Most Ohioans will have to wait at least a year before they see caps kick in on out-of-pocket expenses for health insurance promised under the Affordable Care Act.
A provision in the health care reform law limiting the cost of deductibles, co-payments and co-insurance to no more than $6,350 for individuals and $12,700 for a family has been delayed until 2015, the New York Times reported Tuesday.
The delay coincides with the postponement of the ACA’s employer mandate, which would have required businesses with 50 or more full-time employees to begin offering health insurance next year or pay a fine.
In both instances, the Obama administration said it is putting off key elements of the law to allow employers and insurers more time to implement the provisions.
Applying an overall limit to out-of-pocket costs in group health plans can be tricky because service providers often impose different out-of-pocket limits for different services and use different systems for tracking patients’ expenses against those out-of-pocket maximums, said Mike Suttman, president of Dayton-based employee benefits brokerage McGohan Brabender Inc.
“Generally, those systems are talking to each other, but apparently there are some places where they don’t,” Suttman said. “But for the companies we deal with, and the world I live in in Dayton Ohio, it’s rare that you would have that situation occur.”
Still, delaying across-the-board caps on consumer costs will give insurers more time to coordinate their computer systems and establish regular communications between service providers, said John Bowblis, a health economist and professor at Miami University.
In the meantime, however, ever-increasing medical costs — especially for prescription drugs — will continue to sap consumers’ wallets, Bowblis said.
“When you look at most traditional plans, there is no out-of-pocket max for drugs,” he said. “For most people who take typical drugs, like Lipitor, it’s not a big deal. But certain drugs are extremely expensive … and employers are passing more of the cost of those drugs back to their employees.”
Delaying out-of-pocket caps will primarily affect people who already have health insurance through an employer.
It’s unclear how the delay will affect the hundreds of thousands of poor and uninsured Ohioans expected to sign up for coverage on state-based health exchanges set to go online next year.
Premiums and out-of-pocket caps for 200 different individual health plans to be sold on the exchange have already been approved by the Ohio Department of Insurance and submitted to the federal government for review. But insurance department officials did not immediately respond to questions about whether delaying out-of-pocket limits for employer-based group plans would affect individual plans sold on the exchange.
In any event, critics say the latest delay — which was included in a Department of Labor rule issued in February — provides further evidence that President Barack Obama’s signature 2010 legislation is far from ready to fulfill its promises.
“One one hand, this is positive because there are so many issues that really have not yet been ironed out that it is presumptuous and quite problematic to implement this thing in such a state of flux,” said Greg Lawson, a policy analyst at the The Buckeye Institute for Public Policy Solutions in Columbus. “But even if it is the right thing to do to delay it and create more time to get things right, it creates questions about the entire enterprise from the root on up.”
Still, the latest delay may have done less to undermine the intent of the law than delaying the employer mandate.
“The intent of the law was to make sure everybody had coverage,” Bowblis said. “A secondary part of the law was to also make sure that that coverage met a certain standard.
“So when you look at the delay in the mandate that says businesses are required to provide health insurance, that’s really going against the heart of the law,” he said. “Delaying the cost of deductibles and co-insurance is not as big of a deal as long as people still have health insurance.”