Policy/Biz

Obamacare's Consumer Cost Limit Is Delayed Until 2015: What This Means For The New Health Care Law

Delay On Limit To Consumer Cost Until 2015
Out-of-pocket expenses will not be limited until 2015 in order to give insurers a grace period to upgrade their computers. 401(K) 2013, CC By-ND 2.0

The reconstruction of the United States’ healthcare system is experiencing another setback. A key consumer protection aspect in the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, will be delayed until 2015 in order to allow more time for the insurance companies to setup their computers. In the meantime, certain insurance companies will not have to abide by the limitation on the out-of-pocket expenses, such as deductibles and co-payments for both individual and family expenses.

Originally, the costs were not allowed to exceed $6,530 for an individuals and $12,700 per family but because of a ruling by federal officials, insurers have a one-year grace period to adjust themselves to the PPACA. The U.S. Labor Department’s website explains the ruling and has made it available for the public to read since February, but it has essentially been ignored until now, because it was buried beneath jargon in one of the 137 frequently asked questions pertaining to the ACA on their website. It wasn’t until the delay was deciphered and described by Robert Pear of the New York Times, that the delay was brought to public attention.

“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,” a senior administration official, who chose to speak anonymously, told the New York Times.

How Will The Delay Affect Americans?

These deductible limitations are described on the Department’s website as health benefit implements to which  only non-grandfathered health insurance coverers have to comply. Under this policy, certain health care providers will be able to charge $6,350 for a doctor’s visit or hospital care and then charge an additional $6,350 for prescriptions drugs. These consumer costs may affect many people, something the PPACA was purposed to avoid.

Since the landmark healthcare legislation was signed into law March 2010 by President Obama, it has been both widely supported and criticized across America. It has gained significant media coverage and has been frequently debated, especially since it is the most drastic overhaul of the national healthcare system since Medicare and Medicaid were created in 1965. The Act is designed to specially address health insurance coverage and to increase its availability to all Americans, while creating a reduction in the overall costs of health care.

This isn’t the first delay the PPACA has seen since its inception over three years ago. It took $8 billion to hold back Medicare cuts until after Obama’s reelection in 2012. Changes to Medicare in the health-reform law affect the 36 million Americans covered by original Medicare and another 11 million enrolled in private Medicare Advantage plans, according to Consumer Reports.

This move to delay limits on consumer costs may also affect millions, especially for those living with serious illnesses that require constant medical care. Out-of-pocket costs can dig a hole tens of thousands of dollars deep into consumer’s pockets each year, according to the Chief Executive of the National Health Council, Myrl Weinberg.

With the grace period the insurers were granted, they could set higher limits or no limits at all on out-of-pocket costs until 2015, which will force consumers to research their carrier and understand just exactly what they will be paying. White House senior adviser, Valerie Jarret has said the administration needs to consider businesses’ needs — specifically, the time for computer transitions. In the meantime the cost of a doctor’s visit and drug prescription could cost more than what the average American could afford.

Experts Back the Out-Of-Pocket Cost Limits

President Obama defended the need for limits on out-of-pocket costs in 2009, just before it was signed. “We will place a limit on how much you can be charged for out-of-pocket expenses," President Obama said, "because in the United States of America, no one should go broke because they get sick.”

Theodore M. Thompson of the National Multiple Sclerosis Society, told Forbes, “The promise of out-of-pocket limits was one of the main reasons we supported health reform.”

Patience H. White of the Arthritis Foundation told the New York Times, “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis. But they are extremely expensive.”

Federal officials believe the delay will create a smoother transition into the full implementation of the PPACA and by 2015 there will be an overall limit on out-of-pocket costs for medical, drug, and other benefits combined.

Loading...