Dept. of Labor Rejects Groups’ Pleas To Reconsider ACA Exception
In an email sent this week to patient advocacy groups, the Department of Labor said it will not reconsider an exception for certain health plans to comply with an Affordable Care Act provision, which could leave some patient populations exposed to out-of-pocket costs far exceeding the caps set in the ACA, Modern Healthcare reports.
Under the ACA, out-of-pocket costs are capped at $6,350 for individuals and $12,700 for families. However in February, DOL released FAQ guidance permitting small-group and non-grandfathered individual plans using multiple vendors to delay implementing a unified out-of-pocket cost limit by one year, or until 2015 (Selvam, Modern Healthcare, 8/7).
The government granted the year-long grace period in recognition of the complexities of such plans (Appleby, Kaiser Health News, 4/9).
However, the exception potentially allows health plans with multiple vendors to charge patients the maximum out-of-pocket costs for each vendor. For example, an individual enrolled in any of those plans might have to pay a $6,350 bill for medical costs and another $6,350 bill for drug benefits (Modern Healthcare, 8/7).
In April, 107 consumer groups sent a letter to HHS and DOL warning them about the negative effects of the one-year delay (Kaiser Health News, 4/9). Meanwhile, more than 100 patient advocacy groups sent a separate letter arguing that the exception could "have an enormous negative impact" on patients, particularly those with chronic conditions.
Details of DOL's Email
However on Tuesday, DOL -- in an email response to the advocacy groups' letter -- said, "Unless or until further guidance is issued on this topic, that temporary policy will apply as stated in the [February] FAQ guidance."
Marc Boutin -- executive vice president and chief operating officer of the National Health Council, one of the signatories of the letters -- expressed surprise at the decision, noting that he thought the government "would turn ... around on" the issue based on the concerns outlined in the letter. Boutin said the groups will continue to fight the exception (Modern Healthcare, 8/7).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.