Matt Lewis

Another Obamacare delay shows the benefit of friends in high places

By “Matt Lewis & The News” guest blogger Doug Mataconis

It was just a few weeks ago that the Obama Administration delayed the implementation of the Affordable Care Act’s employer mandate in the face of evidence that large numbers of employers, not to mention the Federal Government itself, would not be ready to comply with that portion of the law. In addition to raising questions about whether or not the Administration actually had legal authority to take this action, the delay has also provided impetus to Republicans on Capitol Hill who have proposed that the entirety of the PPACA be delayed, including the individual mandate scheduled to go into effect in 2014. The Administration has, quite obviously, resisted these calls and insisted that the portions of Obamacare that would most closely impact individual Americans will be ready to go into effect as scheduled. Despite this, however, we learn today that the Administration has delayed yet another provision of the law, and this one is likely to have a serious impact on consumers:

WASHINGTON — In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.

The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.

The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.

The discovery is likely to fuel continuing Republican efforts this fall to discredit the president’s health care law.

Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.

Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.

The justification being given for this delay is that insurance providers are apparently not ready to implement the laws requirement of a single across the board limit on out-of-pocket costs, in no small part because current industry practices involve calculating deductible and out-of-pocket for different types of medical services (i.e., doctor’s visits, hospital stays, and prescriptions) separately. Insurance companies have been complaining to the government that, because of this, it would be next to impossible for them to update their systems in time to be compliance with the law by the end of this year. So, much like employers who complained about the burden of implementing the employer mandate were able to get the Administration to buy them a years time to comply with the law, insurance companies have been able to convince the Administration to relieve them of the burden of having to comply with the law while leaving those portions of it that most directly impact consumers on schedule. Apparently, it pays to have friends in high places.

While this delay is likely to help the insurance industry, it’s not going to be of much help to consumers, or to people suffering from serious illnesses. They will continue to face the problem of having to cover out-of-pocket expenses for medical treatment that, in many cases, they won’t be able to afford. In the case of cancer patients, that’s an expense that can run to hundreds of thousands of dollars per year. Of course, there aren’t many advocates for cancer patients that have the clout on K Street that insurance companies do, so they’re concerns are unlikely to be heard in the halls of Congress or the White House.

Many words have been written already about what’s wrong with Obamacare. We can already see some of those problems developing as more and more people report that their insurance premiums are being raised by astronomical amounts in anticipation of the full implementation of the law, or that their hours are being cut back so that their employers don’t have to comply with the law’s requirement that health insurance be provided for all employees. There isn’t much that I can add here that be “news” as far as the bad news about Obamacare is concerned.

What these recent delays by the Administration in the implementation of the law reveal, though, is the extent to which those with power and money are able to get what they want out of Washington. Employers have complained about the burden of implementing the employer mandate, and the Administration responded by delaying the employer mandate. Insurance companies have complained about the burden of implementing the
across-the-board expense caps, so the Administration has responded by delaying the implementation of that requirement. At the same time, though, average Americans are discovering on an almost daily basis that they will be forced to pay more to keep their health insurance, assuming that they can keep it all, or that they will be earning less because of cutbacks at work.

Based on this alone, it seems pretty clear that when it comes to health care reform and the Obama Administration, it’s money, power, and influence that rule the day. The average American? There won’t be any delays for them, they’re just being left to deal with the aftermath of a plan that clearly nobody thought through prior to letting it become law.

Doug Mataconis is an attorney in Virginia and also blogs at Outside The Beltway.