Taking The “Affordable” Out Of The Affordable Care Act

This week, enterprising journalists discovered that the Obama Administration has delayed another key provision of the Affordable Care Act.

In this instance, the delay affects one of the core selling points of the Act — the provision that capped the total amount of out-of-pocket expenses, in the form of deductibles and co-payments and other contributions by the insured toward health care.  It was supposed to take effect in 2014, but the newly discovered ruling gives insurers a one-year extension.

The delay wasn’t exactly announced in a way that befits an Administration that President Obama recently described as “the most transparent Administration in history.”   The New York Times article linked above describes the relevant ruling as follows:  “The grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.”  I guess “transparency” means burying the bad news in an avalanche of regulatory drivel and minutiae, rather than being honest about the many delays and snags that have affected legislation that was passed three years ago amidst confident predictions about its implementation, enforceability, and impact.

And speaking of impact, Forbes has a very interesting article about the impact of the Affordable Care Act on, well, getting affordable care.  It discusses the inevitable effect of caps on out-of-pocket expenses like co-payments and deductibles.  Because they don’t have anything to do with the cost of health care, that just means more of the cost will be paid through premiums imposed on everyone, rather than through contributions by the users (and, often, overusers) of health care.  The article notes that some colleges that used to offer cheap plans to their healthy students have had to drastically increase the premiums and other schools have stopped offering health care plans altogether.

Of course, the whole notion of burden-sharing underlying the Act means that some people will pay more — the question is, how many people, and how much more?  What we’ve seen of the Affordable Care Act so far doesn’t instill great confidence that we know the answers to those two important questions.

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