London    We may think that Congress does nothing but try to repeal the Affordable Care Act, and although they do a whole lot of that, like it or not both parties do come together every blue moon to amend the Affordable Care Act, but when they do so, it’s not necessarily a win for the lower income workers and families that need the coverage the most.   Once again I’m harping on the theme of allowable deductibles under Obamacare.

My old friend and colleague, Mike Gallagher of SEIU Local 615 fame in Boston, was scratching his head in disbelief recently when reading my reports of bargaining with large health care employers on supposedly qualified plans with virtually no limits on allowable deductibles.  He brought to my attention the predecessor work in Massachusetts and the critical feature there that had allowed them to bargain decent health plans.  A Massachusetts fact sheet made it clear setting:

A cap on annual deductibles of $2,000 for an individual and $4,000 for a family

Why didn’t we have that nationally with Obamacare?

Well, we almost do, and then we didn’t it seems, and it all happened within the last few months when Congress got together across the aisles and on April 1, 2014 passed the Protecting Access to Medicare Act, which sadly eliminates the Affordable Care Act restrictions on separate deductible limits.  The Bureau of National Affairs (BNA) reported the following:

The Affordable Care Act requires annual cost-sharing limits on coverage as part of the essential health benefits package required for plan years beginning in or after 2014. As enacted, it provided for annual limits on total cost-sharing and for annual limits on deductibles for insured employer-sponsored plans offered in the small group market. Section 213 of the Protecting Access to Medicare Act of 2014 (Pub. L. No. 113-93) eliminated the $2,000/$4,000 limitation on deductibles for affected group health plans retroactive to the March 23, 2010, enactment of the Affordable Care Act.

Unfortunately what that bit of doublespeak means is that for large employer and self-funded plans there are no deductible limits, which is why Local 100 United Labor Unions and many others are confronting the problems of substandard group plans being proposed by larger employers which are totally inferior and worthless compared to what might be available to the same lower wage workers under the Affordable Care marketplaces.  For small employer and individual plans, the limits on deductibles under the Act are the same as my friend showed me in Massachusetts at $2000 for individuals and $4000 for family.

An employer newsletter gloating about the Congressional change signed by the President was also crystal clear:

Though getting little attention in the aftermath of the new law, there is a second consequence of the new law. The separate limit on deductibles posed something of a challenge in designing Bronze-level and Silver-level plans, i.e., plans with, respectively, 60 and 70 percent actuarial value. The Department of Health and Human Services recognized as much in final regulations implementing the Affordable Care Act’s rules governing essential health benefits. According to 45 C.F.R. § 156.130(b)(3): “A health plan’s annual deductible may exceed the annual deductible limit if that plan may not reasonably reach the actuarial value of a given level of coverage. . . without exceeding the annual deductible limit.”  In other words, the separate cap on deductibles could be exceeded where necessary in order to get to a particular level of actuarial value.

Since the Bronze and Silver plans are also the ones most often chosen by lower income workers because of the lower monthly premium costs, what the employer advisory was really saying, is “no sweat, buddies, HHS had already allowed you to break the deductible ceiling limit if you needed to, but now Congress has repealed the limits anyway, so go low or go home.”

This was not the fix that millions of lower waged workers desperately needed in order to finally make fake employer coverage and compliance under the Affordable Care Act real.  In fact quite the opposite.  I guess those workers for smaller outfits should feel lucky, because with this alternation, the bigger the outfit, the worse the pain, and the more worthless the health care policy for many under Obamacare.