Explanation of out-of-pocket costs for diabetes
Avik Roy over at Forbes has once again managed to set everyone's hair on fire with his latest whine about a delay in one of Obamacare's consumer protections. In February, regulations were issued which delayed the cap on out-of-pocket costs for all health benefits provided by some employer plans until 2015 because there were some issues with coordinating benefits between two separate providers.
Here's the problem, in a nutshell. Some large employers have a health insurance provider and a pharmacy benefit provider, and the two providers may be different, unrelated entities with no way to coordinate the overall cap. In order to accommodate the IT needs of those providers, the regulation gave them an additional 12 months to get their act together.
This delay only applies to new policies that comply with the requirements of the ACA. Employers who hold onto their grandfathered insurance policies aren't affected by any of this, anyway. Remember the insistence on "If you like your insurance, you can keep it?" With that said, I'm certain that it will have an impact on people who may suffer from chronic conditions that require high prescription drug expenditures and also incur other out-of-pocket costs, where two unrelated providers pay the benefits.
We can talk about how stupid it is that insurers and outside benefit providers like PBMs can't seem to get their act together on this, especially when it does mean that there will be some people for whom the out-of-pocket maximum will be higher. It is stupid. It smacks of teenagers finding excuse after excuse for why they couldn't get their chores done or their rooms cleaned up. It's annoying that these delays occur.
On the other hand, in the larger picture, this is a small glitch and one that could have blown up into a much larger one if they forced the cap in 2014 and people found themselves on the receiving end of collection agencies because the providers couldn't get their act together enough to add up what insureds spent out of pocket. Imagine the field day all the anti-ACAers would have with that. They'd trot every aggrieved insured across Fox News to tell their sad stories and tales of woe about how awful Obamacare is because they expected these caps to be handled and they weren't.
Looking from an even higher level than that, let's just talk for a minute about the irony of right wingers like Avik Roy pretending they give a damn about consumer protections. His concern trolling dripped all over readers:
There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes. And unlike a lot of the “rate shock” problems we’ve been discussing, these limits apply not only to individually-purchased health insurance, but also to employer-sponsored coverage. (Self-insured employers are exempted.)
Or this, which was offensive to anyone who has suffered from a chronic condition for any length of time:
The best part in Pear’s story is when a “senior administration official” 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.” Exactly how is it in consumers’ interests to pay far more for health insurance than they do already?
It’s not. Unless you have a serious, chronic condition, in which case you may benefit from the fact that law forces healthy people to subsidize your care. To progressives, this is the holy grail. But for economically rational individuals, it’s yet another reason to drop out of the insurance market altogether. For economically rational businesses, it’s a reason to self-insure, in order to get out from under these costly mandates.
Fck that nonsense. Roy worked for Mitt Romney as his economic adviser. You remember Mitt. He's the guy who signed the Massachusetts law that the ACA was modeled after. Greg Sargent put his nonsense into perspective before I did, so I'll give him the last word on this:
After all, the GOP position is to repeal Obamacare, which is to say, to repeal all of the law’s consumer protections forever. Now Republicans are hitting Obama for delaying a portion of the consumer protections for a year?
To be fair, Republicans can argue coherently that today’s news shows that the consumer protections are unworkable while simultaneously arguing that the whole law must be repealed. But their criticism inevitably leads back to a question: do they support such protections for consumers in principle, or do they oppose them?
I think we all know the answer to that last question. Of course they're not interested in any consumer protections whatsoever. They pay lip service to them, but when pinned down the best they can do is to say that those with pre-existing conditions might be able to be herded into high-risk pools where they pay exorbitant premiums for limited benefits with lifetime maximums.
As you wade through all the sound and fury this latest delay is bound to generate, just remember that the critics don't think people who get sick should have access to health care. That puts the magnitude of this particular delay in a new perspective.