General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsAnother key provision of Obamacare delayed
The Obama administration has delayed implementation of another key provision of Obamacare the cap on out-of-pocket insurance costs for consumers.1
The Obama administration has quietly delayed for one year, until 2015, another key provision of Obamacare: the cap on out-of-pocket insurance costs. That means that some insurers will be able to set their own limits starting in 2014. The cap is supposed to be $6,350 for individuals or $12,700 for families.
2
"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."
senior administration official
A senior administration official who asked to remain anonymous told The New York Times the delay is attributed to a technology issue. The delay has been outlined on the Labor Department's website since February. But it was buried and went unnoticed until recently.
<snip>
http://cir.ca/story/obamacare-provisions-delayed-1
BS on their technical issues!
Autumn
(45,057 posts)uponit7771
(90,335 posts)Autumn
(45,057 posts)boston bean
(36,221 posts)leftstreet
(36,106 posts)What a fucking scam this is
forestpath
(3,102 posts)woo me with science
(32,139 posts)The scenery is coming down pretty fast now, isn't it.
liberal_at_heart
(12,081 posts)got while helping write the damn law? How can we trust that these key provisions won't be delayed again next year? The government seems to be pretty good at doing just that. Kicking the can down the road just one more year. And then another. And then another. Get the bastard insurance companies out of our health care sytem. We must have single payer.
progressoid
(49,983 posts)I bet if the health plan sponsors and carriers needed to raise the cap, it would have been done in a snap.
bvar22
(39,909 posts)....because it sure feels like we are being Trickled On.
2014 is going to be a nightmare.
reformist2
(9,841 posts)Lee-Lee
(6,324 posts)Yo_Mama
(8,303 posts)It's just not that hard a task to implement in three and a half years, not with modern technology. All you do is have the plans exchange files each night with out of pocket expenses so that they can be aggregated. This is the type of system change which can be implemented in no more than six months, rather than five fucking years.
I am so tired of this shit.
LittleBlue
(10,362 posts)and let someone else attempt to either implement the system or repeal it.
What bravery!
BlueCheese
(2,522 posts)See this article in the NYT:
http://www.nytimes.com/2013/08/13/us/a-limit-on-consumer-costs-is-delayed-in-health-care-law.html?smid=tw-nytimeshealth&seid=auto&_r=0&pagewanted=all
It refers to a federal FAQ, where the important section is apparently the following. (I can see why people might have been confused.)
Public Health Service (PHS) Act section 2707(b), as added by the Affordable Care Act, provides that a group health plan shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under section 1302(c)(1) and (c)(2) of the Affordable Care Act. Section 1302(c)(1) limits out-of-pocket maximums and section 1302(c)(2) limits deductibles for employer-sponsored plans.
Q1: Who must comply with the deductible limitations under PHS Act section 2707(b)?
The HHS final regulation on standards related to essential health benefits implements the deductible provisions described in section 1302(c)(2) for non-grandfathered[1] health insurance coverage and qualified health plans offered in the small group market, including a provision implementing section 1302(c)(2)(C) so that such small group market health insurance coverage may exceed the annual deductible limit if it cannot reasonably reach a given level of coverage (metal tier) without exceeding the deductible limit.[2]
With respect to self-insured and large group health plans, as explained in the preamble to the HHS final regulations, the Departments intend to engage in future rulemaking to implement PHS Act section 2707(b). The Departments continue to believe that only plans and issuers in the small group market are required to comply with the deductible limit described in section 1302(c)(2). Public input is welcome in advance of a future rulemaking, which will implement that only plans and issuers in the small group market will be subject to the deductible limit. Please send comments by April 22, 2013 to e.ohpsca-2707.ebsa@dol.gov.
Until that rulemaking is promulgated and effective, the Departments have determined that a self-insured or large group health plan can rely on the Departments' stated intention to apply the deductible limits imposed by section 1302(c)(2) of the Affordable Care Act only on plans and issuers in the small group market.
Q2: Who must comply with the annual limitation on out-of-pocket maximums under PHS Act section 2707(b)?
As stated in the preamble to the HHS final regulation on standards related to essential health benefits, the Departments read PHS Act section 2707(b) as requiring all non-grandfathered group health plans to comply with the annual limitation on out-of-pocket maximums described in section 1302(c)(1) of the Affordable Care Act.[3]
The Departments recognize that plans may utilize multiple service providers to help administer benefits (such as one third-party administrator for major medical coverage, a separate pharmacy benefit manager, and a separate managed behavioral health organization). Separate plan service providers may impose different levels of out-of-pocket limitations and may utilize different methods for crediting participants' expenses against any out-of-pocket maximums. These processes will need to be coordinated under section 1302(c)(1), which may require new regular communications between service providers.
The Departments have determined that, only for the first plan year beginning on or after January 1, 2014, where a group health plan or group health insurance issuer utilizes more than one service provider to administer benefits that are subject to the annual limitation on out-of-pocket maximums under section 2707(a) or 2707(b), the Departments will consider the annual limitation on out-of-pocket maximums to be satisfied if both of the following conditions are satisfied:
(a) The plan complies with the requirements with respect to its major medical coverage (excluding, for example, prescription drug coverage and pediatric dental coverage); and
(b) To the extent the plan or any health insurance coverage includes an out-of-pocket maximum on coverage that does not consist solely of major medical coverage (for example, if a separate out-of-pocket maximum applies with respect to prescription drug coverage), such out-of-pocket maximum does not exceed the dollar amounts set forth in section 1302(c)(1).
The Departments note, however, that existing regulations implementing Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)[4] prohibit a group health plan (or health insurance coverage offered in connection with a group health plan) from applying a cumulative financial requirement or treatment limitation, such as an out-of-pocket maximum, to mental health or substance use disorder benefits that accumulates separately from any such cumulative financial requirement or treatment limitation established for medical/surgical benefits. Accordingly, under MHPAEA, plans and issuers are prohibited from imposing an annual out-of-pocket maximum on all medical/surgical benefits and a separate annual out-of-pocket maximum on all mental health and substance use disorder benefits.
Egalitarian Thug
(12,448 posts)liberal_at_heart
(12,081 posts)Demo_Chris
(6,234 posts)Everything else is smoke and mirrors.