The Truth About Waivers: Protecting Coverage For Millions Of Americans
Today, you might have seen news stories about waivers from certain provisions of the Affordable Care Act. There has been no shortage of confusion and deliberate obfuscation on this issue and we want to ensure you have the facts.
Under the Affordable Care Act, we have implemented new rules that phase out, by 2014, health insurance companies’ ability to slap restrictive annual dollar limits on the amount they will pay for your care. But between now and 2014, we also want to make sure workers are able to maintain their existing insurance, because on their own they would likely be shut out of the individual market or face unaffordable options. To do that, the Affordable Care Act allows the Department of Health and Human Services to issue temporary waivers from the annual limit provision of the law if it would disrupt access to existing insurance arrangements or adversely affect premiums, causing people to lose coverage. So far, we have granted 1,372 of these waivers to employers, health plans, and others in all 50 states, covering less than 2 percent of the insurance market and protecting coverage for more than 3.1 million Americans. We have been completely transparent about this process, announcing the waiver process in a regulation last summer, publishing clear guidance on the application process on our website, and posting a list of waivers we have granted on our website.
These temporary waivers will not be available beginning in 2014 when annual limits are banned and all Americans will have affordable coverage options. And millions of Americans – including many small business owners – will be able to shop for affordable coverage in new competitive marketplaces.
Some have raised questions about waivers that were recently granted to companies in California. So there’s no confusion, here are the facts:
- A company called Flex Plan Services is a third-party administrator that provides benefit administration services for employers in a number of states, including: California, Washington, Alaska, and Georgia. One type of plan they administer is known as a health reimbursement arrangements (HRA or employer contributions to a tax free account). Many of the company’s clients are hotels, restaurants and home health agencies, all of whom employ low-wage workers.
- On March 23, Flex Plan Services submitted 92 waiver requests on behalf of 45 employer clients. On April 4, 2011, HHS approved the request.
- HHS applied the same standard to the application from Flex Plan Services that it uses when reviewing any application for a temporary waiver. Waivers are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage.
- In addition, enrollees must be informed that their plan offers coverage with a restricted annual limit.
- No other provision of the Affordable Care Act is affected by these waivers: they only apply to the annual limit policy.
The Affordable Care Act puts an end to many of the worst insurance company practices including refusing to sell a policy to a family because someone had cancer or a child has asthma; cancelling coverage when a patient files claims because of an unintentional mistake in their paperwork; and slapping annual or lifetime limits on how much care you can receive. When these rules are fully in place in 2014, our country will be much better off and the cost of coverage will be within reach for the millions of Americans who now live day to day without coverage, worrying about an injury or an illness that could plunge them into bankruptcy. To get from today’s broken system to tomorrow’s patient-centered system takes time and patience through a reasonable transition period. But, together, we will get there.
By: Richard Sorian, Asst. Sec for Public Affairs, HHS, The White House Blog, May 17, 2011
Debunking The Right’s Health Waiver Conspiracy
Is House Minority Leader Nancy Pelosi helping companies in her district get around new health care rules? Conservatives seem to think so, but their evidence is spotty at best.
Last month, the Obama administration granted a reprieve to 204 businesses and policyholders from new health coverage rules under the Affordable Care Act, bringing the total number of waivers to more than 1370. Many of the waivers are for limited benefit or so called “mini-med” plans—controversial rock-bottom plans that provide a very limited amount of coverage (sometimes as little as $2,000 a year) to beneficiaries that are used heavily in low-wage industries like the restaurant business. New federal rules require such plans to offer a minimum of $750,000 of coverage annually, and the waivers exempt the mini-med plans from such rules on a case-by-case basis.
The Daily Caller reported on Tuesday that businesses in Pelosi’s district received nearly 20 percent of the waivers in April, pointing out that many of them went to high-end restaurants and hotels. Sarah Palin piled on in a subsequent interview with the Caller, calling the discovery “unflippingbelievable!” and “corrupt.”
Pelosi’s communications director, Nadeam Elshami, pushed back against the criticisms in an email to Mother Jones, denying that Pelosi’s district received any special treatment. Her office also denied that it was at all involved in the process of granting waivers for these businesses. “It is pathetic that there are those who would be cheering for Americans to lose their minimum health coverage or see their premiums increase for political purposes,” Elshami wrote Tuesday afternoon, emphasizing that health-care waivers “are reviewed and granted solely by the Administration in an open and transparent process.”
In fact, the recent waiver applications from businesses in Pelosi’s district were not even received by the minority leader’s office. Rather, they were submitted directly to the Obama administration through a third-party company, Flex Plan Services, which provides benefit administration to companies in the Bay Area, Washington state, and elsewhere in the country, according to a statement issued by Richard Solarian, an assistant HHS secretary. On March 23, Flex Plan Services submitted applications for annual limit waivers for their clients’ health plan, including 69 businesses in California, 20 in Washington state, two in Georgia, and one in Alaska, including restaurants, home health care providers, and other service-based companies. On April 4, the U.S. Department of Health and Human Services approved the waiver request for all of Flex Plan Services’ clients—not just the ones in Pelosi’s district.
Flex Plan Services never contacted Pelosi’s office about their waiver request, and her office did neither provided any information to the company about the waivers nor helped facilitate the request, according to her spokesperson.
In other words, the reason the waivers were clumped together was because Flex Plan Services—which is in charge of administrating all of these businesses’ health care benefits—had issued a waiver request for the entire group of businesses. Altogether, the Obama administration has granted 1372 waivers and has denied about 100 requests. The mini-med waivers are essentially a stop-gap measure designed to keep employers from dropping health care benefits all together. The White House explains that waivers are granted if conforming to the rules “would disrupt access to existing insurance arrangements or adversely affect premiums, causing people to lose coverage,” acknowledging that the low-benefits plans are sometimes the only option that some employers can offer. The Democrats’ rationale is that the other changes under federal health reform will eventually allow employers to receive better, more affordable coverage under the health insurance exchange, when it begins operating in 2014.
To be sure, it’s worth closely examining which businesses and policyholders have received waivers, as well as which ones have denied them, along with the Obama administration’s rationale for making such decisions. But, as the April waivers reveal, the very fact that reprieves have been granted to businesses residing in democratic districts doesn’t mean the process is unjust. And to assume that the rationale must be political or “corrupt” is to turn a real policy issue into a partisan bludgeon.
By: Suzy Khimm, Mother Jones, May 17, 2011
Of Course Newt Gingrich Supported A Health Care Mandate
Mitt Romney continues to face all kinds of heat over his support for a health care mandate, in large part because he continues to defend it. But Sam Stein notes this week that disgraced former House Speaker Newt Gingrich, a Romney rival for the Republican presidential nomination, was just as ardent an advocate of the idea.
In his post-congressional life, Gingrich has been a vocal champion for mandated insurance coverage — the very provision of President Obama’s health care legislation that the Republican Party now decries as fundamentally unconstitutional.
This mandate was hardly some little-discussed aspect of Gingrich’s plan for health care reform. In the mid-2000s, he partnered with then-Sen. Hillary Clinton (D-N.Y.) to promote a centrist solution to fixing the nation’s health care system. A July 22, 2005, Hotline article on one of the duo’s events described the former speaker as endorsing not just state-based mandates (the linchpin of Romney’s Massachusetts law) but “some federal mandates” as well. A New York Sun writeup of what appears to be the same event noted that “both politicians appeared to endorse proposals to require all individuals to have some form of health coverage.”
Neera Tanden, an aide to Clinton at the time who went on to help craft President Obama’s law, said she couldn’t recall exact speeches, but “strongly” believed that the both Clinton and Gingrich backed the individual mandate. Either way, she added, “Gingrich has been known as a supporter” of the idea for some time.
A simple newspaper archive search bears this out.
Gingrich endorsed the individual health care mandate over and over again, in public remarks, in media interviews, and in policy proposals. Ironically, he even explained the importance of the mandate in a book entitled, “Winning the Future.” Gingrich didn’t just grudgingly go along with the measure as part of some kind of compromise; he actively touted it as a good idea.
And he was right.
But that was before President Obama decided he also agreed with the idea, at which point the mandate became poisonous in Republican circles.
The point to keep in mind, though, is that Gingrich’s support for the idea isn’t at all surprising. Indeed, it would have been odd if Gingrich didn’t endorse the mandate.
For those who’ve forgotten, this was a Republican idea in the first place. Nixon embraced it in the 1970s, and George H.W. Bush supported the idea in the 1980s. When Dole endorsed the mandate in 1994, it was in keeping with the party’s prevailing attitudes at the time. Romney embraced the mandate as governor and it was largely ignored during the ‘08 campaign, since it was in keeping with the GOP mainstream.
In recent years, the mandate has also been embraced by the likes of John McCain, Chuck Grassley, Orrin Hatch, Bob Bennett, Tommy Thompson, Lamar Alexander, Lindsey Graham, John Thune, Scott Brown, and Judd Gregg, among many others. Indeed, several of them not only endorsed the policy, they literally co-sponsored legislation that included a mandate.
During the fight over Obama’s reform proposal, Grassley told Fox News, of all outlets, “I believe that there is a bipartisan consensus to have an individual mandate” — and there was no pushback from party leaders. This isn’t ancient history; it was a year and a half ago.
Newt Gingrich touted the same idea? Well, sure, of course he did.
By: Steve Benen, Contributing Writer, The Washington Monthly, May 13, 2011
What Do You Mean We, White Man? Deficit Edition
Whenever I read pieces like David Brooks’s column this morning — pieces that attribute our budget deficits to the public’s irresponsibility and lack of realism — I find myself wondering how so much recent history went down the memory hole.
To be fair, polling on budget questions does suggest a popular demand that we repeal the laws of arithmetic — that we not raise taxes, not cut spending on any popular program, and balance the budget.
But if we look at actual policy changes, it’s hard to see that too much democracy was the problem.
Remember, we had a budget surplus in 2000. Where did it go? The two biggest policy changes responsible for the swing into deficit were the big tax cuts of 2001 and 2003, and the war of choice in Iraq.
And neither of these policy changes was in any sense a response to public demand. Americans weren’t clamoring for a tax cut in 2000; Bush pushed his tax cuts to please his donors and his base. And the decision to invade Iraq not only wasn’t a response to public demand, Bush and co. had to spend months selling the idea to the public.
In fact, the only budget-busting measure undertaken in recent memory that was driven by popular demand as opposed to the agenda of a small number of powerful people was Medicare Part D. And even there, the plan was needlessly expensive, not because that’s the way the public wanted it — it could easily have been simply an addition to traditional Medicare — but to please the drug lobby and the anti-government ideologues.
Now, a lot of historical rewriting has taken place — I’ve even seen pundits solemnly describe the Iraq war fever as an illustration of the madness of crowds, somehow erasing the fact that it was Bush and Rumsfeld, not the masses, who wanted the thing.
But the reality is that if you want to see irresponsibility and self-indulgence at the expense of the nation’s future, you don’t want to visit Main Street; you want to hang out in the vicinity of Pennsylvania Avenue.
By: Paul Krugman, The New York Times, Opinion Pages, May 6, 2011
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