Rules for equal coverage by employers remain elusive under health law

[Yo_Mama]

Source: CNBC

The Obama administration is delaying enforcement of another provision of the new health care law, one that prohibits employers from providing better health benefits to top executives than to other employees.

Tax officials said they would not enforce the provision this year because they had yet to issue regulations for employers to follow.

Read more: http://www.cnbc.com/id/101347430

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This seems quite shameless - they just haven't issued the regs. There is no other reason why this provision of LAW is not being enforced now, and they've had more than three and a half years to write those regs.

News drop on weekend, of course. The companies pretty much just skate this year, and this is one provision of the law that really did provide protection for employees - if the top executives were in the same boat, the line employees would be likely to get a better deal.

[George II]

1. Is this worse than not having the Affordable Care Act at all?

[starroute]

2. It's one more proof that some animals are more equal than others

Not having it at all would be worse -- but having it the way it was originally written would be better. Right now, millions who should be eligible for Medicaid aren't getting it because of the Supreme Court. And now we find out that companies are being allowed to palm off junk coverage on their employees because the executives aren't being held to the same standard. That isn't right and it isn't fair.

[George II]

3. Okay, so let's scrap it because it isn't 110% perfect for 100% of the population.

[Ms. Toad]

7. Give it a rest.

Noting that there are problems with the implementation of the ACA (or with the ACA itself) isn't a call to scrap it.

I have been speaking in favor of the ACA since long before it was adopted because it was the only step forward which had any reasonable likelihood of passing, and I was regularly lambasted for pointing out that it was a significant improvement - and what a lifesaver it will be for many.

The fact that it is a major step forward doesn't mean it is perfect, or that its further delay in implementation is acceptable. The states refusing to expand Medicaid is a real blow for those who are most vulnerable. In those states (close to half), access to health care for the poorest of the poor is no better than it was before ACA - and that is unacceptable. It isn't how the ACA was designed, and it is a major blow to the hopes many of us had for it.

Similarly (although with a smaller impact), the delays in implementation are inexcusable. The law was written with a substantial period of time for insurance companies and major employers to prepare to merge the medical and prescription caps (for example), and delaying that for a year means - personally - $2,900 additional out of my pocket. It will have a similar impact for anyone covered by an employer plan for whom prescriptions are a substantial part of health care (transplantees, and patients who depend on biologics to name two off the top of my head).

Acknowledging (and even complaining about) real problems with the ACA or how it is implemented is not synonymous with wanting to scrap the entire thing.

[Yo_Mama]

11. That's a complete misrepresentation - the administration scrapped this piece.

Without any justification.

Can't blame this one on the GOP, although we all know they probably aren't going to be in the trenches defending the workers. That's a safe damn bet.

If the companies are allowed to give management one type of benefit and all the line workers another, then the line workers will get the 60 percent actuarial deal, which utterly sucks. This is a lot of protection for employees that was written into the law which is just being given away.

BUT IT IS THE LAW, AND THE ADMINISTRATION HAS DECIDED NOT TO IMPLEMENT IT.

[JoeyT]

14. That was one of the worst misreadings of what someone wrote I think I've ever seen.

How the fuck you got that out of "Not having it at all would be worse" is utterly baffling to anyone that has even the most remote comprehension how language works. Could you not find one of the handy talking points to lob at it and had to grab the first one that came to mind? Is that just the default whaaaargarbl screamed at anyone that's even mildly critical of any decision Obama makes?

Have we fallen so far that "LOVE IT OR LEAVE IT!" is considered a rational point in debate?

[enlightenment]

15. Oh, how I wish we could rec

inline posts.

plus a zillion. Thank you.

[Yo_Mama]

8. No, but why isn't the law being enforced?

This one just astounded me - there is no obstacle at all here. It just isn't being enforced.

[Igel]

13. Prosecutorial discretion.

Used to be a case of looking at the law on a case by case basis and deciding to apply mercy instead of justice. (Before we redefined "justice".) Or deciding that some law, given the resources the politicians have made available, just can't be enforced.

So jaywalking laws gum up the system if enforced. A starving woman with starving kids might be given a pass if she steals a gallon of milk. This could not get out of hand without a response from the electorate--and when it did get out of hand, in a peculiarly biased way, we got minimum sentencing laws and 3 strikes as a reaction.

It used to be that prosecutorial discretion on a large scale was a bad thing. You'd nail the black ex-slave but not the white ex-slaver for a crime. You'd look the other way if it was your wife's nephew or the local gang boss who made sure you got special favors. It reflected prosecutorial whim and not principle; it wasn't administered in a way that guaranteed something like due process to all citizens, with special cut-outs for those relatively few with extreme mitigating circumstances.

In fact, if there was a racial bias in prosecutorial discretion it was even grounds for ruling a law to be unconstitutional. You can't force the administration to apply the law on the ground in a way that is fair--instead of using it to pursue some sort of (racially) political ends--so the punishment meted out to the administration would be suspending the law.

Now the attitude is that this is precisely a good thing. The right racial bias is perfect because it's pursuing a "higher justice", not the petty justice of law enforcement. Political power is a goal, so even if you have the resources to write the regulation, you have the resources to implement the law even-handedly, still you fail to write the regs just for those parts of the law that you don't want implemented for political purposes; you fail to have the funds to prosecute just those groups that help maximize political points. Having sworn to uphold the Constitution and the laws, you first work on politics and pushing morality. No more an executive, you're become judge and legislator.

This started early. TARP had specific uses and restrictions in the funding legislation. A lot of TARP money went for other, "need driven" purposes, not for what the law said. It's not like this administration is unique in doing it. It's just seemingly more prolific.

[SHRED]

4. So now we have a many tiered health care system

With wildly varying degrees of access, quality of care, and affordability.


Executive level
Employer based worker coverage
TriCare
Medicare
ACA health exchanges
Medicaid

...and those who can't afford jack shit who fall through the cracks.

What a fucked up mess.

[Yo_Mama]

9. It's like handing candy to the GOP.

That just occurred to me. At first I was so surprised to read about this that I didn't see the ramifications.

Because we really are impairing some of the union plans, and then to exempt the executive "packages" from the law this year. How. Why? Shouldn't someone be fired for this?

[godevil10]

19. Yep. FUBAR!!!!!

[Ms. Toad]

5. The last delay made more difference to families with large medical expenses

who are covered under employer plans. My costs will be roughly $8,900 under what is considered a fantastic plan by most, because prescription drugs are not capped. Medical care and prescriptions were to have been under a single cap this year, but for a delay.

Most people where I work won't notice it because they don't ever max out. But we have a medically expensive family and I decided to accept a new job partly because I knew we could count on a cap on medical expenses. And then the delay was granted. Since we max out the plan every year, the fact that there is no cap on drugs means we both hit the out of pocket max under medical, and the pharmaceutical costs just keep on growing. That costs me $2,900 - assuming we have no unexpected pharmaceutical expenses. More - if we get sick (beyond the chronic illnesses) and need expensive meds.

[Yo_Mama]

10. I know!!!

The one-year waiver that essentially doubles the out-of-pocket limits is awful for some people, and we have to remember that by definition those people are the vulnerable.

And I was very upset when that was announced, and I don't think the reason given was good enough.

But there isn't even a REASON for this.

[Ms. Toad]

12. It has the potential to more than double.

There are NO caps on prescription drugs (not just two separate caps). I just figured the out of pocket costs based on the prescriptions we currently are using. If my daughter has to switch to a biologic for one of her meds (a real possibility), that will be a specialty drug and our out of pocket will more than double.

[Yo_Mama]

16. I read that the cap was being applied separately

So if you had two companies, one handling the medical insurance and one the prescription insurance, the OOP max would apply to each so it would double?

[Ms. Toad]

18. The cap is only applied to medical.

It is not just a double cap - prescription costs are unlimited for many employees.

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.

http://www.nytimes.com/2013/08/13/us/a-limit-on-consumer-costs-is-delayed-in-health-care-law.html?pagewanted=all&_r=0.

ETA - if you had a separate policy for prescription (the clause that lets you avoid the merged cap), chances are you did not have a cap at all for prescription. But as to my specific my employer, which went from an existing plan without a cap to a new plan without a cap. I do wonder if that is consistent with the regs. At least this recitation seems to suggest that existing no-cap plans may remain uncapped. It is suspicious that they were able to obtain a new, uncapped, prescription plan which went into effect on 1/1/2014.

[Yo_Mama]

20. My understanding was that this is against the law

Of course, that doesn't mean my understanding is right.

The grandfather clause was supposed to be for continued plans only.

[Ms. Toad]

21. This isn't the operation of the grandfather clause.

That is an entirely different issue, which was written into the law. The law was intended to grandfather in certain plans. This plan does not qualify as a grandfathered plan (one in existence before the passage of the law).

This is an order to delay implementation is one which outside of the scope of the law, and has nothing to do with the grandfather clause: The merged cap for medical and prescription coverage (the law requires a single merged cap by 1/1/2014), and the delay goes beyond just letting large employers to have two separate caps to letting them have no cap at all on prescription.

I think the delay really stinks - but my question about compliance with the order delaying implementation is whether the delayed enforcement of the mandatory cap provision was available to all employers who offered a prescription plans without a cap in 2013 - or only those employers who continued their 2013 prescription plan into 2014. That answer wouldn't be covered in the law - because it clearly violates the law as written (as does the delay announced above, as does the delay in a merged cap). I just haven't seen the order delaying enforcement - only reports about it.

[Deep13]

6. Obama, you corporate sell out. nt

[Yo_Mama]

17. The odds are that he doesn't know - I am writing to whitehouse.gov today

Presidents don't sit down and write all the regs, or even hear about them. There are thousands of regs issued each year. It would be physically impossible for one person even to know about them all.

I think we should all contact the administration and make a stink about it.

[Brigid]

22. We need Medicare for all.

That is all.