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ObamaCare Clusterfuck: Out-of-pocket limits delayed for the convenience of insurance companies who didn't reprogram their systems

No, I'm not kidding. The Times:

In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.

The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.

Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer 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.

A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: “We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs. They asked for more time to comply.”

Well, let's be fair. They only hadthree fucking years to implement this! And here's the beauty part, or an even more beautiful part:

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.

No, not HHS. Not CMS. Not The Labor Department. Makes you wonder how many other Easter Eggs litter the landscape in other Federal Departments.

Again to be fair, even though the Labor Department notice had been up since February 20, 2013, Obama wasn't exactly lying when he said this on May 10, 2013:

if you still can't afford it, then you're going to get help reducing your out-of-pocket premiums with the largest health care tax cut for working families and small businesses in our history. (Applause.)

After all, Obama didn't say when, and he didn't say everybody.

* * *

Readers, if you've been following this series, you'll notice several continuing themes in this latest #FAIL:

1. A project that's poorly managed and out-of-control sheds requirements when deadlines approach. We've seen that with the employer mandate postponement, and the income validation switcheroos. A project that's run by sleazebags and really out of control sheds requirements in such a way that the clients -- in this case, ultimately the American people -- remain unawares until it's too late.

2. ObamaCare's implementation problems all come from its system architecture. Here again we've got the exact same systems integration problems that have played out the with the Data Hub, except in the private sector. Just as integrating the disparate computer systems from DHS, IRS, HHS, the Peace Corps, and gawd knows who else are a true technical challenge, so integrating private systems would be at least an equal challenge, and probably greater. After all, private vendors deliberately make their proprietary data formats incompatible to lock in their customers.

3. ObamaCare consistently delivers unfair, unequal outcomes on a random basis. The story says: "a consumer may be required." Which consumers? Why? Will there be any provision made to take care of citizens consumers who are poor and/or ill? Nobody knows. Or cares, so far as I can tell.

Finally -- and this will surprise you -- single payer Medicare for all would eliminate all these problems. ObamaCare, technically, can be viewed as a gigantic exercise in integrating systems that shouldn't even exist in the first place.

NOTE Hat tip, billwarren.

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katiebird's picture
Submitted by katiebird on

And at what point do we find out if we have the protections of the "cap" ? Will this be disclosed at the point of sale? Or at the point of bankruptcy.


billwarren's picture
Submitted by billwarren on

Is Obama a pilot? His handlers could have him land on an aircraft carrier under an "Obamacare Mission Accomplished" banner, (in a leather flight jacket and Snoopy goggles) since this thing is turning out just like Bush's Iraq War did.

jo6pac's picture
Submitted by jo6pac on

looks like it's time to roll out some more PR because it really is turning into what we all thought it would more transfer of wealth from Main Street to the 1%.

Alexa's picture
Submitted by Alexa on

(out-of-pocket) in 2014.

I'd put money on it that Mr Alexa's employer was in the forefront of the push to delay this "feature" of the PPACA. To respect Mr. A's privacy, I won't divulge who it is.

But, it is a major multinational corporation. If his company is "running" dual deductibles, you can be other big companies are, and will. (Until it is outlawed, if it ever is.)

It was beginning this year that they imposed "dual" out-of-pocket limits on his Group Plan.

I have a sinking feeling that before it's over, ALL the "features" that we supposedly going to help "the little guy" will be systematically stripped from this bill.

But, of course, "the mandate" will be left intact.

This is one reason that I've always been against the use of a mandate (not that I don't understand the underlying argument, for it). I do.

But again, if you make purchasing health insurance through the Exchanges "affordable," like Medicare, for the most part you wouldn't need a mandate. And you achieve the same result--without leaving many folks hung out to dry, if a rogue Repub Congress decides to defund the program.

If I understand it correctly, the funding for all subsidies could be cutoff, without nullifying the mandate.

Mr. A's employer has "gone silent" on a topic that they claimed that they would be "discussing and educating" everyone about over the summer months.

I'd say that they "got everything they wanted."

Now we wait anxiously to see if we'll be sc**wed even more badly, next year (since we have very expensive ongoing medical expenses).

Of course, the "best features" didn't apply to our Group Plan, anyway. According to Mr A's employer, several features called for in the PPACA will not apply to our Group Plan (due the grandfathering).

We have always had a lifetime limit, and as far as I can tell, this won't change for "grandfathered" Group Plans.

If anyone knows differently, please let me know.

That would be "good news," for a change. ;-)