Symp­tom of health care law — con­fu­sion

Two years later, states and em­ploy­ers wait for guid­ance

The Washington Times Daily - - Front Page - BY PAIGE WIN­FIELD CUN­NING­HAM

Two years af­ter con­gres­sional Democrats squeezed out enough votes to pass Pres­i­dent Obama’s health care over­haul, con­fu­sion still reigns among the states, in­sur­ers and av­er­age Amer­i­cans strug­gling to com­ply with the hun­dreds of pages in the law.

Some states say they can’t move for­ward un­til the gov­ern­ment is­sues more rules to clar­ify ex­actly what kinds of ser­vices need to be cov­ered, while other states dis­pute that, say­ing enough in­for­ma­tion is avail­able to plow ahead.

In­sur­ance com­pa­nies are bit­ing their nails over how the re­quire­ments will af­fect their bot­tom lines.

Busi­ness own­ers say they can’t be­gin to com­ply with the law be­cause it is too baf­fling. “Most of ‘em don’t have a clue what’s fixin’ to hap­pen,” said Grady Payne, owner of a busi­ness based in Fort Worth, Texas.

An­a­lysts, how­ever, say many ques­tions have been an­swered and that busi­nesses should in­vest the time to find the an­swers.

Add to that the le­gal un­cer­tainty. The Supreme Court is slated to hear oral ar­gu­ments over the law next week, Re­pub­li­can pres­i­den­tial can­di­dates are vow­ing to repeal or waive the law, and some pol­i­cy­mak­ers are ask­ing for a pause.

“I think it would make an aw­ful lot of sense to say, ‘Let’s wait a minute, let’s take a breath,’ “said Bill Hazel, the sec­re­tary of health and hu­man re­sources in Virginia.

“Let’s get through this Supreme Court decision, let’s get through the elec­tions and then re­con­sider this.”

The leg­is­la­tion passed by a 219-212 vote in the House and a 60-39 vote in the Se­nate, with just a sin­gle Re­pub­li­can in fa­vor of it. The bill cleared Congress on March 21, 2010, and Mr. Obama signed it into law two days later in a cer­e­mony at the White House.

“I’m con­fi­dent that you will like what you see: a com­mon-sense ap­proach that main­tains the pri­vate in­sur­ance sys­tem but makes it work for ev­ery­body, makes it work not just for the in­sur­ance com­pa­nies, but makes it work for you,” Mr. Obama said at the time.

Ever since — and es­pe­cially this week — the Obama ad­min­is­tra­tion and con­gres­sional Democrats have touted the im­me­di­ate ben­e­fits: man­dated cov­er­age for em­ploy­ees’ chil­dren up to age 26, a ban on lim­it­ing life­time ben­e­fits and drug dis­counts for se­niors.

But two years af­ter the pres­i­dent signed the Af­ford­able Care Act, the law re­mains con­tentious. An Abc/washington Post poll re­leased Mon­day found that Amer­i­cans op­pose the law by 52 per­cent to 41 per­cent.

Wait­ing on the ad­min­is­tra­tion

“There are still a lot of out­stand­ing ques­tions be­cause we’re still wait­ing for a lot of the reg­u­la­tions,” said Robert Zirkel­bach, a spokesman for Amer­ica’s Health In­sur­ance Plans, the in­sur­ance in­dus­try’s trade as­so­ci­a­tion.

The as­so­ci­a­tion hasn’t seen the final rules on whether the ad­min­is­tra­tion will con­sider costs when de­cid­ing what kinds of ser­vices in­sur­ers will be re­quired to cover as es­sen­tial ben­e­fits.

The be­wil­der­ment is read­ily ap­par­ent among busi­ness own­ers, who re­cite long lists of wor­ries.

It’s all the more con­fus­ing when large and small busi­nesses are gov­erned by dif­fer­ent sets of rules.

Take Mr. Payne, the Fort Worth­based busi­ness owner who runs a chain of plants that pro­duce wooden pack­ag­ing and crat­ing parts.

Since the 1990s, Mr. Grady has of­fered full-cov­er­age poli­cies to about 140 ad­min­is­tra­tive staffers, but not to 300 or so fac­tory work­ers, mainly young and male, who he said aren’t will­ing to help foot the bill. Now that he will be re­quired un­der the law to ei­ther pro­vide cov­er­age to all of his em­ploy­ees or pay a $2,000 fine for each, he said, he wor­ries that he won’t be able to af­ford the plans or per­suade work­ers to pay their share.

Able to re­cite cost es­ti­mates off the top of his head, Mr. Grady has spent a lot of time por­ing over the fig­ures. To cover fac­tory work­ers, he said, he would have to dou­ble what he spends on in­sur­ance to $1.5 mil­lion a year, which would eat up all his prof­its.

“It’s re­ally dis­cour­ag­ing to go to work ev­ery day and think all I’m do­ing is work­ing to pay med­i­cal in­sur­ance,” he said.

His chief fear is how he will cover the ben­e­fits Texas may end up deem­ing “es­sen­tial.”

An­a­lysts said Mr. Grady’s fear may be un­founded. The es­sen­tial ben­e­fits man­date ap­plies di­rectly to small com­pa­nies, while Mr. Grady’s busi­ness, with more than 50 em­ploy­ees, is con­sid­ered large.

Drag­ging their feet

Such con­fu­sion is wide­spread, said Stacey Pogue, se­nior pol­icy an­a­lyst for the Texas-based Cen­ter for Public Pol­icy Pri­or­i­ties, which sup­ports the law. She said the prob­lem is es­pe­cially ev­i­dent in Texas and other states where of­fi­cials are chal­leng­ing the law be­fore the Supreme Court and drag­ging their feet on im­ple­ment­ing it.

“I think public ed­u­ca­tion is one of the big­gest chal­lenges we’re fac­ing with im­ple­ment­ing the Af­ford­able Care Act — with­out a doubt,” Ms. Pogue said. “A lot of peo­ple are mis­in­formed about what’s in the law, and I think cer­tainly that needs to be the fo­cus of the fed­eral gov­ern­ment.”

Oth­ers blame the un­cer­tainty on the Obama ad­min­is­tra­tion, say­ing it has been slow in pro­vid­ing guid­ance.

Last week, the ad­min­is­tra­tion re­leased more than 600 pages of lon­gawaited rules on state-run in­sur­ance ex­changes through which mil­lions of Amer­i­cans are ex­pected to ob­tain base-line cov­er­age.

But health care play­ers are still wait­ing for rules about the min­i­mum cov­er­age that plans in the ex­changes must of­fer.

The ad­min­is­tra­tion has told states only the first steps to­ward set­ting up ex­changes. It has told them to iden­tify an in­sur­ance plan that will serve as their min­i­mum level of cov­er­age.

The fed­eral gov­ern­ment is ex­pected at some point to give more spe­cific guid­ance, and some states won­der why they should write their own rules only to find out later that they don’t meet fed­eral stan­dards.

“It would have helped to have the es­sen­tial ben­e­fits pack­age worked out some time ago,” said Mr. Hazel, the Virginia of­fi­cial. “That’s the ba­sic thing — how can you price it and fig­ure out what your rules will be?”

The Obama ad­min­is­tra­tion says its ap­proach gives states flex­i­bil­ity, and some of­fi­cials said they ap­pre­ci­ate that.

Kansas In­sur­ance Com­mis­sioner Sandy Praeger, a Re­pub­li­can, said she is frus­trated with states that blame their own in­ac­tion on the ad­min­is­tra­tion. A dozen states have passed bills to set up ex­changes, but 17 have yet to take any leg­isla­tive steps for­ward.

“This is the hall­mark of the pres­i­dent’s first term in of­fice, and I think it’s be­ing fought by con­ser­va­tive Re­pub­li­can states, and I think a lot of it is po­lit­i­cal,” Ms. Praeger said.

She plans to is­sue rec­om­men­da­tions for how her state should pro­ceed, but fears her state’s Re­pub­li­can-led Leg­is­la­ture and Gov. Sam Brown­back, also a Re­pub­li­can, won’t take ac­tion.

More ques­tions than an­swers

No mat­ter how they felt about the ad­min­is­tra­tion’s ap­proach, states, em­ploy­ers and in­sur­ers are left with a laun­dry list of ques­tions, in­clud­ing how they should go about ap­prov­ing a bench­mark plan, how close a plan must come to meet the law’s re­quire­ments to be con­sid­ered ac­cept­able and how to de­fine cat­e­gories less com­monly cov­ered, such as ha­bil­i­ta­tive ser­vices.

Ac­knowl­edg­ing that there is no widely ac­cepted def­i­ni­tion of what qual­i­fies as “ha­bil­i­ta­tive,” the ad­min­is­tra­tion has of­fered an ex­am­ple of a ser­vice it could in­clude: speech ther­apy for a child who is not talk­ing at the ex­pected age. Busi­nesses say the ex­am­ple isn’t enough and that they need to see final rules.

At the core of the ar­gu­ments are con­cerns about the ul­ti­mate costs of the plans. If states se­lect a ben­e­fit-rich plan as their bench­mark, in­sur­ers will charge more in pre­mi­ums for all of their plans, and that could raise costs for busi­nesses.

“If you were to re­quire all auto man­u­fac­tur­ers to make cars with sun­roofs and leather seats, cars are go­ing to be more ex­pen­sive,” said Katie Maloney, a health care pol­icy spe­cial­ist at the U.S. Cham­ber of Com­merce. “What if some­one wants to buy a beater?”

While large busi­nesses are al­lowed to pur­chase plans out­side the ex­changes that may not of­fer the same min­i­mum cov­er­age, they can’t im­pose any life­time lim­its on any es­sen­tial ben­e­fits they do of­fer. Un­cer­tain of the costs, some large busi­nesses are re­con­sid­er­ing whether to cover any es­sen­tial ben­e­fits at all, Ms. Maloney said.

As they try to fig­ure it out, the clock keeps tick­ing to­ward Jan­uary 2014, when many of the law’s key pro­vi­sions take ef­fect.

“I think there are more ques­tions than there are an­swers,” Ms. Maloney said. “We’re urg­ing agen­cies to is­sue rules that are clear and sim­ple. We’re look­ing at a very short­ened crunch time.”

In­sur­ers are also pre­oc­cu­pied with the ques­tion of whether thou­sands of new pro­vi­sions will com­bine to lower costs or make plans more ex­pen­sive.

Un­cer­tainty over health care re­form be­gan un­nerv­ing some busi­ness own­ers even be­fore Congress en­acted the leg­is­la­tion.

Rose Corona, owner of a farm and feed store in Te­mec­ula, Calif., de­cided to hold off of­fer­ing cov­er­age to her 34 em­ploy­ees when Mr. Obama started talk­ing about re­form­ing health care be­cause she feared his plan could end up mak­ing plans more ex­pen­sive.

“You have to have some cer­tainty about the costs of your busi­ness, and I think that’s what this comes down to,” Ms. Corona said. “I have to keep this busi­ness run­ning, and we have to con­trol our over­head costs.”

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