Commentary & Opinion
3:43 pm
Mon August 19, 2013

Blair Horner: Back-peddling On Obamacare

The debate over health care reform has been remarkable.  The Obama Administration offers a plan based on the program in Massachusetts, which was developed as the result of a bipartisan agreement.  The Congress approves it and the US Supreme Court rules it to be legal.

Yet, the opposition persists.  The House leadership continues to push for repeal, even with no prospect of success.  And repeal advocates offer nothing as an alternative.  To them, it appears, the 50 million Americans without health insurance should be on their own.

Unfortunately, this opposition can lead to real life consequences.  Efforts to undermine the law impact on policies.  And the Obama Administration has made decisions to delay implementing some sections of the law in order to attempt to address concerns and political opposition.

Such a delay was first reported last week.  The Obama Administration has delayed until 2015 the law’s limits on how much people may have to spend on their own health care.

Under the health care reform law, insurance companies would have a limit on “out-of-pocket costs,” including deductibles and co-pays that a consumer would have to pay.  As a result, no insurer could charge a consumer more than $6,350 for an individual and $12,700 for a family.  But under pressure from insurers, the Obama Administration granted a one-year delay in the law that allows higher limits, or no limit at all on some costs, in 2014.

As a result of that decision, 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 reason for this change is that the Administration 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.

The health care reform law’s limits on “out of pocket costs” were based on the real-life consequences of paying for medical care when someone got seriously ill.  For patients with cancer, for example, paying for health care can be extremely expensive. 

While some individuals diagnosed with cancer have meaningful and adequate health insurance to cover most of the cost of treatment, the uninsured and an increasing number of privately insured individuals face the prospect of crippling out-of-pocket costs.  Financial barriers that delay treatment for cancer can mean the difference between life and death.

Cancer patients face deductibles, copayments, and other cost-sharing requirements, often compelling them to make difficult decisions in order to make ends meet.  Almost a third of cancer patients have out of pocket health care costs totaling 10 percent or more of their family income.  As a result of such high costs, 11 percent of individuals with cancer reported an inability to pay for food/necessities while paying for cancer treatment.  And cancer patients are twice as likely to declare bankruptcy from these costs.  For them, this one year delay could prove devastating.

Last month the White House announced a one-year delay in enforcement of another major provision of the law, which requires larger employers to offer health coverage to full-time employees.  At that time, Obama Administration officials said that the delay of the employer mandate showed that they “are listening” to businesses, which had complained about the complexity of federal reporting requirements.

Federal officials said they were offering transition relief to certain health plans in 2014. But, they said, by 2015, health plans must comply with the law.

Let’s hope that they’re right.

Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division.  His commentary does not necessarily reflect the views of the American Cancer Society.

The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.

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