Editorial: Health law complexities undercut progress toward laudable goals


Published May 24, 2013 at 05:00AM / Updated Nov 19, 2013 at 12:31AM

For all the controversy about President Barack Obama’s grand revision of health care, there was wide agreement on at least two things: Too many people lack access to health care, and too many household budgets are ruined by its cost.

The goal — everybody gets health care at a reasonable cost — was valued however much the methods were critiqued.

Now, however, it appears large numbers of people won’t see that benefit.

The Los Angeles Times detailed Saturday how millions of the poor will be left without coverage because 24 states have decided not to expand Medicaid, or are likely to do so. The Wall Street Journal reported that a loophole in the regulations may allow many employers to provide extremely low-benefit plans that don’t even cover X-rays or hospital stays.

The Medicaid expansion issue was launched by the Supreme Court. When the justices decided last year that the Affordable Care Act is constitutional, they also ruled that states could opt out of its Medicaid expansion provisions. The states have legitimate concerns about the ballooning costs they would be forced to assume, but without the expansion, one of the neediest groups won’t get the anticipated help in those states.

The loophole that could allow extreme low-benefit plans from employers may yet be changed. But the Journal says the language mandating essential benefits applies only to small businesses and individuals. Employers with more than 50 workers need cover only preventive services, without a dollar limit, if they seek to avoid penalties. Benefit advisers and insurers that have identified this provision are promoting more limited plans as an option for larger employers, the Journal said. Another off-ramp is early renewal, which can give employers an extra year before changes are required. Employers that self-insure also have fewer requirements.

The Affordable Care Act seeks to address a real problem and includes many valuable provisions. But these two and many other issues show the folly of ramming through — on a partisan basis — a law so complex that we’ve only begun to discover its unintended consequences.