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Another Key Obamacare Provision Delayed by 'Little-Noticed Ruling


"...was obscured in a maze of legal and bureaucratic language that went largely unnoticed."

President Barack Obama waves to a group of on-lookers while golfing at Farm Neck Golf Club in Oak Bluffs, Mass., on the island of Martha's Vineyard, Sunday, Aug. 11, 2013. (AP)

And the hits just keep on coming.

Adding to the growing list of pre-full implementation hiccups, yet another key provision in President Barack Obama’s landmark health care law has been temporarily delayed thanks to a little-known ruling from February, Forbes and the New York Times report.

The recently reported ruling delays for more than a year the cap on out-of-pocket insurance costs, Forbes reports.

The halted provision, which focuses on issues including co-pays and deductibles, is explained by Forbes:

Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.”

Annual limits on cost-sharing are specified by Section 1302(c) of the Affordable Care Act; in addition, starting in 2014, deductibles are limited to $2,000 per year for individual plans, and $4,000 per year for family plans.

The New York Times adds: “The limit on out-of-pocket costs ... was not supposed to exceed $6,350 for an individual and $12,700 for a family.”

But thanks to the little-known February rule change, fed officials have granted certain insurers a “one-year grace period,” giving certain providers the flexibility to set higher limits (or no limit at all) for next year.

And as noted by the Times, the ruling may make it possible for less-than-ethical insurers to fleece consumers.

“[Consumers] may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager,” the report explains.

The "grace period," as it is being officially called, "was obscured in a maze of legal and bureaucratic language that went largely unnoticed."

But what’s the reasoning behind the delay? What’s the rationale?

Simply put, the feds claim many insurers and employers needed more time to comply with the health care law.

“[T]hey used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs,” the Times report explains. “In many cases, the companies have separate computer systems that cannot communicate with one another.”

A fed official reportedly said that “we had to balance the interests of consumers with the concerns of health plan sponsors and carriers…They asked for more time to comply.”

Because making consumers pay more for health insurance is in their “interest,” right?

The out-of-pocket insurance costs delay, which has been confirmed by sources familiar with the situation, adds to growing concerns that the Affordable Care Act may not be ready for full implementation in 2014.

Furthermore, as noted by even Democrat politicians, aside from presenting possible legal problems, the timing of various delays associated with the president’s health care law is suspect.

Consider, for example, that fact that the controversial “employer mandate” has been postponed until after the 2014 midterm elections. Likewise, the recently reported “grace period” ruling extends the caps until after -- you guessed it -- the 2014 midterm elections.

"Why are 'Obamacare' employer mandates held off until after the next election?” Democrat Congressman Kurt Schrader of Oregon asked in a recent TV interview. “Sounds like they want to retain Congress people before we get clobbered with much higher insurance rates," a viewer, Andre Stefansky, asks via Facebook.”

"Well, I don't know. I mean, like Andre, I have my suspicions about the political motivations here, too," he continued. "I'd be less than honest if I [hadn't] said that."

As of November 2011, as Forbes’ Avik Roy notes, “the Obama administration had missed as many as one-third of the deadlines, specified by law, under the Affordable Care Act.”


Follow Becket Adams (@BecketAdams) on Twitter

Featured image AP. This post has been updated.


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