A Limit on Consumer Costs Is Delayed in Health Care Law...
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 health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.
This paragraph right below where you stopped the cut and paste is, IMO, important.
ReplyDeleteA senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: “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. They asked for more time to comply.”
I'm hesitant to even bother trying to discuss this TD because I believe you are in a category of people who believe we should just do nothing or adopt a policy wherein all we do is limit the amount of damages a person can receive through legal litigation.
That para, to me, is at the heart of the matter. Insurance companies do not want Obama care. They do not want to cover people with pre-existing conditions, they don't want to compete with each other and most importantly, they don't want their profits cut. A theme I throw out over and over is that insurance companies do absolutely nothing to improve health care outcomes. They just deny payments when they can. None of you here have ever challenged me on that which makes me think you either don't care about that reality or don't want to be bothered doing the work to question me.
Even at our facility, the issue of technology is a nightmare. Every time a company spends money on a software program, medicare or someone else comes up with a new reporting requirement that forces us to spend money trying to create a patch or pay the software company to create something. It's a flipping mess and it's been that way everywhere I worked. At best, I see Obamacare as a catalyst to start pushing the system to become something better. Since we are going to fight it every step of the way, it is going to take decades to get it right and we are going to waste a lot of money.
Still, the idea that 40 million Americans should just go to the ER for healthcare didn't work. IMO, there is a disconnect. First of all, we don't want to acknowledge the REAL cost of healthcare. As a result, we are simply playing shell games to dump cost on taxpayers and off of for profit insurers. The other disconnect is that a large portion of people do not want to take responsibility for their health. Again, IMO, our focus is on protecting profit in the system, as a result, that is the only piece that will stay healthy.....for now.
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ReplyDeleteCan't have his myrmidons getting PO'd before the 2014 elections.
ReplyDeleteShould be interesting as the PPACA is rolled out followed by the election. Then gyrations should be entertaining. The denials, ignoring their position, the early retirements.
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