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Most Recent Obamacare Implementation Delay, Also Most Pronounced

Medical-money-300x225No matter which side of the aisle you most closely connect, the assumption by the vast majority of both Democrats and Republicans must have included the recognition that overhauling a system (health care insurance) that was so engrained into the fabric of our country … would indubitably require a complicated and lengthy transition – one that would never be referred to as “seamless.”

And so it seems  the Healthcare Reform Act is suffering yet another setback. Unfortunately, this one extends beyond the realm of a mere temporal delay. Rather, it has the potential to bring extraordinary fiscal strain and pain to many individual consumers. Again, I am sure this is something that both parties would have preferred to avoid.

Just last week, it was revealed that a legal/policy implementation (that would otherwise have protected consumers from exorbitant out of pocket costs) has been delayed until 2015.

These out-of-pocket cost limits (said to include both deductibles and co-payments) were originally conceived so as not to exceed $6,350 for an individual or $12,700 for a family. However, federal officials have allowed some insurers a one-year grace period before the policy is implemented. What that means is, for 2014, they will be able to set higher limits, or even remove them altogether, for some costs. Probably not the way lawmakers had conceived of this from the get go. But, again, no one expected “seamless.”

For the record, the Labor Department’s website alluded to the grace period as far back as February, albeit it was offered with substantial industry and legal jargon. Suffice it to say, the grace period generally went unnoticed for the most part – until now. Again, this is a megalithic reform so continued hiccups are to be expected. In fact, we should be stunned if this were to be the last.

So, what does this hiccup actually mean to consumers?

Well, myriad group health plans will be able to divide the limits set above. So, a consumer could very realistically pay the $6,350 for doctor, hospital visits, and services and then conceivably still have to shell out another $6,350 for prescriptions administered through a pharmacy benefit manager. And, there are some that may be obligated to pay even more than the aforementioned totals as it seem that some group healthcare plans are beholden to zero limits on their patients’ out-of-pocket drug costs for next year. In short, if they do not have one now, they will not impose one for 2014.

While the President specifically set an immovable overall limit when it was first voted in, it seems the insurers are unable to comply quite yet. Why? They literally are incapable of leveraging their current technology to operate the new parameters quickly enough. Most providers go through one company to administer their major medical and another for drug benefits – each with separate out-of-pocket limits. Not surprisingly, these disparate companies have completely different computer systems and as a result, an egregious inability to communicate.

Again, this is not an indictment on the motivations of policy makers, it is just the natural ebb and flow of indoctrinating new policy. Hopefully the next problem area is more of the “delay, please exercise patience” variety, than it resembles the most recent “hitting the consumer in the pocket” example. One thing is for certain, it’s going to take just a bit more time before we get an idea of what this entire implementation will actually feel like when complete.

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