The Department of Health and Human Services (HHS)
also announced it would extend for one month a temporary program
that offers insurance to some of the sickest Americans, who have had
trouble finding private plans in new health insurance marketplaces
set up in all 50 states under Obamacare.
Friday's announcements add to the series of delays and modifications
the administration has made to the Patient Protection and Affordable
Care Act, commonly called Obamacare, since the law was enacted in
2010 and formally launched last October.
Obamacare's six-month enrollment period ends March 31. And with
volume expected to surge in the final two weeks, officials say the
website HealthCare.gov continues to operate smoothly after technical
problems in October and November paralyzed the portal for consumers
in 36 states. The remaining 14 states run their own markets.
About 4.2 million people have enrolled in private Obamacare health
plans so far, and millions more have been found eligible for the
Medicaid program for the poor, according to the administration.
It continues, however, to wrestle with complicated and controversial
issues related to the law.
In its decision on gay couples, HHS exercised federal authority to
prevent discriminatory insurance market practices on an issue that
has been caught up in state marriage laws.
The move follows a February lawsuit filed by an Ohio gay couple, who
were unable to obtain family coverage under Obamacare, they said,
because their state does not recognize same-sex marriage.
The gay community is a key constituency for Democrats, who are
facing a Republican onslaught over Obamacare in this year's midterm
elections for control of Congress.
"If an insurance company offers coverage to opposite-sex spouses, it
cannot choose to deny that coverage to same-sex spouses," Dr.
Matthew Heinz, who heads HHS outreach to lesbian, gay, bisexual and
transsexual communities, said in a posting to a government website.
"In other words, insurance companies will not be permitted to
discriminate against married same-sex couples when offering
coverage. This will further enhance access to health care for all
Americans, including those with same-sex spouses."
A formal clarification from the Centers for Medicare and Medicaid
Services (CMS), the lead Obamacare agency within HHS, said the
administration is encouraging insurers to voluntarily implement the
non-discrimination policy for the 2014 coverage year under the
Public Health Service Act.
Compliance will be required starting in 2015.
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"We expect issuers to come into full compliance with the
regulations as clarified in this guidance no later than for plan or
policy years beginning on or after January 1, 2015," CMS said.
"We also expect states to begin enforcing the regulations in
accordance with this clarification no later than for plan or policy
years beginning on or after January 1, 2015," it said.
Administration officials said the gay marriage decision and
extension of the program for people with pre-existing conditions,
known as the Pre-Existing Condition Insurance Plan (PCIP), were both
intended to help Americans transition to the new healthcare era
established by Obamacare.
The law requires most Americans to pay a penalty unless they are
enrolled in insurance coverage by March 31, which is also when the
PCIP program was set to expire.
Patient advocates welcomed the move, saying people with cancer,
multiple sclerosis or other serious disorders need time to find
insurance plans that meet complicated healthcare needs.
"We encourage patients in PCIP to look at other insurance options,
including the health insurance marketplace at HealthCare.gov, as
soon as possible so they are assured of coverage beyond the short
term," the American Cancer Society Cancer Action Network said in a
The extension came a day after U.S. Health and Human Services
Secretary Kathleen Sebelius told lawmakers in Congress that the
enrollment deadline would not be delayed.
Administration officials said the PCIP program was being extended
through April 30, under congressional authorization that has already
allowed for two other extensions. PCIP was originally intended to
expire at the end of 2013, but was extended first through January
and later through March.
(Reporting by David Morgan, editing by
Karey Van Hall and Gunna Dickson)
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