Another ACA Provision to be Delayed Until 2015

The health reform key is in, but the implementation ignition just won't start.

The health reform key is in, but the implementation ignition just won’t start. The Affordable Care Act (ACA) employer mandate has been pushed to 2015, states are still heavily wagering Medicaid expansion, healthcare insurance exchanges are at risk for misappropriation, and at least one state is delaying their full entrance into the insurance marketplace. Growing hesitancy to embrace healthcare reform is due to the uncertainty these various delays create. And now that unease may only grow worse, as the ACA provision that limited the caps on out-of-pocket insurance costs will be also delayed until 2015.

The provision would limit out-of-pocket costs, including deductibles and copayments, to $6350 for individuals, and $12,700 for families. The delay on cost maximums will mean that insurers can set limits higher, or even offer no limit on costs through 2014.

A senior administration official, who spoke with the NY Times, said the delay came after many insurance companies voiced concern as to whether their data collection systems would be effective enough in administering coverage in a timely manner.

“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,” the official stated. “They asked for more time to comply.”

The wait is a relief for insurers and payers. “If you work for a large employer, it's a good bet that you have one insurance company for your medical benefits, like hospital and doctor's visits, and another company, like Express Scripts or CVS Caremark, which handles your prescription drugs. Employers like this setup because the insurers focus on controlling medical costs and Pharmacy Benefit Managers, or PBMs, as they're called, keep a lid on drugs,” Sarah Varney said a recent National Public Radio interview. “The problem is, often, the two companies don't talk to each other.”

Ed Kaplan, a senior vice president at the health benefit advisory company Segal Consulting, added that many experts are struggling with how to comply. The data is simply not managed efficiently between payers and providers.

However, some healthcare professionals worry what the delay will mean for those with chronic conditions. If a consumer has one plan for their healthcare, and another for their prescription benefits, they may end up paying up to $6350 for doctor’s services or hospital care, and another $6350 for prescription drugs through a PBM.

“We have wonderful new drugs, the biologics, to treat rheumatoid arthritis, but they are extremely expensive,” said Dr Patience H. White, a vice president of the Arthritis Foundation. “In the past, patients had to live in constant pain, often became disabled and had to leave their jobs. The new drugs can make a huge difference, and we were hoping that the cap on out-of-pocket costs would make them affordable. But now many patients will have to wait another year.”

Around the Web

ACA Implementation Continues to Face Challenges [AJMC]

Oregon to Delay Insurance Exchange Enrollment

Oregon to Delay Insurance Exchange Enrollment [AJMC]

Federal Officials Delay Another Health-law Provision for Employers [Los Angeles Times]

Administration Delays ObamaCare Caps on Out-of-Pocket Costs [The Hill]

A Limit on Consumer Costs Is Delayed in Health Care Law [NY Times]

Obama Delays Implementing Another Part Of Affordable Care Act [NPR]