ACA delays concern patients, opponents

Of all the policies to come out of the Obama administration, few have caused more controversy and greater uncertainty than healthcare reform.

Passed and signed into law in 2010, the Patient Protection and Affordable Care Act is designed to address the tens of millions of Americans who lack healthcare coverage, and it is expected to add more than 30 million new patients when it takes full effect. Following a legal challenge to the law, the U.S. Supreme Court ruled last year that one of its key elements, the individual mandate, did not violate the Constitution.

Now, however, the law has hit another speed bump as the administration allowed a one-year delay in another key part of the law, the requirement that employers provide health insurance for employees or pay a penalty. Originally set to take effect next year, it has been put off until 2015. Experts have said that the delay could significantly reduce the number of people lacking insurance who will gain it next year. At the same time, a Kaiser Health Tracking Poll from June found up to 77% of respondents ages 18 years to 25 years old considered health insurance "very important," with almost two-thirds concerned about paying medical bills for serious illnesses and accidents, and 44% concerned about paying for routine care.

Some groups, notably the National Retail Federation, already had called for the full implementation of the law to be delayed. In testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations, NRF VP and employee benefits counsel Neil Trautwein, said that his group had "consistently" opposed the law and retailers had "serious concerns" about it. "Our nation, particularly employers, cannot afford for the ACA to stumble out of the starting gate," Trautwein said. "We fear that as time diminishes between June 2013 and January 2014, a cascade of additional last-minute regulations will create added confusion and could encourage more employers to back out of coverage."

But while some employers may cheer the delay, it will likely come as a disappointment for patients who had been counting on receiving coverage. In announcing that 17 health insurers had joined the state health insurance exchange, New York Gov. Andrew Cuomo said the approved 2014 rates even for the highest-tiered plans — plans on the state exchange will be tiered as Bronze, Silver, Gold and Platinum — would be 53% lower compared to last year's direct-pay individual rates, not including the effects of federal financial assistance for people meeting certain income thresholds. And while healthcare costs per capita in New York are 18% higher than the national average, the new rates would be in line with the nationwide average previously forecast in a report by the Congressional Budget Office.

"New York's health benefits exchange will offer the type of real competition that helps drive down health insurance costs for consumers and businesses," Cuomo said. "The opportunity to choose among affordable, quality health insurance options will mean improved health outcomes, stronger economic security and better peace of mind for New York families."

According to a Truven Health Analytics study, the healthcare reform law will add 6 million Americans to Medicaid and 21 million to affordable insurance exchanges. New York and Los Angeles are likely to see the largest absolute increases in Medicaid rolls, while large increase are also likely to occur in the Texas cities of Houston, San Antonio and Austin as the number of uninsured Americans is expected to drop from 49 million in 2012 to 27 million in 2016.