(ABC) – Three months after the $938 billion health care bill was signed into law, questions abound about whether the Obama administration can meet all the deadlines in the massive law while dealing with the political pressures of Congress.
Meanwhile, the impact on Americans’ health insurance costs remains negligible, and premiums are actually rising as many Americans lose their coverage in a troubled job market. About three in four Americans who buy their own insurance reported seeing an uptick in their premium prices, according to a Kaiser Family Foundation survey released this month.
Republicans have accused the Department of Health and Human Services (HHS) of missing key deadlines, such as one requiring the establishment of an advisory committee for an advertising campaign to educate young women about breast cancer. The deadline was May 22, but members have yet to be selected.
HHS was also ordered to establish a government task force by May 7 to come up with a strategy to improve health care programs in Alaska. The agency has moved forward in the process but the task force hasn’t been selected yet.
HHS has successfully met bigger deadlines, and even beaten some of them. Seniors who fall into the “doughnut hole,” when they hit the cap for their prescription drug coverage, have begun to get $250 rebate checks.
The requirement allowing young adults under age 26 to stay on their parents’ health plans has also been implemented ahead of schedule.
The Internal Revenue Service (IRS) is sending out fliers to small businesses informing them of the tax credit they could be eligible for by providing health coverage to their workers.
“HHS has met and beaten the deadlines required by the new law, with several important benefits becoming a reality well in advance of their deadlines,” HHS spokeswomen Jessica Santillo told ABC News. “HHS will continue working efficiently and effectively to get the benefits of the new law to the American people quickly and responsibly.”
But concerns remain high as to whether HHS — which bears most of the burden of implementing the reforms in the health care law — can effectively meet all of its objectives without making errors.
The process for making rules is long and rigorous, and new rules often have to go through multiple agencies and departments. It will also take many more people with specific expertise to carry out the various parts of the law, and hiring in itself can be a slow process in the federal government.
“The average rule takes 18 months, which means that there are many of those that take two or three years to do, because they have controversy or they require integration with some other rulemaking process. So this is a tsunami of rulemaking that has tipped the Department of Health and Human Services,” said Michael Leavitt, HHS secretary under former President George W. Bush.
“The political pressures that are inevitably going to come to bear here, from inside and outside of the administration, it’s a recipe for uncertainty,” he added.
Can Health Care Regulators Meet Deadlines?
Some of the changes have already raised red flags. Small businesses have expressed concern about the “grandfather rule,” designed to keep insurance plans that were in place by March 23 remain with minimal changes.
The new rule is designed to discourage companies from making major changes to their insurance plans, but small businesses often change their plans and doing so would jeopardize the “grandfather” status of their plan. At the same time, some experts say there aren’t enough safeguards in that rule to prevent insurance companies from raising premiums.
Then there is also the issue of working with states, many of which are still fighting the health care law. The administration has to coordinate with states to establish the temporary high-risk pools that Americans can start enrolling in by July 1. But that deadline could slip as several states remain undecided about how they will proceed forward.
Jennifer Tolbert, a health policy analyst on Medicaid and the uninsured at the Kaiser Family Foundation, said those regulations where HHS has to work with other agencies and states may be delayed, such as medical loss ratio or premium rate reviews, but it’s too early to gauge how late they might be.
The National Association of Insurance Commissioners was asked to deliver its recommendations to HHS on medical loss ratio — the ratio of medical expenses to administrative spending — by June 1, but the group said last month it won’t be able to present its full review until at least July 1.
“Where HHS appears to need more time to develop regulations that avoid any errors or problems or challenges with implementation, it does seem that they are taking extra time to work through some of those issues,” Tolbert said. “This is still pretty early on in the process.”
Meanwhile, members of Congress are calling for more oversight and Republicans continue to assail the law. Not one GOP member in either the Senate or the House voted for it.
“This is one of the largest pieces of legislation we’ve ever seen. What we need to do is have an appropriate oversight function to get on the record information as to what’s happening with regards to this bill,” said Dave Camp, R-Mich., ranking member of the House Ways and Means committee, who has invited HHS Secretary Kathleen Sebelius to testify before the House. “Let’s have a public hearing and let’s hear how the implementation is going.”
Support for the health care law remains divided. In a USA Today/Gallup poll released last week, 49 percent of Americans said they think the plan is a “good thing” while 46 percent said it’s bad.
Experts say it’s difficult to predict what will happen to the number of uninsured Americans in the immediate future until the administration fully doles out the reforms.
“If the economy remains sluggish and employers continue to be reluctant to hire new workers more people will likely remain uninsured simply because we have a health insurance system which ties health insurance coverage to employment,” Tolbert said. “Many of the provisions of the health reform law have yet to take effect. … It would be impossible to flip a switch and have all of these provisions go into effect within such a short time frame.”
The Affordable Care Act: Timeline of Implementation:
June: HHS began mailing out $250 rebate to seniors in the “doughnut hole” — those who have spent more than $2,830 for prescription drugs. Starting in 2011, older Americans who go past the allotted amount will be given a 50 percent discount on prescription drugs. The bill aims to close the “doughnut hole” completely by 2020, but older Americans will still have to pay for 25 percent of their drugs.
June: Young adults under 26 can be eligible to stay on their parents’ insurance plan.
June: Insurers announced they would no longer rescind coverage of patients who get sick.
June: HHS announced $250 million grant program to help create and strengthen insurance rate review processes.
July: A tanning tax of 10 percent takes effect.
Aug.: Americans with pre-existing conditions can start enrolling in the high risk pools.
Sept.: Health insurance companies will be prohibited from dropping children with preexisting conditions, adults with preexisting conditions and eliminate lifetime limit co-pays.
2011: Small businesses who qualify can start applying for tax credits under the new health care law for 2010 and beyond.
2011: Louisiana specifically will receive an expansion of $300 million in Medicare funding from the federal government.
2014: Most Americans would be required to have health insurance or pay a fine, with the exception of low-income Americans. Small businesses, high-risk patients and the uninsured would have the option of shopping for coverage in health insurance exchanges, a marketplace in which people could shop for and compare insurance plans.
2014: Those who are at 133 percent of the federal poverty level, or $29,327 for a family of four, would be eligible for Medicaid, starting in 2014.
Also in 2014, adults who don’t have children would be eligible for such benefits that have traditionally only been given to households with children.
2014: Employers would also be required to provide coverage to their workers, or pay a fine of $2,000 per worker. Companies with fewer than 50 employees, however, are exempt from this rule.