The version of the Affordable Care Act that will go into effect in January 2014 will be very different than the one envisioned by its authors and the one detailed by President Barack Obama when he campaigned for the law back in 2009. Numerous delays are the reasons for that difference; making the pages and pages of rules — the exact length of the health care reform ranges from 974 to 33,000, depending on who you ask — into reality has proved to be difficult.
In July, the Obama administration postponed two key provisions related to the health care reform. As originally written, Obamacare mandated that businesses with 50 or more full-time employees provide those workers with coverage or face penalties of as much as $3,000 per employee beginning in 2014. But that date has now been pushed back until 2015. The Affordable Care Act’s requirement that the new insurance marketplaces verify consumers’ health insurance status and their incomes, two pieces essential for the successful function of the exchange system, has been delayed by a year as well.
However, as it turns out, the postponement of the employer mandate was not the first delay. In February, the administration announced the delay of an important consumer protection, but that announcement was hidden in the bureaucratic language of an answer to one of 137 frequently asked questions about Affordable Care Act implementation. The limit on out-of-pocket costs, including deductibles and co-payments, written into Obamacare’s pages was meant to keep expenses from surpassing $6,350 for an individual and $12,700 for a family. But a department official has confirmed that the policy has been delayed.
“We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs,” an anonymous senior administration official told The New York Times. “They asked for more time to comply.”
Thanks to the postponement, many group health plans will be able to maintain their separate, out-of-pocket limits for benefits in 2014, meaning a patient can be forced to pay $6,350 for doctors’ services and hospital care, and then an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager, before insurance kicks in. Some insurance consumers may even fare worse, as other group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for prescription drugs next year.
There are numerous ways to interpret this delay. For some — like the opponents of Obamacare — the postponement shows that the Affordable Care Act’s “train wreck” has only gathered moment; for others, the grace period for insurers is just a minor side effect that should be expected when a vast and complex law is implemented, which is an argument the president himself has made; the more cynical interpretation is that the Obamacare administration is favoring the interests of politically powerful groups, like insurers, over the interests of consumers, especially those that are chronically ill and have higher medical expenses; and, for the optimists, the delay is seen as a minor speed bump as it will last just a single year.
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