Posts tagged: grandfathered

Truck, Meet Hole

By , October 30, 2013 11:44 am

Here’s the relevant provision in the Affordable Care Act, a provision that President Obama touted again and again and again and again:

(a) No changes to existing coverage
(1) In general Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on March 23, 2010.[42 USC Sec. 18011 (a)(1)] (Emphasis supplied)

Nope, the Affordable Care Act doesn’t require you–the individual–to terminate that health insurance plan you like. Nope, you don’t even have to get up from the couch. Your friendly federal government, in the form of regulations promulgated by Health and Human Services, will terminate it for you, if your insurance provider or group plan:

-eliminat[es] of all or substantially all benefits to diagnose or treat a particular condition,

-increase[s] . . . a percentage cost-sharing requirement (such as . . . [your] coinsurance . . .),

-increase[s] . . . a fixed-amount cost-sharing requirement other than a copayment (for example,deductible or out-of-pocket limit). . . if the total percentage increase in the cost-sharing requirement . . . exceeds the maximum percentage increase (as defined in paragraph (g)(3)(ii) of . . . [S]ection 54.9815–1251T),

-increase[s] . . . a fixed-amount copayment [by greater than essentially the medical inflation plus $5.00],

-impose[s] . . . [or] decrease[s] an overall annual limit on the dollar value of benefits, [or]

-[if an employer] decreases its contribution rate [essentially, by more than 5%].

(Some emphasis and incidental formatting/punctuation supplied)

Those who are gluttons for punishment can read HHS’s summary of the sordid details here. If you want to read the fine print, click on the link at the very end of the summary. (Oddly, the other links, or at least the ones I tried, don’t work.)

Or you can read my copy here (scroll down until you find the yellow highlights). Have fun: Interim Final Regulations_HHS-OS-2010-0015-0001

A final comment. The HHS regulation makes sense. The Affordable Care Act is supposed to deliver better healthcare–supposed to. And the regulation is an attempt to deliver on that promise to those with existing plans that they like and want to keep. Each of the reasons for terminating your coverage makes sense if you accept the premise that the requirements represent a safety net, a blockade to prevent your health insurance company from reducing your benefits. But that’s not how President Obama sold the Act. As the videos linked to above demonstrate, he promised unequivocally that you could keep your health insurance, no if, ands, or buts, and knowing full well that you probably would not be able to.

Would the Act have passed if he had been up front about this? I don’t think so.

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