News came Tuesday on the front page of The New York Times that the Obama administration is delaying yet another provision of the Affordable Care Act—this time, an important one that will affect household pocketbooks in short order.
The article, by the well-connected veteran reporter Robert Pear, disclosed that a much-touted provision to limit out-of-pocket costs, a category that includes deductibles, coinsurance, and copayments, will be delayed for a year. If the provision were to take effect as scheduled, next year, consumers with insurance purchased on the individual market and those with employer coverage would have to pay no more than $6,350 out of pocket, or no more than $12,700 for families.
These are already big chunks of dough for families who amass high medical bills, but the delay means that they might continue paying much more. Many insurance policies, particularly those sold in the individual market, currently require consumers to pay very high out-of-pocket costs, sometimes as much as $15,000 or $20,000. For that reason, the limits have been widely regarded as one of Obamacare’s most valuable protections.
But according to the Times, insurers and employers successfully argued that they need more time to comply with the new rules, in part because they use separate companies to administer major medical and drug coverage policies, each with their own limits on out-of-pocket costs. “In many cases, the companies have separate computer systems that cannot communicate with one another,” the Times reported. An unnamed senior official said the administration had to “balance the interests of consumers with the concerns of health plan sponsors and carriers.”
Goodness! The administration has been doing a lot of balancing lately. The employer mandate requiring businesses to provide insurance to full-time workers was delayed because firms needed more time to comply. SHOP exchanges for small businesses will only offer one insurance policy in many states next year, due to what the administration described as “operational challenges.” Penalties for smokers in the form of higher premiums also are delayed; same rationale. So the latest news delivered by the Gray Lady the public might be seen as part of a trend, and well-informed readers—which, to be fair, is not very many people—might be getting a becoming a tad skeptical about when many of the law’s benefits will materialize.
But if there’s a backstory to the administration’s ongoing delays to mollify stakeholders with the big bucks, there’s also a backstory to the coverage article that says something about how our profession still works, and whether that should change.
The Times piece, as you might expect, generated tons of pick-up from bloggers on the left and right who interpreted the delay in ways that fit their politics, and from mainstream outlets that noted somewhat matter-of-factly another provision faced a delay. The Times, for its part, played up the “scoop” angle. The administration had actually announced the delay back in February, and the Times article called it a “little noticed ruling” that was “obscured in a maze of legal and bureaucratic language that went largely unnoticed.” Steve Kenny, the night editor in the paper’s Washington bureau, tweeted, “Another speed bump for the Affordable Care Act found by the NYT’s Robert Pear.” Even the rival Wall Street Journal acknowledged in its own rehash of the story that “the delay went largely unnoticed until a report this week in the New York Times.”
Found by Pear? Well, it’s a bit more complicated than that. The Times story was valuable, and certainly brought the news to a much wider audience. But it turns out that patient advocacy groups have been objecting to the delay for months, and the trade publication Modern Healthcare had covered the latest development in that wrangling about a week before the NYT article appeared. Ashok Selvam’s write-up requires (free) registration, but here’s the lede:
Patient advocacy groups seeking to protect patients with chronic conditions from an exception that could increase out-of-pocket spending beyond the limits set in the federal healthcare reform law aren’t happy with the terse response they received on Tuesday from the U.S. Labor Department.
The government’s response indicates that patients could face much higher out-of-pocket costs than the limits established by the Patient Protection and Affordable Care Act.
The Labor Department told patient groups, including the National Health Council, Easter Seals and the Epilepsy Foundation, that it won’t reverse its policy issued in February for the millions of Americans who have either group coverage through their employer or buy individual health insurance.
And the author of the Politico Pulse email blast expressed some amusement at the opportunistic reaction from DC Republicans to the Times story, reporting the delay “became fairly well known in the policy world by April when some consumer groups including ACSCAN [American Cancer Society Consumer Action Network] publicized it.”