for consumers with health problems – has worked less
well than hoped. PPACA requires insurers to sell coverage on a guaranteed-issue basis, without using most types
of personal health information in pricing, starting in 2014.
Congress created PCIP as a temporary solution for consumers who were willing and able to pay for private coverage, unable to qualify for Medicaid or Medicare, and unable
to qualify for conventional, individually underwritten commercial health coverage.
PCIP enrollment has been much lower than program creators had predicted. The consumers who are enrolled end up
generating an average of about $30,000 in medical bills each
per year, in part because Congress saddled the program with
restrictions that made the program unappealing to typical
people with health problems, officials said.
To avoid having PCIP crowd out private coverage, Congress
required that PCIP enrollees be consumers who had been
uninsured for at least 6 months, and it required that the
rates be comparable to the rates that ordinary consumers pay for conventional individual coverage. Few people
with serious health problems can afford to be completely
uninsured for 12 months, and the premiums turned out to
be too high for many uninsurable people who have health
problems, officials said.
PCIP managers had said they would pay brokers a $100 enrollment assistance fee to drum up interest in the program. Brokers reported that collecting the fee was difficult, and program
managers eventually canceled the assistance fee offer.
The Internal Revenue Service (IRS), an arm of the U.S.
Treasury Department, and the Employee Benefits Security
Administration (EBSA), an arm of the U.S. Labor Department,
have been working with the Center for Consumer Information
and Insurance Oversight (CCIIO), an arm of the U.S. Department of Health and Human Services (HHS), to develop many
PPACA regulations.
Implementation leaders include HHS Secretary Kathleen
Sebelius, a former Kansas insurance commissioner, former
Kansas governor and former president of the NAIC, and
CCIIO officials like Steve Larsen, the CCIIO director.
EBSA and the IRS have faced questions from Republicans in
Congress about the amount of time and effort they’ve put into
implementing PPACA.
sion that could have greatly expanded the need for small
businesses to send out 1099 forms.
In October 2011, Obama administration officials said they
would suspend efforts to implement the PPACA CLASS
Act provisions because they did not believe the version
of the program required by PPACA would be actuarially
sound. House Republicans have talked about coming up
with an alternative to the act but have not yet introduced
a new LTC bill.
CAN CONGRESS REQUIRE
CONSUMERS TO BUY INSURANCE?
The U.S. Supreme
Court heard oral
arguments on
several sets of
legal challenges to
PPACA in March.
One controversial
provision of PPACA
would require most
individuals to own
health coverage or
else pay a penalty.
Many plaintiffs have
sued to challenge
the individual mandate provision, arguing that the mandate goes beyond the
intent of the Commerce Clause of the U.S. Constitution — a
clause that permits Congress to regulate commerce — in a
way that is unconstitutional.
U.S. District Judge Roger Vinson, a judge in Pensacola, Fla.,
gave the question media vitamins by asking during oral arguments whether the government had any more right to require
citizens to buy health insurance than it does to require them
to buy broccoli.
Plaintiffs also have been challenging the constitutionality of
a provision that could require states to expand their Medicaid
programs to maximize federal funding and a provision that
could require many employers to provide health coverage.
The IRS, for example, already is implementing a requirement
that employers report how much they are spending on health
benefits on employees’ W- 2 forms.
HHS is in the middle of a heated battle over whether
new minimum preventive services benefits requirements
imposed by PPACA should require employers that oppose
contraception to cover birth control products and services.
Other questions include whether any, some or most of PPACA
can remain in force if the court invalidates the individual
mandate provision and whether federal law will let plaintiffs
challenge PPACA penalty provisions before the act takes effect.
Photo © Thinkstock.com
At least two PPACA provisions appear to be dead.
In April 2011, Obama signed H.R. 4, a bill eliminating a provi-
Observers have pointed out that even a ruling that appears
decisive on paper may not be the end of the story. More chal-
lenges to the constitutionality of PPACA are moving through
the federal courts, and the outcome of the November general
elections could affect the atmosphere in Congress and at-
titudes toward PPACA at federal agencies.
