Is US health-care reform on track for 2014?

July 11, 2013 by Karen Pallarito, Healthday Reporter
Is U.S. health-care reform on track for 2014?
Health policy experts weigh in on the fate of the Affordable Care Act.

(HealthDay)—At the heart of President Barack Obama's sweeping yet controversial health-reform law is the largest expansion of health insurance in decades, and it's set to take effect on Jan. 1, 2014. But some observers wonder whether it will get off the ground as scheduled.

The law requires most adults to purchase or face a penalty—the so-called individual mandate. It seeks to broaden by:

  • creating state health insurance exchanges where individuals can buy coverage on their own—in some cases, with federal subsidies;
  • expanding Medicaid, the program for poorer Americans;
  • and requiring all but the smallest employers, those with 50 or more workers, to offer health insurance or pay a fine.

But in a surprise announcement last week, the Obama administration delayed the employer mandate, granting companies another year—until 2015—to work through federal rules and reporting requirements.

Could the "individual mandate" be next? Is further upheaval in store?

"It does call into question, 'Is this just a one-time thing or the beginning of more delays and changes,'" said Steve Wojcik, vice president of public policy at the National Business Group on Health, in Washington, D.C.

With the 2014 deadline fast approaching and a lack of definitive guidance from the federal government on implementing some parts of the law, the Affordable Care Act—dubbed "Obamacare"—remains a work in progress.

"I'm actually in the middle of still reading proposed regulations for exchanges," said Cristine Vogel, an associate director in the Chicago-based health-care practice of Navigant Consulting, Inc.

Timothy Jost, a professor at Washington and Lee University School of Law in Lexington, Va., said core parts of the law, including the exchanges and individual mandate, can operate without the employer mandate. "I think the train is still on track, although not moving as quickly as I would like," he said.

Half of states sit out Medicaid expansion

The Affordable Care Act faced its most significant challenge last year when the U.S. Supreme Court considered whether requiring most consumers to have health insurance, or pay a penalty, was constitutional. The high court upheld this individual mandate last June. But it also ruled that states could opt out of expanding Medicaid—the federal-state health insurance program for the poor and disabled.

Expanding Medicaid to more low- and middle-income people is one of the ways the architects of the health-reform law envisioned reducing the ranks of the nation's uninsured by up to 30 million people.

Under the law, people making up to 138 percent of the federal poverty level may qualify for coverage under the Medicaid expansion. (That's as much as $15,856 for an individual or $32,499 for a family of four.)

So far, though, only 23 states and the District of Columbia plan to participate in the Medicaid expansion. The remaining states are mostly led by Republican governors who refuse to go along with expansion.

Low-income individuals in states that do not expand Medicaid eligibility will not be penalized for not having health coverage. But the poorest among them—people living below the poverty line—won't be able to access federally subsidized coverage through the state health exchanges, either. That leaves nearly 10 million of 15 million potentially eligible adults without coverage, according to a recent Associated Press analysis of Urban Institute data.

"This rips the heart out of health-care reform because it denies access to America's most vulnerable," said Lawrence Gostin, professor of global health law at Georgetown University School of Law.

Will the health exchanges open in time?

Another 24 million people will be enrolled in health plans through the state health insurance exchanges by 2023, according to a Congressional Budget Office estimate. The administration hopes to enroll 7 million people in the first year of eligibility.

Recently, though, Congress' Government Accountability Office reported that health officials are running behind schedule on many aspects of health exchange formation, including testing data systems that will be used to determine eligibility for coverage.

On Friday, the Obama administration published regulations scaling back the requirement that state health insurance exchanges, or marketplaces, verify consumers' income and health insurance status to obtain coverage under the law. Instead, the exchanges will rely more heavily on self-reported information until 2015, according to the Washington Post.

In a recent interview with CNBC, Todd Park, chief technology officer with the U.S. Department of Health and Human Services, said the state health insurance exchanges are "on track" and will be up and running on Oct. 1 for open enrollment.

Self-reporting will streamline the enrollment process, said Dan Schuyler, director of exchange technology at the Salt Lake City-based consulting firm Leavitt Partners. But, he added, "it also opens the door to deliberate fraud, abuse and unintentional eligibility errors."

Is Obamacare in trouble? Depends on whom you ask

Republican opponents of the Affordable Care Act assert that the Obama administration is playing politics by delaying provisions of the law, particularly the employer mandate, until after 2014 mid-term Congressional elections, The Hill reported.

By 2023, the law will reduce the number of people without health insurance by 25 million, still leaving 31 million uninsured, according to Congressional Budget Office (CBO) estimates.

House Budget Committee Chairman Paul Ryan (R-Wis.) wants the CBO to reevaluate the estimate of the law's impact in light of the recent delays, according to The Hill.

Alden Bianchi, group leader of the law firm Mintz Levin's employee benefits practice in Boston, doesn't believe recent changes suggest the federal law's implementation is in trouble, as Republican opponents assert.

"The exchanges won't be perfect on Day One. The underlying electronic infrastructure that communicates among HHS (Health and Human Services) and the various state exchanges won't be up and running. But will people be able to get access to health care? Yeah, and that's really what exchanges are for," said Bianchi, who represented former Gov. Mitt Romney's administration for Massachusetts' 2006 legislation.

David Smith, Leavitt Partners' director of payer services, downplayed the possibility that the White House would put the brakes on the state insurance exchanges or the individual mandate.

"Politically, the administration can't afford a delay of the more critical pieces of the and will move mountains to implement them on time while managing expectations," he said.

Explore further: White House delays key element of health care law

More information: To learn more about the Affordable Care Act visit the U.S. Department of Health and Human Services.

Related Stories

White House delays key element of health care law

July 3, 2013
President Barack Obama's health care law, hailed as his most significant legislative achievement, seems to be losing much of its sweep.

U.S. gives states more time to set up health insurance exchanges

January 15, 2013
(HealthDay)—The Obama administration is giving states additional time to set up so-called health insurance exchanges, a key element of the 2010 health reform law designed to bring coverage to an estimated 30 million Americans ...

Big gap looms for poor in Obama health care law

July 1, 2013
(AP)—President Barack Obama's historic promise of health insurance for nearly all U.S. residents looks unlikely to be fulfilled as envisioned—with nearly two in three uninsured low-income people who would qualify losing ...

Many states say 'no' to health insurance exchanges

December 18, 2012
(HealthDay)—Half of the states in the nation have rebuffed a key provision of the Obama administration's health reform law: the creation of state-based health insurance exchanges, according to data compiled by the Henry ...

'Pragmatic' Obamacare delay a victory for business lobby, expert says

July 8, 2013
The Obama administration's decision to delay a key healthcare reform provision requiring large employers to pay a penalty if they don't offer health insurance is a big victory for the business community, says attorney and ...

Feds propose fee on health insurers in new market

November 30, 2012
(AP)—Health insurance companies will have to pay to play in new health insurance markets coming under President Barack Obama's health care law.

Recommended for you

Sugar not so sweet for mental health

July 27, 2017
Sugar may be bad not only for your teeth and your waistline, but also your mental health, claimed a study Thursday that was met with scepticism by other experts.

Could insufficient sleep be adding centimeters to your waistline?

July 27, 2017
Adults in the UK who have poor sleep patterns are more likely to be overweight and obese and have poorer metabolic health, according to a new study.

Vitamin E-deficient embryos are cognitively impaired even after diet improves

July 27, 2017
Zebrafish deficient in vitamin E produce offspring beset by behavioral impairment and metabolic problems, new research at Oregon State University shows.

The role of dosage in assessing risk of hormone therapy for menopause

July 27, 2017
When it comes to assessing the risk of estrogen therapy for menopause, how the therapy is delivered—taking a pill versus wearing a patch on one's skin—doesn't affect risk or benefit, researchers at UCLA and elsewhere ...

Blowing smoke? E-cigarettes might help smokers quit

July 26, 2017
People who used e-cigarettes were more likely to kick the habit than those who didn't, a new study found.

Brain disease seen in most football players in large report

July 25, 2017
Research on 202 former football players found evidence of a brain disease linked to repeated head blows in nearly all of them, from athletes in the National Football League, college and even high school.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

freethinking
1 / 5 (4) Jul 11, 2013
The answer to the question is NO!

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.