Instead, Republicans have seized on the waivers as just more evidence that the law is fundamentally flawed because, they say, it requires so many exceptions. To date, for example, the administration has relaxed the $750,000 standard for more than 1,000 health plans covering 2.6 million people.
The waivers have become a flash point as supporters and opponents try to shape public perceptions of the law, theAffordable Care Act, signed byPresident Obamalast March 23.
Administration officials, labor unions and consumer advocates plan to celebrate the first anniversary with a week of events highlighting benefits of the law to consumers. But SenatorMichael B. Enziof Wyoming, the senior Republican on the Senate health committee, asked,“If the law is so good, why are so many waivers needed?”
Waivers are usually seen as a way to deal with exceptional circumstances in which the enforcement of a law or policy might cause hardship. But with the new health care law, exceptions like these have become increasingly common. They provide wiggle room in a law originally thought to be strict and demanding.
Maine has just won a three-year reprieve from a provision of the law stipulating that insurers selling coverage to individuals and families must spend at least 80 percent of premium revenues on medical care and efforts to improve it. The White House had described this as one of the law’s most beneficial provisions, guaranteeing that consumers would get“more value for your dollars.”
The Obama administration lowered the requirement to 65 percent for Maine, after finding“a reasonable likelihood” that the tougher standard would drive one big carrier out of the market for individuals, leaving thousands without insurance.
Five other states— Florida, Georgia, Kentucky, Nevada and New Hampshire— have requested similar waivers, and at least a dozen other states are considering whether to apply.
President Obama recently embraced legislation that would let states opt out of the law’s most contentious provisions, including a requirement for most Americans to carry insurance, if the states come up with alternatives that cover at least as many people.
And Representative Mike Rogers, Republican of Michigan, has introduced a bill that would allow people to seek exemptions from major provisions of the law if they could show they would be harmed.
Under the law and rules issued by the administration, health plans this year must generally provide at least $750,000 in annual coverage for essential benefits like hospital care, doctors’ services and prescription drugs. The government may grant a one-year exemption from the requirement if it is shown that compliance would cause a significant increase in premiums or a significant decrease in access to benefits.
Such waivers have gone to entities as diverse as the Waffle House and Ruby Tuesday, health plans run by Aetna and Cigna, and labor unions representingTeamsters, electrical workers, plumbers, carpenters and food and commercial workers.
Administration officials said the waivers showed a pragmatic, flexible approach to carrying out the law. Without the waivers, saidKathleen Sebelius, the secretary of health and human services, many employers would have increased premiums, and some would have dropped coverage altogether.
Edmund F. Haislmaier, a health policy expert at the conservativeHeritage Foundation, said the waivers“result in unequal application of the law and create a temptation to engage in political favoritism.”
Republicans like RepresentativeDarrell Issaof California said that in granting waivers, the administration had favored political allies, including labor unions.
Tom Leibfried, a lobbyist for theA.F.L.-C.I.O., said:“This is just union bashing. The numbers do not show a pro-union bias.”
Mr. Leibfried said some union health plans had a legitimate need for waivers because they had annual coverage limits lower than $750,000. If they had to increase coverage to that level, he said, they would incur significant new costs. But, Mr. Leibfried said, the main source of financing for such health plans— employer contributions— will not immediately increase because they are set by collective bargaining agreements, which are typically in effect for several years.
Steven B. Larsen, director of the federalCenter for Consumer Information and Insurance Oversight, which carries out many of the health law’s provisions, said the waivers provided a“bridge to 2014,” when more affordable insurance options should be available. He denied that unions had received“special treatment.” Indeed, he said, the center has granted waivers to 94 percent of all applicants.
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