Some patients waiting to enjoy Obamacare’s advertised cap on out-of-pocket healthcare expenses will have to wait another year. Federal officials have quietly delayed until 2015 a key provision in Obamacare intended to limit patient costs.
The cap was supposed to take effect next year, but officials arranged a one-year grace period in response to complaints from insurance companies, The New York Times reported on Monday evening. The government decided to delay the provision months ago (the Department of Labor’s website explained the decision on a Q & A page in February), but the ruling went unnoticed amidst debate over other elements of the massive healthcare overhaul.
The delay is significant because the cap was a major selling point for the Affordable Care Act. It will limit to $6,350 annual patient out-of-pocket expenses—including deductibles and co-payments—for individual health plans. For families, the limit will be set at $12,700.
But under a temporary set of technical rules, some group plans will be able to operate in 2014 without capping all patient healthcare expenses—meaning some patients may have to pay $6,350 to a hospital and another $6,350 to a prescription drug provider. Drug plans without any cap on patient expenditures also won’t have to impose a limit until 2015.
According to administration officials, insurers had complained their computer networks weren’t configured to track all out-of-pocket payments made by a single patient. A health plan may use multiple service providers to deliver benefits, and those providers sometimes tally out-of-pocket expenses differently. The companies asked the government for more time to coordinate their systems.
Patient advocacy groups told The Times they were dismayed to hear of the obscure delay. “The promise of out-of-pocket limits was one of the main reasons we supported health care reform,” said a spokesman for the National Multiple Sclerosis Society. Molly Daniels, a lobbyist for the American Cancer Society, said the delay could mean “patients who require expensive drugs could continue to have enormous financial exposure, despite the clear intent of the law to limit a patient’s total out-of-pocket exposure.” New cancer drugs may cost $100,000 a year, an expense patients must contribute to in proportion to the terms of their health plan.
News of the delayed cap comes one month after the Obama administration decided to delay until 2015 an employer mandate that will require mid-sized and large companies to provide health coverage to full-time workers or face fines. Conservatives in Congress said on Tuesday the delays illustrate Obamacare was ill-conceived from the start.
“Faced with the obvious and predictable consequences of the caps, the administration again faces another embarrassing delay of this unworkable and unfair law,” said Sen. Mike Lee, a Republican from Utah. He added: “The best way to delay Obamacare is to defund it.”
Sen. Rand Paul, R-Ky., who also opposes the healthcare overhaul, told Fox News President Barack Obama had overstepped his authority in delaying the out-of-pocket expense cap: “The president doesn’t get to write legislation, and it’s illegal and unconstitutional for him to try and change legislation by himself.”