Another Shoe Drops

We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick.

                                                                           Barack Obama (2009)

One of the most important consumer protections used to sell the Affordable Care Act was the annual limit on the out-of-pocket health care costs that insurance companies were allowed to charge consumers. The ACA states that, beginning in 2014, insurers cannot ask clients to pay more that $6,350 annually per individual, or $12,700 per family, in health care expenses—a sum of money that is already well beyond the means of many American families.

Now, after postponing the employer mandate—but not the individual mandate—the Obama administration has quietly postponed the cap on out-of-pocket costs as well. This was done without any public announcement. Instead, they changed the Department of Labor website's “FAQs about Implementation of the Affordable Care Act (Part XII).” Apparently the change was made in February, but went unnoticed until it recently came to the attention of New York Times health reporter Robert Pear. So far, it has remained under the radar of most of the mainstream media, but Republicans will undoubtedly make it a 2014 campaign issue.

What this means is that, at least through 2014:

• Insurance policies that currently have no limits on out-of-pocket health care costs may continue not to have any limits.
• Policies which have separate out-of-pocket limits for different components of coverage, i.e., separate limits for hospital costs and prescriptions drugs, may continue to apply these separate limits even though they total more than $6,350 per individual and $12,700 per family.

The people who will be hit hardest by this change are people with disabilities or chronic medical conditions, who will no doubt continue to go bankrupt at the current rate.

The reason given for this postponement is almost absurd in its cynicism. More than three years after the ACA was signed, we are asked to believe that insurers “need more time to comply” with the law because some of them “have separate computer systems that cannot communicate with one another.” (I would guess that insurance companies could reset their computers in three weeks if there were money to be made by doing so.)

The Times quotes an unnamed administration official as saying, “We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, . . .” But it's hard to see much balance in these two recent changes to the ACA. Rather, they are best described by the title of a July 2 blog by Obama advisor Valerie Jarrett: “We're Listening to Businesses About the Health Care Law.” Once again, the interests of Americans suffering from serious health problems are subordinated to American corporations' insatiable drive to maximize profits.

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Obama on the Employer Mandate:  ". . . never mind"