would be illegal for Sebelius to utilize the exchange marketplace and receive her employer subsidy (taxpayer subsidy, remember she works for us). In order for her to enter the exchange she would have to waive her subsidy and then use healthcare.gov to sign up for a plan in DC.

To summarize:

  • Unless Sebelius is an illegal alien or somehow hiding her being incarcerated there is nothing legal that prevents her from using the marketplace exchange.
  • Sebelius would have to give up her employer contribution to enter the marketplace exchange. It would be illegal for her to be subsidized on the marketplace exchange.
  • The Patient Protection and Affordable Care Act is still a pain the ass to read.

PS. If anyone finds something in ACA that contradicts my findings I would be more than happy to look at it. That is one of the crazy things about reading bills and codified law, there are so many contradictions that exist.

PPS. For some reason I couldn’t get this song out of my head while reading the text of Obamacare this time:

  1. October 31, 2013 at 11:12 pm

    hello
    that are an ok post. Gucci Factory Online Outlet http://reflectionplanetfurniture.com/gucci-factory-online-outlet.html

  2. November 17, 2013 at 1:14 am

    Hello there, I found your site by the usee
    of Google evern as looking for a comparable subject, your site
    got herre up, it seems too be good. I have bookmarked
    it inn my google bookmarks.
    Hello there, just became aware of your weblog via Google,
    and found that it’s truly informative. I’m going to be careful for brussels.
    I’ll be grateful in case you proceed this in future.

    A lot of other people will probably be benefited out of your writing.
    Cheers!

  3. November 28, 2013 at 2:21 am

    Just desire to say your article is as astonishing.
    The clarity in your post is just nice and i could assume you are
    an expert on this subject. Fine with your permission allow me
    to grab your feed to keep up to date with forthcoming post.
    Thanks a million and please carry on the enjoyable work.

  4. March 9, 2014 at 6:25 pm

    Greetings! Very useful advice within this post!

    It’s the little changes that make the most important changes.
    Thanks a lot for sharing!

  5. April 18, 2014 at 12:37 am

    Good article! We are linking to this great article on our website.
    Keep up the great writing.

  6. May 29, 2014 at 2:18 am

    Somebody necessarily assist to make critically articles I’d state.
    That is the very first time I frequented your web
    page and up to now? I surprised with the analysis you made to create this particular submit
    amazing. Fantastic process!

  7. July 5, 2014 at 5:48 pm

    I used to be suggested this blog through my cousin. I’m no longer positive whether
    or not this publish is written via him as no one else understand such particular approximately my
    trouble. You are incredible! Thank you!

  8. July 9, 2014 at 3:27 pm

    What a information of un-ambiguity and preserveness of
    valuable know-how about unexpected emotions.

  9. July 12, 2014 at 6:42 am

    Hey! This is my 1st comment here so I just wanted to give a quick shout out and
    say I truly enjoy reading your posts. Can you suggest
    any other blogs/websites/forums that cover the same topics?
    Thanks a ton!

  1. No trackbacks yet.
Comments are closed.
%d bloggers like this: