28 Delays, and Counting, to Health Reform

For the second time in about a year, the Obama administration gave companies, including small businesses, more time before they must offer affordable health insurance to almost all their full-time workers or pay a tax.

To date, there have been 28 delays to provisions in health reform, and counting. Still no delay in the individual mandate, which requires all U.S. citizens to buy health insurance or pay a mandate tax. Here’s a running tally of the delays to health reform:

Timeline of Major Health-Reform Delays

November 6, 2012 Medicaid physician reimbursements: Increased reimbursements for primary-care physicians who treat Medicaid beneficiaries didn’t go into effect on Jan. 1, 2013, as scheduled. The health-reform law temporarily increases Medicaid payments in 2013 and 2014.  However, guidance on the increased Medicaid physician reimbursements was not released until November 2012. In many states, the higher payments to doctors were delayed since states had little time to ramp up Medicaid programs. The federal government allowed states to make the adjustments retroactive to Jan. 1. The federal Centers for Medicare & Medicaid Services (CMS) gave states until March 31, 2013, to submit their methodologies to CMS for approval and then CMS had a few months to review them.

January 31, 2013 Bundled Payments initiative: The Obama administration was late starting an experiment with changes to how doctors and hospitals are paid by Medicare, which was slated to take effect Jan. 1, 2013.  But it wasn’t until January 31, 2013, that CMS announced the start of its “Bundled Payments for Care Improvement” initiative. Bundled payments are seen as a way to encourage hospitals and doctors to work together to hold down costs and improve care.

February 1, 2013 Medicaid funds and preventive care:  Increased federal funding for states that eliminate Medicaid co-payments for preventive care didn’t really go into effect on Jan. 1, 2013, as scheduled. Under health reform, a 1 percentage point higher Medicaid matching rate is available to states that eliminate requirements for co-pays for immunizations and other preventive services. But qualifying states didn’t immediately start getting those increased payments because it took until February 1, 2013, for CMS to issue a letter outlining the new Medicaid preventive services coverage option, which became effective January 1, 2013.

February 6, 2013 Basic Health Program: The federal government announced a one-year delay for the “Basic Health Program.”  The program is aimed at low- to moderate-income people who won’t qualify for the expanded Medicaid program under health reform. Health & Human Services (HHS) said it ran out of time to put out guidelines to get the program running by 2014 so it will not become operational until 2015.

February 20, 2013 Out-of-pocket costs: The administration announced that the law’s cap on out-of-pocket costs of $6,350 for individuals and $12,500 for families will not be enforced for some employer-based health insurance plans until 2015. Under the law, starting Jan. 1, 2014, health plans are required to cap the amount consumers can be charged through deductibles, co-payments and co-insurance, but officials will now let some insurers wait until 2015 to comply. (Note: The change was included in a Department of Labor rule issued in February).

April 1, 2013 Small Business Health Options Program: The federal government announced that the Small Business Health Options Program (SHOP) will be delayed until 2015. SHOP was supposed to provide small employers with an insurance marketplace, or exchange, that offers multiple plan options starting in 2014. In most states employers will instead be limited to a single plan in 2014.

July 2, 2013 Employer mandate: The Obama administration announced that the employer mandate requiring employers with at least 50 full-time workers to provide them with coverage or pay a penalty will now be enforced starting in 2015, not 2014 as originally planned. The move to delay the employer mandate will mean $12 billion in lost tax revenue and additional costs, according to the Congressional Budget Office.

July 2, 2013 Employer reporting requirements: The Obama administration announced that it is going to also delay, until 2015, associated reporting requirements relating to potential employer penalties. Under the law, insurers and certain other health coverage providers (primarily employers that self-insure) will be required to report the names of those receiving coverage, and certain large employers will be required to report on the health insurance coverage offered to their full-time employees. The information reporting requirements will now be effective for 2015 instead of 2014.

July 5, 2013 Verifying coverage status: The Obama administration announced that it has decided to roll back requirements for new state insurance marketplaces to verify health coverage status of people who apply for subsidized coverage.  Before the delay, the administration had proposed that exchanges verify whether new applicants receive employer-sponsored insurance benefits through random checks. The rules gave 16 states and Washington,  DC, which are setting up their own exchanges, until 2015 to begin random sampling of enrollees' employer-insurance status. Marketplaces to be operated by the federal government in 34 states will still make random checks to verify applicant insurance status in 2014.

July 5, 2013 Verifying income: The Obama administration announced that it had decided to roll back requirements for new state insurance marketplaces to verify the income of people who apply for subsidized coverage. Before the delay, the administration had sought to require marketplaces to verify each enrollee's income status. The rules now allow random - rather than comprehensive - checks on income eligibility in 2014 in some cases where income cannot be verified electronically against other data including tax records.

July 5, 2013 Electronic Medicaid notices: The Obama administration announced a delay in the requirement that state Medicaid agencies be able to use electronic notices to notify individuals of their eligibility for federal assistance. Medicaid rules allow individuals to opt to receive electronic rather than paper notices. Recognizing that all states are not ready to implement electronic notices, the rule allows states to delay providing notices electronically until January 1, 2015.

August 27, 2013 Finalizing federal exchange plans: CMS notified insurance companies that it would delay signing final agreements on plans for the new insurance exchanges. The signing was to occur between Sept. 5 and 9, but was pushed back to mid-September. The announcement affects plans that would be sold in federal exchanges, not those run by the states. The tight timeframe has raised concerns that any delays could force the government to miss the deadline, although officials maintain that the exchanges will be operable by Oct. 1.

September 26, 2013 Online enrollment for small-business exchanges: HHS said employers with 50 or fewer workers will not be able to sign their staff up for insurance in federally operated exchanges until a month later, November 1, because of technical problems. Small businesses in some states that want to sign up their employees for health coverage on the health reform exchanges will have to use paper forms until November.

September 26, 2013 Online enrollment in Spanish: The Obama administration announced that the Spanish-language version of healthcare.gov will not be equipped to handle online enrollments on Oct 1. Instead, Spanish speakers will have to wait until sometime between October 21 and October 28 to sign up online.

October 23, 2013 March enrollment deadline: The Obama administration said that it would delay imposing penalties for six weeks on some consumers who might have been caught in a sticky timing problem for enrolling in coverage through the health law’s new insurance exchanges. The law had been interpreted as giving people until Feb. 15, 2014, to have health coverage start before April 1. With the new administration announcement, consumers can wait until March 31 – when the open enrollment period ends -- to enroll and not face fines.

November 14, 2013 Canceled insurance plans and minimum standards: The Obama administration announced that it is allowing insurers to extend existing individual and small group plans for one more year for current customers even if those insurance policies don’t meet the minimum standards set by the health reform law, which set minimum standards for individual and small group health insurance policies sold after Jan. 1, 2014. Policies renewing before the end of 2013 would last until late 2014. Policies that expire in 2014 would be permitted to extend into 2015 (potentially extending as far as October 2015).

November 22, 2013 Extra days to enroll for Jan. 1, 2013 coverage: Americans hoping to sign up for health insurance under health reform will have an additional eight days to do so for coverage to begin January 1, 2014. The decision to move the deadline to December 23 from December 15 is an acknowledgement that the online portal for enrollment, HealthCare.gov, has been plagued with problems since it opened on October 1.

November 22, 2013 Health Insurance Enrollment for 2015: The administration pushed back the period during which Americans sign up for coverage under health reform in its second year of operation, a change that could reassure insurers while also avoiding the 2014 midterm elections. HHS said it will allow Americans to start signing up for coverage starting Nov. 15, 2014, rather than Oct. 15, 2014. People will have until Jan. 15, 2015, rather than Dec. 7, 2014, to complete the process.

November 27, 2013 Online enrollment for small businesses: The Small Business Health Options Program, known as the SHOP exchange, will not offer online enrollment until November 2014, a one-year delay from a launch that was initially planned for this past October. SHOP was supposed to provide employers a new way to shop for coverage.  Small business owners who want to apply for new health coverage for their workers through the new marketplaces will have to do so through brokers or paper applications. The delay affects businesses in those 36 states that are supposed to use healthcare.gov for enrollment.

December 12, 2013 Payment deadline delayed: HHS Secretary Kathleen Sebelius for the first time directed insurers to give consumers until Dec. 31 to pay their first-month premiums. Rather than a deadline of Dec. 23, insurers were required to accept premium payments through Dec. 31 for people seeking coverage that started on Jan. 1. Sebelius urged insurers to begin providing coverage at the beginning of the year to customers who pay just part of their first month’s premium or pay in January. Many health insurers gave enrollees until Jan. 10 to pay their first month's premium (extensions beyond Dec. 31 are up to the insurers and can vary).

December 12, 2013 High-risk insurance pools: About 85,000 people with a history of serious illnesses, who are enrolled in high-risk insurance pools created under the health reform law, will get a month’s reprieve before they lose that coverage. The “Pre-Existing Condition Insurance Plan” (PCIP) — scheduled to close at the end of December 2013 — was extended until the end of January 2014 to give people more time to enroll in health plans through the exchanges.

December 19, 2013 Delay of individual mandate for some: The Obama administration will not require the millions of Americans who received health-insurance plan cancellation notices to purchase a new policy next year. They're granting those consumers an exemption from the health reform's individual mandate. The mandate requires everyone to have health insurance or face a tax penalty, the greater of $95 or 1 percent of income in 2014.  The administration will also allow those consumers to sign up for catastrophic coverage. Those bare-bones plans are available to people who are under 30 or qualify for a "hardship exemption."

December 23, 2013 Extra day to enroll for Jan. 1, 2013 coverage: The Obama administration extended a deadline for health insurance under health reform, giving consumers shopping on HealthCare.gov in 36 states an extra day, until Dec. 24, to pick plans to kick in for coverage beginning Jan. 1.

January 14, 2014 High-risk insurance pools: About 30,000 people (down from 85,000 in October) with a history of serious illnesses, who are enrolled in high-risk insurance pools created under the health reform law, will get an additional two months -- until March 31 -- before they lose that coverage. The “Pre-Existing Condition Insurance Plan” (PCIP) -- which was originally scheduled to close at the end of December 2013 before being extended until the end of January 2014 -- is now extended until March 31 to give people more time to enroll in health plans through the exchanges.

January 18, 2014 Equal coverage rules: The Obama administration is delaying enforcement of a provision of the health reform law that prohibits employers from providing better health benefits to top executives than to other employees, the New York Times reported on Jan. 18. Tax officials said they would not enforce the provision this year – holding off on penalties – because they had yet to issue regulations for employers to follow, according to the New York Times.

February 10, 2014 Employer mandate for medium-sized employers: The Obama administration announced it would give medium-sized employers (businesses with between 50 and 99 employees) an extra year, until 2016, before they must offer health insurance to their full-time workers. If companies lay off workers during the year so that they fall below the 100-worker threshold, they are supposed to sign a form saying that they were not trying to avoid offering health coverage to their workers. Otherwise they will face a fine. Firms with at least 100 employees will have to start offering coverage in 2015 - the employer mandate, originally scheduled to take effect in 2014, had already been delayed one year (see above).

February 10, 2014 Employer mandate coverage percentage: The Obama administration announced that they would phase in the percentage of full-time workers that employers with more than 100 employees need to offer coverage to from 70 percent in 2015 to 95 percent in 2016 and beyond. Under an earlier proposal, employers with at least 50 employees would have been required to offer insurance, beginning 2015, to 95 percent of those who work 30 hours or more a week, along with their dependents.

February 10, 2014 Measuring employees for employer mandate: The Obama administration announced that they are allowing companies that have close to 100 workers some discretion in whether they have to comply. For 2015, employers can decide whether they had at least 100 full-time employees in the previous year (2014) by picking a period of at least six consecutive months, instead of a full year. Rather than being required to use the full 12 months of 2014 to measure whether it has 100 full-time employees (or equivalents), an employer may measure during any consecutive six-month period (as chosen by the employer) during 2014. Employers can do the same thing to determine if they are close to the 50 full-time employee threshold.