This Obamacare rule delay could really hurt

Insurers are getting a one-year reprieve on a key provision aimed at limiting consumers' out-of-pocket costs.

 

By Aimee Picchi 

 

• The Obama administration touts the Affordable Care Act as a way to make health care insurance both widely available and cost-effective. But a new twist in the law may put the second goal at risk. 

Buried in a tangle of bureaucratic language is a key change to Obamacare that will delay an out-of-pocket cost limit for individuals and families, The New York Times reports.


Obamacare had promised to hold out-of-pocket spending to no more than $6,350 for an individual and $12,700 for a family. But federal officials are now allowing some insurers to take an additional year to meet those limits, the newspaper notes.

Why delay the cost ceiling? Pressure from insurers, according to an unnamed administration official. 

"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," the official said.

The change was called illegal and unconstitutional by Sen. Rand Paul, R.-Ky., Fox News reports. "The president doesn't get to write legislation, and it's illegal and unconstitutional for him to try and change legislation by himself," Paul said.

People most likely to be hurt by the delay are those with chronic conditions. Multiple sclerosis patients, for instance, can face direct treatment costs that exceed $20,000 per year, according to a 2007 paper. Some drugs for chronic illnesses can cost more than a car, such as Sanofi-Aventis' (SNY +0.87%) Cerazyme, a treatment for Gaucher disease that can cost as much as $200,000 per year.

The delay was greeted with dismay by representatives of several groups, including the National Multiple Sclerosis Society, which told The New York Times it was disappointed, and the American Cancer Society, which warned that patients "could continue to have enormous financial pressure."

By 2015, health plans must be in compliance with the law.

But given that this tweak comes after Obamacare's one-year delay on its employer mandate to provide insurance, it raises doubts about whether the legislation will actually provide the relief it had promised.