After signaling for months that it was going to crack down on abuse of special enrollment periods, the Obama administration announced this week that it would be requiring those signing up for Patient Protection and Affordable Care Act (PPACA) plans to provide proof that they couldn’t sign up during the open enrollment period.

The decision is in response to complaints from insurers that people who have declined to get coverage during the open enrollment period have been signing up for plans only after they get sick by using the special enrollment exemptions. Insurers say that data shows that those who sign up through special enrollment cost more, on average, than other customers. As a result, a number of major insurers have told brokers that they won’t pay commissions for special enrollment customers.

“We are committed to making sure that special enrollment periods are available to those who are eligible,” Kevin Counihan, the CEO of Healthcare.gov, told the New York Times. “But it’s equally important to avoid misuse or abuse.”

In the midst of threats from some insurers, notably UnitedHealthCare, to halt its participation in the PPACA marketplace, the Obama administration no doubt feels pressure to prove that it’s willing to reduce problems that are preventing insurance profits.

While the decision is good news for insurers, many left-leaning advocacy groups are unhappy with a policy that they say will erect yet another barrier to boosting coverage for low-income Americans.

“The Administration should focus on raising consumer awareness about these opportunities instead of putting bureaucratic roadblocks in the path of people trying to protect their health and that of their families,” said Families USA, a group that helps people sign up for PPACA plans, in a statement.

The group also pushed back on the claims that abuse of special enrollment is rampant, saying that less than 15 percent of those eligible for exemptions have used them.

Instant Insights /

Obama administration demands proof for PPACA special enrollment

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