Obamacare Cap on Some Health Costs Delayed

Another provision of President Obama's health care law has hit a snag.

ByDevin Dwyer
August 13, 2013, 4:12 PM

WASHINGTON, Aug. 14, 2013 — -- Another provision of President Obama's signature health care law has hit a snag.

An annual cap on out-of-pocket health care expenses for some consumers will remain on hold until 2015, one year later than planned, according to little-noticed guidelines posted on a Labor Department website.

The delay means some Americans will have to wait a little longer to realize the full benefit of one of the Affordable Care Act's key consumer protections -- a first-ever legal limit on how much people have to spend on their own health care.

The hiccup in implementation primarily affects people enrolled in group health plans with separate administrators for medical services and prescription drug benefits, government officials and industry representatives told ABC News.

Under the law, combined out-of-pocket spending on medical care and prescription drugs cannot exceed $6,350 a year for an individual or $12,700 a year for a family, including co-payments and deductibles, starting in 2014.

Those caps will take effect as planned for all health plans sold in the new insurance exchanges and offered through employers whose medical and drug benefits are administered by the same entity. But Americans enrolled in other plans could still face higher costs.

For example, some patients could face up to $6,350 for medical services, such as doctor's visits and hospital treatments, and up to an additional $6,350 for prescription drugs. Also, prescription drug plans that do not currently cap out-of-pocket expenses will not have to do so at all in 2014 because of the administrative delay.

"For people with complex chronic conditions, this decision contradicts the out-of-pocket provisions the patient community fought for in the ACA," said Nancy Hughes of the National Health Council, a patient advocacy group. "It will be a major financial burden that will most certainly impact patient access to quality health care."

Administration officials downplayed the impact of the delay, noting that the vast majority of health plans will see limits on consumer costs for the first time ever, starting next year.

The one-year grace period for compliance of some plans will allow insurers more time to finalize computer systems to track their beneficiaries' spending in order to comply with the law, officials and industry representatives said.

The delay was quietly announced in February but went largely unnoticed until reported on Monday by the New York Times.

"This is really driven by information technology challenges more than anything else," said Jim Klein, president of the American Benefits Council, which represents and advises some of the nation's largest companies.

"It's really more a question of vendors coordinating information so that a 'trip wire' is hit at the appropriate time and the consumer is protected," Klein said. "Nobody is fundamentally disagreeing with the outcome here."

Republicans have seized on the latest glitch in the health law rollout to rally their political supporters for the 2014 midterm elections and maintain a repeal of Obamacare as a primary campaign issue.

House Speaker John Boehner today called the delay of some caps on out-of-pocket costs "evidence that the law is too costly and too complex to work – and that it's not being implemented fairly."

"If the president's health care law is too complex and costly for big businesses and insurance companies to figure out, American families deserve a break from it as well," he said in a statement, alluding to the law's individual insurance mandate and other controversial measures.

While the Supreme Court has upheld the law's constitutionality, and the electorate returned Obama to the White House for a second term knowing his signature legislative achievement, House Republicans have continued to make it an issue.

Republicans lawmakers have voted 40 times to repeal the law; and some have vowed to oppose any 2014 budget measure that includes funding for implementation of the law, even if it could mean a government shutdown.

The delay on some caps on consumer costs follows other steps by the administration to adjust implementation of the Affordable Care Act, including an announcement last month of a one-year delay on a requirement that employers with more than 50 employees to offer health insurance or pay a penalty.

For his part, President Obama has acknowledged the rocky road but insists everything is going according to plan.

"This is a big country, and the health care industry is massive and there are tons of providers. And so as we implement, there are going to be glitches," he said last month. "And we're just steadily working through all that stuff."

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