The waivers have been issued in the last several weeks as part of a broader strategic effort to stave off threats by some health insurers to abandon markets, drop out of the business altogether or refuse to sell certain policies.
Among those that administration officials hoped to mollify with waivers were some big insurers, some smaller employers and McDonald’s, which went so far as to warn that the regulations could force it to strip workers of existing coverage.
At a time when the midterm elections are looming and Republicans have been vocal in campaigning against the law, reaction to the rollout has been closely watched.
To date, the administration has given about 30 insurers, employers and union plans, responsible for covering about one million people, one-year waivers on the new rules that phase out annual limits on coverage for limited-benefit plans, also known as“mini-meds.” Applicants said their premiums would increase significantly, in some cases doubling or more.
These early exemptions offer the first signs of how the administration may tackle an even more difficult hurdle: the resistance from insurers and others against proposed regulations that will determine how much insurers spend on consumers’ health care versus administrative overhead, a major cornerstone of the law.
Several leading insurers, including WellPoint,AetnaandCigna, have also objected to new rules requiring them to cover even those children who are seriously ill, warning that they will stop selling new policies in some states because the rules do not protect them from having to cover too many sick children.
“The hardest part of health reform is always going to be the transition,” said Peter T. Harbage, a former state health official who is a policy consultant in Sacramento. He predicts more insurers and employers will lean on the government to delay or weaken the new regulations.“I think this pressure just increases until we get to 2014,” he said, referring to the year that the law will fully go into effect.
How much the administration can, or should, compromise in ways that could dilute the effect of the new law in the next few years is a subject of much debate, depending on the politics from state to state or the economic dynamics in a particular market.
Policy experts say much of the authority to enforce the new law rests with the states, and they say the federal government may have little ultimate control over whether insurers will keep offering coverage in specific markets.
Nancy-Ann DeParle, the director of the Office of Health Reform at the White House, acknowledged that the concessions given to companies and insurers reflected attempts to avoid having people lose their current coverage before the full law goes into effect while meeting the aim of improving that coverage.
“It is a balancing act,” Ms. DeParle said.“The president wants to have a smooth glide path to 2014.”
The waivers issued so far include the policies offered by McDonald’s to its fast-food workers, typically capped at just a few thousand dollars, sold by a profit-making company owned by Blue Cross and Blue Shield plans. As a result of the administration’s efforts, McDonald’s says it is“confident that we’ll continue to provide health care coverage for our 30,000 hourly restaurant employees.”
Aetna and Cigna have also received waivers to continue selling limited-benefit policies, according to the list released by theDepartment of Health and Human Services, as have small employers like Sanderson Plumbing Products and Guy C. Lee Manufacturing. HealthMarkets, which offers policies through MEGA Life and Health and other insurers, says it also plans to apply for a waiver for some of its plans.
Some states, like Iowa and Maine, have already said they might seek additional authority from federal officials to exempt some insurers, at least for a time, because of the potential disruption if carriers leave the market over the new standards on medical spending.
“We have some very small carriers in the state,” said Susan E. Voss, the Iowa insurance commissioner, who said she favored letting state regulators decide whether some carriers should be given more leeway. The state has already lost some carriers, including thePrincipal Financial Group, which announced its decision last week.
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