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Key Obamacare Consumer Protection Delayed for a Year

One of the most important new consumer protections in the Affordable Care Act is an annual out-of-pocket limit on all medical expenses. Insurance that doesn’t put some limit on your potential cost if you get very sick doesn’t really function as “insurance.”

An important aspect of this provision was quietly delayed for a year. From the New York Times:

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.

Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.

Supposedly the reason for the delay is that companies didn’t have enough time to upgrade their computer systems, but this excuse is pathetic. Both companies and the government have had four years to prepare for implementation, a shockingly long time. In other countries entire universal health care systems have been created from scratch in far shorter time frames.

I suspect one of the unspoken reasons for the delay is to keep premium increases in group plans to a minimum. By still allowing higher out-of-pocket limits, companies can keep premiums slightly lower. Possible “premium spikes” caused by the new law have been a major Republican attack line.

Photo by VeronicaSheppard  released under Creative Commons License

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Jon Walker

Jon Walker

Jonathan Walker grew up in New Jersey. He graduated from Wesleyan University in 2006. He is an expert on politics, health care and drug policy. He is also the author of After Legalization and Cobalt Slave, and a Futurist writer at